Walsall Healthcare NHS Trust - case study

Older man and relative

28 / 01 / 2016

When health and social care professionals in Walsall looked at the support offered to older people, it became clear institutional care was frequently used: whether in a general hospital, mental health hospital, or nursing or residential home. With over 45,000 people aged 65 or over living in this area of the West Midlands – a number expected to increase by 50,400 people by 2020 – it was clear alternatives were needed, both to cope with demand and to provide the best possible patient experience.

A specific Frail Elderly Pathway (FEP) has therefore been created. It has several aspects. Firstly, a specialist FEP team is on hand seven days a week in A&E. The team members – a GP, nurses, social worker, and older adults’ mental health worker – help to reduce inappropriate admissions to hospital, and ensure patients are discharged smoothly and safely when they are medically fit.

For patients who need more care before they are able to return home, there is Swift Ward. This is specifically for frail older people, and patients can be referred from A&E or the community. Physiotherapists, reablement officers and social workers can all be easily accessed, helping prepare people to leave hospital.

Support is also available in the community. A rapid response team consisting of specialist nurses and therapists can visit patients in their homes, assessing, treating and reviewing as needed.

Audits show the FEP services help avoid hospital admission in 79 to 89 per cent of cases.

For more information:

Dr Simon Harlin, GP Medical Lead for the Frail Elderly Pathway, Walsall Healthcare NHS Trust

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