The Ten Year Health Plan for England, published in July 2025, committed to the development of Modern Service Frameworks (MSFs) to drive improvement across different areas of health. We were pleased that the first tranche included an MSF on Frailty and Dementia, for which our own President, Professor Jugdeep Dhesi, was appointed as one of the co-chairs. Various BGS members have been involved in this process and we expect the MSF to be published towards the end of this year.
MSFs are intended to set an aspirational goal for health services along with interventions that will work towards achieving that goal and delivering improvements for those receiving care and reducing unwarranted variation across the country. The MSF on Frailty and Dementia represents a once-in-a-generation opportunity to transform older people’s healthcare in England. Implementation of the MSF will be the responsibility of healthcare professionals and clinical leaders locally. We believe that there are steps that individuals and systems can take now to prepare for the implementation of the MSF, enabling them to hit the ground running when the MSF is published. We encourage you to consider how you can help your system prepare.
Consider both frailty and/or dementia
This MSF straddles two conditions – frailty and dementia. Therefore, implementation must work equally well for those living with one or other of these conditions as well as those living with both. It will also be important to acknowledge that many people living with frailty, dementia or both will also be living with other multiple other long-term conditions. The needs of all of these groups must be considered when planning the implementation of the MSF to ensure it works for everyone.
Get to grips with the evidence base
There is a strong evidence base for many of the interventions in older people’s healthcare with accepted best practice outlined in many guidance documents. Get to know the standards set out by organisations such as NICE as well as guidance documents provided on the BGS website. These include Quality Standards and Models of Care which set out what the evidence is for interventions across older people’s healthcare. It is also important to learn from others. While there is no perfect system, there are examples across the country of systems where services work well for older people. Look for case studies from across the country and steal with pride. If you have a case study of best practice, let us know as we’d love to share it with others.
Understand the rationale for change
The MSF will provide the building blocks for the future of older people’s health services and it is important that systems make the most of it. The NHS is constantly undergoing change and it is easy to dismiss new initiatives as a flash in the pan. However, the demands of the ageing population are not going away and systems must innovate to ensure that they are able to meet the rising needs of a population with increasing levels of frailty, dementia and multimorbidity. Improving frailty and dementia services will have clear benefits for people living with one or both conditions and their families. There will also be wider system benefits, including supporting people to live independently and reducing their need for interaction with the healthcare system. This includes improving patient flow, making services operate more efficiently and, ultimately, saving systems money. At the BGS, we are rather fond of saying that if you get services right for older people, they will work better for everyone else. We are convinced that the whole system will benefit if services are reconfigured to better serve the needs of those who use it the most. We hope that the MSF will provide the blueprint for this.
Get your people ready with clinical leadership in place to support
We know that the NHS is nothing without its people and that the implementation of this MSF will require a change in mindset and culture across the system. Don’t wait until the MSF is published to start thinking about this – start to communicate now and prepare your staff for the changes that are coming and how they can be involved. Think about the importance of clinical leadership at a local level in driving these changes forward, and your part in that.
Workforce planning and education
The long-awaited NHS Workforce Plan has yet to appear and it is unlikely that any system will see an influx of new staff in advance of the MSF being published. Therefore, it would be helpful to take stock of the staff you already have working in your system and ensure that they are deployed in the most efficient manner and have the skills needed to care for an ageing population with complex needs. This includes basic skills for those who have limited responsibility for the care of older people with frailty and Tier 3 level skills, such as those provided by the BGS frailty elearning module, for those leading services.
Understand your local population
In order to plan services, it will be important to understand the demands of the local population. Systems may find it helpful to interrogate local health systems data in order to understand the numbers of people who have been identified as living with frailty and/or dementia as well as those living with these conditions and other long-term conditions. Systems may also wish to map local services such as care homes and home care services to understand where people living with frailty and dementia are living.
Understand your assets…
This is a helpful time to look at what services you already have in place for people living with frailty and dementia. This might include services such as Front Door Frailty or Memory Clinics. It is helpful to know what already exists before planning new services. Don’t reinvent the wheel and build on what you have already.
… And your gaps
When mapping what services already exist, it is also helpful to recognise what doesn’t exist. Are there key services that are missing locally that would be helpful for people living with frailty and dementia? This might include services such as Hospital at Home or liaison services or working relationships such as those with social care or the voluntary sector. Can steps be taken now to plan for introducing these in the near future?
What’s provided by other organisations?
When mapping local services, be sure to look outside the health service. Many of the services that support people to live well and independently are provided by organisations outside of health including social care and the voluntary sector. This might include services to support people in caring roles, social clubs to prevent loneliness and social isolation or home support services such as meal deliveries. Quality of life is often improved by services that are unrelated to an individual’s health or the care they are receiving from health services. The voluntary sector can be a key partner in ensuring that individuals are able to live well and independently.
Build relationships
Older people’s healthcare is cross-sector, cross-specialty, multiprofessional endeavour. True transformation will not be possible without relationships across traditional boundaries. Strong relationships across primary, community and acute care will be essential as well as with the social care and voluntary sectors. Now is the time to nurture the professional relationships you are going to need for genuine cross-sector collaboration and delivery of integrated care.
System-wide impact
In order for the MSF to make a real difference to the way care is delivered for older people living with frailty and dementia, change will be required across the system. People with frailty and dementia are living in their own homes and in care homes across the country. While it is important that they access high-quality hospital care when they need it, most of their interactions with the health service will be in community and primary care as well as with social care services. Culture change will be needed across the whole system to ensure that the MSF lives up to its potential.
Governance
Strong governance will be required to support implementation of the MSF with buy-in to change required at all levels. In addition to preparing your staff and leadership for the MSF, can you take steps to ensure that your Board is committed to this culture shift and that adequate governance structures are in place to ensure success?
Share your successes
The MSF has the power to dramatically transform the way that older people’s healthcare is delivered in England, but only if it is implemented well. The value of the BGS lies within our community and our ability to share best practice. If you want to share how you’re preparing for the MSF, please do let us know so that we can help others to learn, and ensure that older people across the country benefit from this new initiative.
Join the BGS
If you or your team are not already members of the BGS, now is the time to join. In addition to access to a community working in this space, membership provides discounted attendance at BGS events, free access to elearning and access to member-only resources. We also offer group membership for organisations who wish to provide membership to a group of nurses or AHPs. The strength of our membership enables us to contribute to policy on older people’s healthcare at a regional and national level. More details about BGS membership can be found at: https://www.bgs.org.uk/about/become-a-member
