To download the case studies please click on the link below:

Harrogate and District’s frailty journey has been full of unexpected twists and turns. However, the Trust’s frailty improvement team has adapted to each new circumstance and challenge along 
the way, maintaining its objective of making frailty everyone’s business. In 2022, Harrogate and District joined the Acute Frailty Network’s Optimiser Programme – an intensive six-month 
programme aimed at Network alumni. The programme’s aim is to help organisations that have already built a successful frailty pathway to take the next steps. This is Harrogate’s story…

Maidstone & Tunbridge Wells NHS Trust: Being part of AFN helps Maidstone and Tunbridge Wells’ drive frailty improvements during the COVID-19 pandemic. 

Maidstone and Tunbridge Wells NHS Trust provides care for around 560,000 people in the south of West Kent and the north of East Sussex. It is a split site trust, with Maidstone Hospital in Maidstone, and Tunbridge Wells Hospital in Pembury. Each of the hospital sites has its own dedicated consultant-led Acute Frailty Unit (AFU). When the Trust joined the Acute Frailty Network (AFN) in Spring 2020, the units were seeing an average of ten frailty patients per day, pulled from the Emergency Department (ED). There was also a basic frailty
pathway which took patients from A&E and the Acute Medical Unit (AMU). Maidstone and Tunbridge Wells was keen to build on these foundations, developing its frailty pathway, increasing frailty in-reach and embedding a frailty governance structure into the Trust. This is their story…

Ashford & St Peters/North West Surrey Alliance: North West Surrey Alliance’s ambitious plans for system-wide frailty improvement

Ashford and St Peter’s Hospitals NHS Foundation Trust has been working to improve the care of frail patients since 2013 when it established its Older Persons Assessment and Liaison (OPAL) team. However, in recent times the focus has moved beyond the acute setting and out into the wider community. The hospital is part of the NW Surrey Alliance and, since joining the Acute Frailty Network (AFN) in 2020, it has been working to develop a system that can effectively understand, recognise and manage frailty, and to embed this within an integrated partnership approach. This is the story of how the NW Surrey Alliance is creating a whole system integrated frailty service…

Oldham Care Organisation - Northern Care Alliance NHS Foundation Trust: Oldham powering ahead with frailty improvement after a slow start.

There are many different benefits to working as an integrated healthcare system. For the Oldham Care Organisation – which provides acute care in Oldham - much-needed support for its frailty improvement work came from the wider Northern Care Alliance NHS Foundation Trust. This timely intervention helped Oldham to overcome challenges that were hindering its improvement work and threatening to derail the project. This is their story…

St George's University Hospitals NHS FT - Data informs frailty work at St George's

St George’s Hospital in Tooting is the largest healthcare provider in South West London and one of the country’s leading teaching hospitals. It’s part of St George’s University Hospitals NHS Foundation Trust, serving a population of 1.3 million people in South West London, as well as providing specialist services across Surrey and Sussex. They are working hard to improve the care of frail patients. This is their story…

North Middlesex University Hospital NHS Trust - Aspiring to become a frailty exemplar

Prior to November 2018, North Middlesex University Hospital NHS Trust had no dedicated frontline frailty service, aside from an overstretched therapy team which covered the Emergency Department (ED) and two medical admission units. The hospital did not routinely screen for frailty and there was no other specialist clinical care for frail patients in ED.

North Middlesex introduced clinical frailty scoring for patients aged over 65 years towards the end of 2018. Nearly  two years later, in October 2020, it joined the Acute Frailty Network (AFN). From a standing start five years ago, the Trust has implemented wide-reaching frailty improvements and has ambitions to become an exemplar Trust for the care of frail patients. This is their story…

Calderdale and Huddersfield NHS FT case study - Taking acute frailty improvements out into the community

Calderdale and Huddersfield NHS Foundation Trust has spent the last few years developing its frailty service for the local population. The Trust worked with the Acute Frailty Network (AFN) in 2016 and made many improvements, early on in its frailty journey, but by 2019/20, it was ready to take its next steps. In January 2020, it joined the AFN Optimiser programme – a bespoke six-month intensive programme that supports organisations to make rapid improvements to existing frailty services. This is their improvement story.

Princess Alexander Hospital case study

A challenge for many of our frailty sites has been being unable to engage with patients on a face-to-face basis, for example as part of regular outpatients’ appointments, and the issue that working with new technologies may pose for some older people. One solution is for acute teams to rethink the approach to working with community and social care colleagues to deliver continuity for their patients and maintain their high quality of care. This is the story from the frailty team at The Princess Alexandra Hospital NHS Trust.

AFN - Royal Surrey case study

This case study attempts to capture the remarkable feats of staff at the Milford site during the Covid19 pandemic. The memories, stories, tears and laughter were all part of a unique journey for the acute and community teams alike. People went above and beyond as they came together in the midst of a crisis. This would never have been the usual approach to change or for integrating teams. Nevertheless there is key learning to be taken from this transformation, for the teams across the pathway, the Trust and the system. 

Withybush General Hospital leads frailty improvement in Wales

North Bristol NHS Trust - A frailty service with a patient at its heart

Barnet Hospital - A focus on frailty at Barnet

Return on investment - Royal Shrewsbury Hospital
Changes to the frailty pathway made by the Shrewsbury and Telford Hospital NHS Trust have resulted in a reduction in occupied bed days by patients aged 75 and above. The financial saving associated with this reduction is investigated in this report.

Royal Surrey County Hospital - A 'big room approach' to improving acute frailty services

Frimley Park Hospital - Improving the care of people with frailty at Frimley Park Hospital

Return on investment - Frimley Park Hospital
Development of a Frailty Team at Frimley Park Hospital has resulted in a reduction of admissions from the Emergency Department.  This report explores the financial saving associated with this change.  The last 50 patients seen in the Emergency Department by the Frailty Liaison Team for whom an admission was avoided were selected for review.

Nottingham University Hospitals NHS Trust - A Frailty service built on solid foundations 

Patient Experience Story - Frimley Park Hospital 

Return on investment - Royal Surrey Hospital
Improvements to the acute frailty pathway at the Royal Surrey Hospital has resulted in fewer bed days being occupied by patients aged 75 and above. The financial saving associated with this reduction is explained in this short case study.

Return on investment - Hillingdon Hospital
Improvements to the acute frailty pathway at Hillingdon Hospital have resulted in fewer bed days being occupied by patients aged 65 and above. The financial saving associated with this reduction is explained in this short case study, first when looking at patients aged 65 and above, then subsequently when only looking at patients aged 80 and above.

Norfolk and Norwich - Redefining Frailty at Norfolk and Norwich

Return on investment - Bournemouth and Christchurch Hospitals NHS FT

Portsmouth case study - Frailty improvements contribute to significant cost savings

Royal Berkshire NHS Foundation Trust - Reducing Dependence on admission for Frail Older People

University Hospitals of Leicester NHS Trust - Patient Centred, Holistic Approach to Assessing Older People with Frailty and Urgent Care Needs

Heart of England NHS Foundation Trust - Frailty at the Front Door!

United Hospitals North Midlands NHS Trust - Holistic Care for Frail Older Patients in the North Midlands

Wirral Teaching Hospitals NHS Foundation Trust - Wirral embraces the 10 frailty principles on it's improvement journey

Return on investment - Portsmouth Hospitals NHS Trust

Acute Frailty Network N&T Case Study Compilation.pdf

Acute Frailty Network Improvement Programme Information Web.pdf