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Frailty Pathways Framework

This Framework was commissioned and funded by Hertfordshire and West Essex (HWE) Integrated Care Board (ICB) and developed in collaboration with Hertfordshire and West Essex Frailty Board to provide a resource to Learning and Development teams looking to review their frailty training in line with local pathways. Development of the Framework was steered by relevant steering groups for each topic, with Frailty Clinical leads consulted and reviewing throughout development of the learning objectives. This work was overseen by the HWE Frailty Board.

Scope of the Framework

All Hertfordshire and West Essex health and social care organisations are expected to follow the ICS clinical frailty pathways which cover topics on Frailty, Falls, Tissue Viability, Dementia and End of Life (Links can be accessed below) and are overseen by the HWE Frailty Steering Board. 

To deliver these pathways it is expected that staff need a base level of knowledge. To support organisations to monitor their assurance against this level of knowledge this framework provides learning objectives that include all aspects of the specific pathway. These objectives can then be used as a minimum to compare against organisations education programmes for staff supporting individuals living with or at risk of frailty. 

The World Health Organisation (WHO) defines frailty as “… a clinically recognisable state in which the ability of older people to cope with every day or acute stressors is compromised by an increased vulnerability brought by age-associated declines in physiological reserve and function across multiple organ systems.”

As well as the base learning objectives, this framework includes:

  • Links to related pathways
  • Example Case studies 
  • Pre and Post Knowledge assessment questions
  • Lesson Plans 
  • Template PowerPoints for delivery
  • Additional resources and tools linked to related topics

This framework is mandatory for all staff in organisations who have contracts provided by the ICS (Primary and Secondary Care) and is suggested best practice guidance for statutory social care services (county councils) and PVI (Private, Voluntary and Independent) health and social care services (Care Homes, Homecare, Hospice etc.). 

This framework is designed for general staff working with people living with frailty. Specialists in specific subjects would be assumed to be working to the level of the subjects listed within this document, for example, a Tissue Viability Nurse would be assumed to be fully trained in learning objectives set out in this document as part of their specialist training.

This framework, and its contents, are designed to work generically across all types of health and care organisations and educate the staff who support individuals living with, or at risk of, frailty. Organisations must include adjustments in their own training if there are more localised processes that certain staff groups need to follow, as well as utilising case studies that are more specific to their service delivery areas. 

The learning objectives within this document are split into three tiers with detailed descriptions of the recommended audience included in the next section of this document and in each subject area. Please note that these learning objectives are written for staff working directly with people living with frailty and therefore does not currently include administrative roles.

Structure of Framework

This framework is separated into six topics relating to Frailty. Within each section are further sub-topics to make it easier to review and deliver training. Each subject comprises:

  • Introduction
  • Suggested target audience
  • Links to relevant resources and/or legislation
  • Links to Training Needs Analysis
  • Learning objectives
  • Links to relevant training and case studies 
  • Links to pre and post knowledge assessments 

Within each subject, the learning objectives are split into subtopics, with recommended target audiences and tiers. The learning objectives are intended to provide organisations with a clear understanding of what the learner should know to safely and effectively carry out their role. The tiers are incremental with the assumption that staff at the Intermediate and Advanced levels possess the knowledge and skills at preceding levels.

Benefits of the Framework

This framework has been developed with support from relevant, local steering groups and input from local organisations to ensure that the training, resources and learning objectives reflect policies in Hertfordshire and West Essex. This framework can be used by employers, learning and development teams, employees and training providers that train on related topics in the Hertfordshire and West Essex area. Use of this framework will support:

  • Standardisation of education across individual organisations
  • Standardisation of education across the ICS
  • Following of local pathways 
  • Improved quality and consistency of education relating to frailty
  • Better understanding of interdependencies relating to frailty

This document should be used as a guide to review the current education being delivered to staff. The learning objectives in this document should be seen as the minimum requirement with organisations reserving the right to add additional learning objectives as required for their staff. Within each topic there are resources to support with development of training as well as links to existing training where this is applicable.

