10 Bridging the gap, frailty and palliative care

<h3>Background</h3> In the UK, an estimate of the prevalence of frailty in over 65yrs in the community is 10.7%. Undertaking a Clinical Frailty Score (CFS) may help predict their mortality. NHS frailty toolkit advocates that patients with moderate/severe frailty (CFS 6+) should have access to Advance Care Planning (ACP). ACP provides advantages to both the system and patients. Reducing acute hospital admissions and potentially reducing NHS costs, possibly saving between 16–49% (£399 - £1450) comparing hospital to community EoL care. <h3>Method</h3> North East Essex Alliance commissioned an integrated frailty team and Hospice palliative care project. To engage patients in hospital with a CFS of 6+, complete a Comprehensive Geriatric Assessment (CGA) and offer a home visit to discuss ACP using our EPaCCS (Electronic Palliative Care Coordination System) My Care Choices Register (MCCR). Mainly focusing on an Core20+ postcode area. <h3>Results</h3> Over a year 121 people were identified with 64 participated in engagement. 61.6% of which had a CGA completed. Due to engagement 48 new ACP via MCCR were created and 50 new ReSPECT forms completed. Reviews undertaken at 3 and 6 months revealed that 29 patients had died, 15 within their Preferred Place of Death (PPD), 7 hadn’t recorded a PPD, 3 patients had a PPD recorded however their situation had changed and were in care home but their PPD wasn’t updated. The cost per patient was between £200.14 - £233.52, meaning a potential saving of £165.48 to £1216.48 per community death. <h3>Conclusion</h3> Case studies collected highlighted the need for more pro-active ACP discussions in many patients, being openly offered the opportunity to discuss ACP had been welcomed and successful in a good number of people. This could also lead to a reduction in acute admissions at the EoL and cost saving to the NHS.