Gray: Frailty service in A&E units can build on ‘good progress’ to cut NHS waits

Health Secretary Neil Gray has insisted “good progress” is being made in tackling NHS waiting times, as he said a scheme being rolled out across Scotland could also have a “positive impact”.

With ministers having pledged to set up a frailty service at Scotland’s 30 main hospital accident and emergency departments by the summer, Mr Gray saw first-hand how it works at Glasgow Royal Infirmary.

The service provides an intense assessment of the needs of frail older patients, with access to the specialist skills and care plans needed to help people be discharged from hospital earlier, reducing the length of their stay and delays.

In the last 18 months, the unit at Glasgow Royal Infirmary has cut the average length of hospital stays for these vulnerable patients by three days – without an increase in the readmission rate.

On a visit to the hospital on Wednesday, Mr Gray outlined the Scottish Government’s plans to build on this progress by installing a frailty service in every site with a core A&E unit by the summer.

This would see frailer patients sent to hospital by GPs, or taken there by the Scottish Ambulance Service, go directly to these services instead of A&E, Mr Gray said – allowing staff to start working to put in place any additional care they may need.

Five frailty units are already operating, in Ayrshire and Arran, Lanarkshire, Tayside, Glasgow, and Dumfries and Galloway, and these will be expanded to more hospitals – with the rollout funded through £200 million allocated to help clear NHS waiting lists in the Scottish Budget.

The move comes after the Scottish Government met its commitment to carry out 64,000 procedures within the NHS by the end of March – with health boards reporting to have delivered 75,500 by the end of January.

A target for 90% of patients referred to Child and Adolescent Mental Health Services (Camhs) within 18 weeks has also been met, with the latest figures showing 90.6% of youngsters are seen within this time.

The Scottish Government also pointed to a 4% decrease in the total number of patients awaiting diagnostic tests, adding waits are at their lowest since October 2021.

Mr Gray said: “In recent weeks we have seen good progress in reducing waits and there are encouraging signs that our plan is working.

“However, we know there is more to do and we want to drive further improvement. That is why we are investing £200 million to help clear waiting list backlogs, improve capacity and reduce delayed discharge.”

The Health Secretary said he had been “pleased” to meet staff at Glasgow Royal Infirmary’s frailty unit and “see first-hand the positive impact their crucial work is having – with the service allowing speedier assessment of vulnerable people presenting at A&E and reducing length of stay for patients significantly”.

He added: “We want to replicate this success across Scotland and shift the balance of care from acute, to community.

“Through a portion of our £200 million investment, we will deliver direct access to specialist frailty teams in every A&E by this summer.

“This will enable people who experience frailty to be referred directly by GPs and the Scottish Ambulance Service to specialist frailty services as an alternative to attending A&E or admission.”

Laura Duffy, consultant geriatrician at Glasgow Royal Infirmary, said that together with staff from the emergency department and the acute assessment unit, they had “created a process which identifies people living with frailty”.

She added: “This enables us to direct and prioritise these people to receive care from a specialist team, in specialist areas and initiate early comprehensive geriatric assessment.

“A key part of developing this service has been ensuring that we identify the priorities and concerns of our patients and their carers promptly and work in partnership with them to develop a plan for their care.”

She said the service also works on “enhancing our links” with community and social care, allowing for the “early exchange of key information” about patients, helping to provide better care.

Ms Duffy said: “The results so far have been promising, with 74% of patients admitted through the acute medical receiving unit being screened for frailty. We have also noted a reduction in length of stay of three days for people with frailty, without an increase in readmissions.”