Metrics, Measures and Outcomes

A regional approach to frailty has been established in North Cumbria and the North East, in order to drive the development of better ways of preventing frailty and supporting those living with frailty.  A frailty toolkit – ‘Frailty ICARE’, which reflects the components of effective care (Involve, Consider, Assess, Respond and Evaluate) has been developed.  The Frailty ICARE toolkit is underpinned by a set of key outcome measures, agreed by local and national experts. These metrics are considered to be the best reflection of the broad recommendations of the toolkit and will help localities see at a glance how things are for this population in their area.  Each section of the toolkit is shaped by work from local care economies and steered through a regional Community of Practice.  The North of England Commissioning Support unit (NECS) has been supporting the Community of Practice members and each of the local areas in terms of identifying areas of good practice and priority areas for development and reviewing progress in each local area over time.  This Regional Frailty Metrics report provides the latest position and change over time for each of the outcome metrics for the region, to support localities and the ICS Integrated Care System (ICS) for the North East and North Cumbria.  Without measuring it is impossible to demonstrate success or develop robust strategies because it depends upon setting a baseline and having something to track.  The metrics agreed for Frailty iCARE are quantifiable and trackable and have been agreed by national and local frailty leads as useful indicators of impact and outcomes for this population.

By using the Frailty iCARE measures we can support local areas to be curious about what they may be reflecting for their population, help implement and review plans, understand what good looks like and provide a means for evaluating progress that in time provides a historical record of impact, which could be helpful for a long time to come.

The current report is being updated with colleagues from each of the localities to reflect what is important to them. The updated report will include key measures from the Ageing Well National Priorities – Urgent Community Response, Anticipatory Care and Enhanced Care in Care Homes. In addition to this regional NHSE and NECS are developing Population Health Management support for Primary Care Networks and have developed a ‘frailty profile’ tool to the management of older people at risk of frailty or currently living with frailty. A link to this will be available soon. Work is happening to bring these pieces of work together and we will bring updates.

Through our Frailty ICARE Outcomes Framework, the programme has a suite of measures that are being adapted to encompass the wider Community Health Service and Discharge performance metrics.

Actions 2022:

  • Development of Power BI Tool.
  • Review the metrics, measures and outcomes to be in line with national and local priorities.
  • Development and implementation of a qualitative dashboard to support Ageing Well across the region.
  • Work with place to stimulate curiosity around their outcomes to help shape service and pathway design.
  • Create opportunities to share our learning with other areas, whilst learning from one another in the process.