Background and Context
The Public Health Agency (PHA), vision is that “All people and communities are enabled and supported in achieving their full health and wellbeing potential, and inequalities in health are reduced.” In working to fulfil this vision, one of the five overarching outcomes, identified in the PHA Corporate Plan 2017 – 21 is that:
‘All older adults are enabled to live healthier and more fulfilling lives’.
Frailty is defined by the World Health Organisation as “a progressive age-related decline in physiological systems that results in decreased reserves of intrinsic capacity which confers extreme vulnerability to stressors and increases the risk of adverse health outcomes”. Frailty means that even minor events can trigger disproportionate changes in health status after which the patient fails to recover to their previous level of health. Frailty is a spectrum condition from mild to severe frailty.
Frailty is not an inevitable part of ageing; it is a long term condition (LTC) in the same sense that Diabetes or Alzheimer’s disease are LTCs .
It varies in severity (individuals should not be labelled as being frail or not frail but simply that they have frailty). The frailty state for an individual is not static; it can be made better and worse.
The prevalence of frailty among people aged 60+ in Northern Ireland is estimated at 21%. Prevalence of frailty rises with age. In NI 16% of people aged 60-64 are likely to be living with frailty, rising to 36% in those aged 80+ (Frailty and Disability, Research Brief, CARDI, 2014).
People living with frailty have a substantially increased risk of falls, disability, long-term care and death. Presently many of these individuals will be unaware that they are living with the condition. However with proper identification and appropriate active management of older people living with frailty, health and social care crisis can be reduced or detrimental impacts diminished through holistic health and social care provision.
There are 5 recognised frailty syndromes and the presence of one or more of these could suggest that the individual has frailty:
- Falls
- Immobility – sudden change, ‘gone of feet’
- Delirium – acute confusion or sudden worsening of confusion in someone with previous dementia or known memory loss
- Incontinence – new onset or worsening or urinary or faecal incontinence
- Susceptibility to side effects of medication
In additional to these, in Northern Ireland, experts would also argue that social isolation and poor nutrition are also factors which could indicate the presence of frailty.
At a NI Frailty Symposium in April 2018, the following 3 actions were prioritised by stakeholders:
- Need to agree a regional method of identifying frailty;
- Collaborative working and setting up a regional Network linked to existing Strategies that will drive forward the vision for frailty; and
- Develop an evidence based regional vision and communicate messages supporting the vision and engaging the public with key health messages.
Structure
The overall structure which will deliver on these priorities is based on a strong foundation of co-production and co-design and is set out in the diagram below.
The Frailty Expert Panel will oversee a series of task and finish groups, which will deliver recommendations in relation to:
- Key Public Health Messages
- Identification of Frailty
- Assessment Tools
- Education
- Service Model – in conjunction with other regional work – TIG (Transformation Implementation Group), Unscheduled Care Review etc.
The Frailty Expert Panel will be supported by a Experts by Experience Community, which will comprise members of the Age NI Consultative Forum. This co-production group will provide a level of assurance on the development of recommendations and outcomes.
Aim
To support older adults in Northern Ireland to age well and live long, healthy lives through a focus on the early identification and management of frailty.
To describe a service model where help is available when it is needed and delivered by personnel with adequate skills , moving away from crisis driven, late presentations where hospital can be the only default option.
Services should be , delivered in an evidence based and proactive way, in accordance with older people’s wishes and priorities.
Objectives
- To connect key stakeholders who will work collaboratively to improve quality of life and outcomes for older people across Northern Ireland
- To support the development of recommendations for a frailty model of care across Northern Ireland
- To agree key priority areas of work in conjunction with regional commissioning/policy leads
- To agree a Northern Ireland roadmap for frailty in conjunction with regional commissioning and policy leads
- To take a co-production approach to all aspects of work within the remit of the panel.
- To inform and oversee the monitoring and evaluation of work programmes, using outcomes based accountability methodology
- To ensure appropriate engagement and communication with the NI Frailty Network
- To identify priority areas, establish and oversee task and finish groups as appropriate.
- To consider evidence, research and best practice and make recommendations for future commissioning of frailty services to the Frailty Oversight Group
- To quality assure key reports which have relevance to the Northern Ireland context around frailty and to share information with Task and Finish Groups as relevant to their remits.
- To raise awareness of frailty as a condition and the ability to prevent, reverse and delay its progression.
Membership
Membership will be comprised of a broad range of experts in frailty, drawn from Service Users, Carers, Statutory, Independent, Voluntary, Education, Research and relevant Professional representatives.
A current list of members is attached in Appendix A. This will be kept under review.
Other individuals and organisations will be co-opted onto the group for a specified time period as appropriate to support the work plan.
Arrangements
The group will normally meet quarterly in a central venue where possible. Teleconference facilities will be available.
Agenda and papers will be issued 2 weeks prior each meeting. Action notes and copy of all papers will be available to members
The group will be chaired by Dr Lynne Armstrong (Consultant Geriatrician – South Eastern Trust) and Paschal McKeown (Charities Director, Age NI). This arrangement will be reviewed after 1 year, with a view to an Age NI Consultative Forum representative taking on a co-chairing role.
