Developing services for older people living with frailty in the community | News

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Developing services for older people living with frailty in the community

When the Covid-19 pandemic began we responded with rapid changes to protect our population, as part of our Level 4 incident emergency response. As part of this, we acted quickly to set up acute frailty services using the community bed base at Milford Hospital to create more capacity for sick patients.    


In addition to creating capacity, this move allowed us to significantly increase the scope and complexity of the care we are able to offer at Milford Hospital. Its Frailty Unit can now manage the full spectrum of complex needs as well as rehabilitation. Its beds are not just for older people with frailty who have suffered trauma and fractures, they are also open for any of our older patients requiring a multidisciplinary approach and Comprehensive Geriatric Assessment. This means we are now in a position where we can offer acute frailty care in the community at nationally-recognised high standards of care.

The Trust has decided to retain this model. This not only ensures we can continue to offer the benefits of this new model, it ensures that we remain prepared for further peaks of Covid-19 and winter capacity pressures. The decision includes retaining the increase in specialist multidisciplinary medical staff on site.

Building on the successful transformation during the initial pandemic response, we are working on an ambitious vision to develop the Milford site further. Supported by our £1.3 million investment into community services, our vision is to develop the site into a leading frailty hub offering a full portfolio of services for older patients living with frailty who have complex needs. This vision and investment would allow us to offer same day emergency services, closer working with other important mental health and social care services on site and radically increasing proactive care assessments for our at risk population.

Dr James Adams, Clinical Director for Frailty Services and Consultant Geriatrician, said:

“These changes were driven by the ongoing need to prepare for the effects of a global pandemic but we’ve seen significant additional benefits to patients through this enhanced model of care.  For example, we can now deliver the full spectrum of acute care alongside the specialist multidisciplinary care and rehabilitation that this cohort of patients need to stay independent. In addition, we have seen our capability to deliver really high quality end of life care outside the acute hospital increase, which is so important for dignity and quality toward the end of someone’s life.

“Our vision for Milford Hospital is for it to become a nationally leading frailty centre, offering a comprehensive portfolio of services to meet the needs of our local population. We want to work closely with the local community, primary care colleagues and partners to develop this vision over coming months.”

Prior to the pandemic, Milford Hospital was primarily used to assess and support patients with on-going rehabilitation or 24-hour care needs. Since the pandemic peak and following a national mandated Discharge to Assess programme, many of these patients are now having their needs either assessed at home or in a care home facility. They are continuing to be cared for by Royal Surrey’s Community Team and other system partners. 

Royal Surrey Charity

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