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Get in Early
Choose to Admit
Specialist Acute Care
Discharge 2 Assess
Recovery Before
Placement
Every Moment Counts
Priority Programme for Frailty Transformation :Cutting the costs of Frailty
Compassionate CareTechnology Enabled CareMental Health and DementiaOrthogeriatrics, falls and Surgical LiaisonCarersCommunity Activation
Get In Early
We will develop systematic approaches to identifying these risks in people aged 75 and above and mobilise a response based on the priorities of the older person
and their families.
Choose to Admit
We will develop emergency response systems to identifying people with a frailty crisis and build
capacity and responsiveness for the provision of safe, effective services in people's homes or in step up intermediate care beds as an alternative to acute
hospital admission.
Specialised Acute Care
We will ensure that frail older people in acute settings are identified during emergency response or after surgical intervention, with early involvement of old
age specialist teams.
Discharge to Assess
We will develop the capacity and responsiveness of community based post acute‐care services to ensure that older people can be transferred quickly with simple triage to post‐acute settings, with 48 hour follow‐up by advanced care practitioners to reset
post‐acute care plans.
Recovery before Placement
We will develop systems to ensure that all older people recovering from a frailty crisis have access to up to six weeks of rehabilitation and re ablement prior
to the provision of long term support services.
Every Moment Counts
We will provide an opportunity for all frail older people and their families who receive our services to
develop anticipatory care plans for their future treatment options.
Death Happens‐ Live With It
• Get in early• Together is
better• What matters
to me is everyone’s business
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