Task and Finish Groups will report to the Expert Panel, with updates will be a regular agenda item; this will provide the opportunity for monitoring, sharing information /best practice and ensuring integration and promotion of consistency across work areas.
Extraordinary meetings of the expert panel and workshops may be held as appropriate.
Accountability
The group will be accountable to the Frailty Oversight Group which is a multi-disciplinary group comprising key regional leads from across the HSCB and the PHA. The oversight group will provide direction and ensure that the work of the frailty programme maintains connection with key regional work areas / projects. Recommendations from the Expert Panel will be referred to the Frailty Strategic Oversight Group (see below) for consideration, prioritisation and integration into commissioning processes and departmental policy.
Frailty Strategic Oversight Group– this is a multi-disciplinary group where key regional leads from across the HSCB and the PHA will provide direction and ensure that the work of the frailty programme maintains connection with key regional work areas / projects. This group will prioritise recommendations from the Expert Advisory Panel and ensure that these are reflected in commissioning priorities. This group will be chaired by Dr Brid Farrell, Assistant Director, PHA.
Quorum
A quorum shall be greater than 50% of the membership
Rules
All members are equally valued and respected as experts in their own right.
Members will be open, honest and supportive of each other.
Members will undertake to liaise with their profession / organisation on all relevant matters.
Appendix A
Regional Expert Advisory Panel on Frailty Membership
Dr Lynne Armstrong, Consultant Geriatrician, South Eastern Trust (Co-Chair)
Mrs Paschal McKeown, Charities Director, Age NI (Co-Chair)
Barry Smyth, Alzheimer’s Society
Emily Gill, Age NI Consultative Forum
Ann Murray, Age NI Consultative Forum
David McCurry, Age NI Consultative Forum
David Florida James, Age NI Consultative Forum
George Bell, Age NI Consultative Forum
Chris Clarke, NI Ambulance Service
Prof. Assumpta Ryan, University of Ulster
Dr Bernadette McGuinness, Queens University Belfast
Christine Brown Wilson, Queens University Belfast
Carol Cousins, Four Seasons Healthcare
Dr Jan Ritchie, Consultant Geriatrician, Belfast Trust
Dr Grainne Bonner, GP / Belfast Integrated Care Partnership
Paula Forrest, Belfast Trust
Dr John Maxwell, Emergency Department Consultant, Belfast Trust
Sarah Meekin, Mental Health, Belfast Trust – TBC
Siobhan Sweeney/Sarah Reid, Health & Wellbeing, Public Health Agency
Dr Brid Farrell, Assistant Director of Service Development, Safety, Quality & Screening, Public Health Agency
Martina Thompson, Service Lead, Southern Trust
Catherine Sheeran, Acting Assistant Director of Enhanced Services, Southern Trust
Fiona Waldron, Social Care, Southern Trust
Dr Chris Leggett, GP / South Eastern Integrated Care Partnership
Deirdre McCloskey, Mid & East Antrim Active Ageing Partnership / Northern ICP
Peter Wright, Pharmacist / Belfast Integrated Care Partnership
Julie Jess, Physiotherapist, South Eastern Trust
Laura Elias, Clinical Manager, South Eastern Trust
Eleanor Ross, Assistant Director of Nursing, Public Health Agency
Sandra Aitcheson, Nurse Consultant for Older People, Public Health Agency
Dr Max Watson, NI Hospice
Barbara McDowell Anderson, Clinical Manager, South Eastern Trust
Dr Brid Kerrigan, Royal College of Psychiatrists / South Eastern Trust /
Dr Simon Coulter, Consultant in Palliative Care, South Eastern Trust
Ashley Ramsay, Lead Nurse – Social / Palliative Care, Northern Trust
Eleanor Bridges, Clinical Lead – Physiotherapy, Northern Trust
Dr Emily McIntosh, Consultant Geriatrician, Northern Trust
Carmel Darcy, Consultant Pharmacist, Western Trust
Rachel Armstrong, Nurse Practitioner, Older Persons, Western Trust
Dr Stephen Todd, Consultant Geriatrician, Western Trust
Sarah Penny, University of Ulster
Paul Rooney, Professional Adviser, NI Social Care Council
Fiona Dunbar, Senior Information Manager, Health & Social Care Board
Mary Emerson, AHP Consultant, Public Health Agency
Pete Burbridge, Podiatrist, South Eastern Trust
Louise Sharpe, Community Dietitian, Southern Trust
Paddy McCance, Orthoptist, Western Trust
Ann Murray, Advisor
Kim Munce, Planning and Projects Manager PHA
Linda Lyttle, Clinical Lead Occupational Therapist Northern Trust
Mary O’Boyle, Project Lead Nurse, Northern Trust
Ruth Watson,Clinical Manager, South Eastern Trust
Dr Mark Bowman, Geriatric Medicine, South Eastern Trust
Catherine Sinclair, Speech and Language Therapist, Belfast Trust
Alison Patterson, Frailty Network Co-ordinator, Public Health Agency
Andrea Tierney, Project Officer,MEAAP