About the toolkit

Clinical guidelines
Simon Conroy
Date Published:
28 August 2018
Last updated: 
28 August 2018

You are an anaesthetist, a surgeon, an oncology specialist, or other acute care physician. In your service, your and other team members’ training may not have focused on the needs of older people. There may be a lack of confidence and expertise in managing older people and conditions associated with ageing. Yet you are interested in improving care for these patients who come to your service. You may have seen research evidence and you may have talked to your colleagues and reflected on personal experience. You may have collected own data showing the care for frail older people in your service could be improved. Or you may have been asked to improve your service performance in respect to this patient group.

This is a first chapter in a series. See the rest of the series here

There are different starting points on your journey to improve care for frail older people in your service, and this toolkit will try to assist you on that journey.

Each chapter brings together knowledge about key challenges in improving healthcare, resources proven to help in overcoming these challenges (many have been collated online as part of the NHS Change Model[1], the NHS Scotland Quality Improvement Hub[2], and the Welsh 1000 Lives Plus[3]), and experiences of those who have successfully improved care for frail older people in acute settings across the country. This way the toolkit aims to bring together a combination of clinical and implementation knowledge, together with practical experiences of leaders in improving care for frail older people.  

A key part of the toolkit is the self-assessment (Chapter 2), a unique tool developed to give your team the opportunity to identify service level competencies that are already in place and those in need of further development. It also offers recommendations about what to do when gaps in service provision are identified.

The toolkit is aimed at teams who will lead on improving the care for frail older people provided by their services. To be successful, improvement efforts require a concerted effort of a range of actors, not only those “on the ground” but also actors located outside individual services. The toolkit will eventually be supplemented by several other interventions, currently in development, that will target other audiences at the levels of strategic and operational management, and a tool to help patients and carers take an active role in their care. We believe that a multi-level approach to improvement enhances the chances of more effective change (see Box 1), and ensure that clinicians and their colleagues “on the ground” are not working in isolation.

Box 1: Multi-level approach to change
  1. Strategic (regional) level: Relevant strategic players, namely System Resilience Groups (SRGs) with Chief Executives and Commissioners as their attendees, will be alerted about the problem in care such as higher than expected volumes of attendance and high admission rates, length of stay, readmission rates and institutionalisation. They will be offered a solution in the form of improving care for the frail older patients detailed in this toolkit, and prompted to take action, e.g. to include service development in strategic planning, and delegate implementation to operational arms[CS(1] .
  2. Operational (trust) level: Managers will be presented with convincing evidence of the problem, for example national reports from Royal Colleges, data from the NHS benchmarking audit on acute care for older people and patient stories. Their action will ideally be supported by strategic level decisions. Divisional and service managers will delegate service development across the hospital to non-geriatric services and provide support to improvement teams. Support may include: oversight by experienced senior clinical and managerial teams from different directorates and specialities, dedicated measurement team, devolved budgetary autonomy, project management support, and service level review.
  3. Service level will see improvement teams being set up who will lead on embedding CGA in services. This is the area covered by this toolkit.
  4. Patient and carer level will be empowered to take a more active role in their care, if they wish to do so. Patients and carers may influence the ways acute services are provided locally, and will be targeted by a specific intervention (an information leaflet or a video) to increase awareness about high-quality care for frail older people. In turn, patient and carers will be able to demand the care from their services.

[CS(1]There could be links to the relevant sections (levels 1-4)

[1] http://www.nhsiq.nhs.uk/capacity-capability/change-model.aspx