ICS Frailty Pathways

The NHS Long Term Plan outlined important changes to the way the NHS should support patients and their carers. Our aim is to support people to age well and to stay independent at home for longer.  A key component of delivering this is ensuring frailty is everyone’s business and all involved in health and social care can recognise frailty and the impact this may have on someone’s quality of life and independence. Education is essential to the delivery of the long-term priorities and improving care. 

Over the last four years the Frailty Board and its workstreams have developed a series of clinical and non-clinical pathways for any staff supporting frail adults adults across Hertfordshire and West Essex ICB. The following education framework has been developed based on the content of these pathways. 

This education framework which has been developed in collaboration with professional and clinical leadership from across the ICS aims to support our Learning and Development teams to utilise and deliver the outcomes of the ICS pathways – Frailty, Falls, Dementia, End of Life, Tissue Viability and other linked areas such as Malnutrition, which are covered in the General Health Learning Objectives.

The framework is structured to enable Learning & Development teams to highlight areas of need and adapt delivery methods. The toolkits are broken down into knowledge modules and lesson plans with suggested activities, resource reference guide, case studies and knowledge assessments.

Frailty Pathways includes – 

Falls Pathways 

  • Falls Pathway –includes:
  • Falls Risk Identification in the Community
  • Management by a Clinician of a Person who has Fallen in the Community
  • Management by a non-clinical person of person who has Fallen in the Community
  • Osteoporosis – Assessing risk of fragility fractures as per NICE clinical guidelines 146
  • Management of a person who has fallen in a Care Home 

Tissue Viability Pathways

  • Lower leg wounds –includes:
  • Initial Assessment and Treatment-Management of Lower Leg Wounds (Including Ulcers) Pathway
  • Lower Leg Ulcer Management Pathway – for non-specialist healthcare professionals
  • Skin Tears –includes: 
  • Acute Skin Tear Management by Clinician from 24-48 hours onward in the Community
  • Acute, Same-Day Management of Skin Tears by Clinician in the Community (for adults)
  • Acute Management by Non-Clinician in the Community of Skin Tears

Dementia and MCI Pathways

  • Dementia –includes:
  • Dementia Diagnosis 
  • Dementia Diagnosis Support
  • MCI – Post Diagnostic Support
  • Screening in High-Risk Individuals and Suspected Dementia

End of Life Pathways

  • End of Life (EoL) –includes:
  • Identification of Adults Nearing End of Life
  • GSF End of Life MDT
  • Management of Adults in the last few days of life
  • Summary End of Life Care Map 

Training Tiers

All learning objectives have been grouped into three categories: Awareness, Intermediate and Advanced. Guidance for who should meet each of these levels is provided below but should be at the discretion of the organisation. 

Awareness

Awareness training is developed for all staff who interact with people living with frailty. This level will ensure that staff understand how to recognise red and amber flags relating to frailty, recognise deterioration, and understand how to provide front-line support as required. Staff at this level would not be expected to be responsible for making decisions or conducting assessments but would be expected to collaborate with the responsible staff and provide insights relevant to observations. Example roles that may take the Awareness training include:

  • Health Care Assistants
  • Nursing Associates
  • Voluntary staff
  • Porters and domestics
  • Pharmacy Staff
  • Social Care Staff

Intermediate

Staff at this level would be expected to take on more decision making relating to a person’s care. Their training should cover everything included in the Awareness level as well as additional objectives relating to assessments and planning. 

Example roles that may take the Intermediate training include:

  • Paramedics
  • Pharmacist
  • Registered Nurses
  • Social Care Team Leaders
  • GPs

Advanced

Staff at this level will tend to be the most senior decision-maker relating to the person’s care. This may include being able to make diagnoses, signing off risk assessments, and writing care plans. Their training should cover everything included in Awareness and Intermediate level as well as the additional objectives relating to accountability.

Example roles that may take the Advanced training include:

  • Matrons
  • Occupational therapists, physiotherapists, and dieticians
  • Doctors
  • Registered Care Managers
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