News and Notices

Care of frail patients in Derbyshire leads the way in NHS care

A new approach to the care of frail older people suffering from delirium in Derbyshire is winning national recognition.

Clinicians at Derbyshire Community Health Services NHS Foundation Trust and Chesterfield Royal Hospital NHS Foundation Trust have worked together on a successful project to aid the prevention, early recognition and treatment of delirium. This is reducing the length of stay in hospital, improving outcomes for people suffering with delirium and supporting more people to be treated at home or in their local communities.

Now the work spearheaded in Derbyshire, developing what is known as an integrated delirium pathway, has been included in a new toolkit, produced by NHS Elect, to help other healthcare teams across the country adopt a similar approach.

Dr Bola Owolabi, deputy medical director for Derbyshire Community Health Services NHS Foundation Trust, said: "We are delighted our work is included in this new toolkit. It will help raise greater awareness of delirium and the impact it can have on frail patients. By recognising the early signs of delirium we can ensure patients and carers receive the reassurance and support they need at an early stage, which has a major positive impact on their ability to recover.” 
Dr Kath Shakespeare, consultant geriatrician at Chesterfield Royal Hospital NHS Foundation Trust explains: "Delirium is a sign that someone is physically unwell, and is also known as being in an ‘acute confusional state’. It is a sudden change over a few hours or days and the condition can fluctuate. People who become delirious can behave in ways that are unusual for them; they may become more agitated than normal, withdrawn or feel more sleepy."
Frail and elderly patients are susceptible to delirium and this is usually due to an underlying treatable cause. Delirium usually develops suddenly over a few hours or days, so the need to manage it promptly and effectively is crucial.
Dr Shakespeare added: "Anyone of any age can get delirium, but it is more common in older people or those living with frailty. People with dementia are more likely to get delirium and cannot always explain what is wrong or how they are feeling. Around 30% of all elderly patients admitted to hospital will suffer from delirium throughout their stay.

"It is a serious condition, and can be associated with higher risk of longer stays in hospital, dying, needing a care home, or developing dementia, and so it is vital that we do everything we can to prevent it from happening, and to treat it promptly when it does happen.  This project is a major piece of work involving collaboration of all health and social care organisations across North Derbyshire to allow this to happen. We want to deliver the very best care for our older people in North Derbyshire, and we realise that working together is the best way to achieve this.”

Chesterfield Royal Hospital NHS Foundation Trust and Derbyshire Community Health Services NHS Foundation Trust are founder members of the Acute Frailty Network, established by NHS England in January 2015. Derbyshire is one of 10 pilot sites nationally chosen to identify improvements in the quality of care received by frail people.

Frailty affects up to half of people over 80 years. About 10% of people over 60 will be affected by frailty. Older people living with frailty are the highest users of services across health and social care and have the highest levels of unplanned admissions to hospital. 

By 2033, the number of people aged 85 and over living in the UK is projected to increase to 3.3 million. Of these, 1.9 million will be aged 85-89, 962,000 will be aged 90-94, 384,000 95-99 and 80,000 will be aged 100 or more. 
Under the Derbyshire initiative, around two thirds of the 800 patients admitted to the specialist acute frailty unit at Chesterfield Royal Hospital last year were able to return home to their usual place of residence. This is largely due to the development of the integrated care pathways used across primary care, community care and acute hospital services in Derbyshire. Nursing and therapy staff work collaboratively between the frailty unit and working in the community. 

The new national Acute Care for Frail Older People toolkit provides a checklist to help teams in other parts of the UK to redesign their services so that the journey of frail older people during the first 72 hours of their urgent care experience is streamlined and leads to better clinical outcomes. More information about the Acute Frailty Network is here: