79th Report - Supporting people with frailty outside hospitals

NHS England is not reducing the unacceptable variation in support for people with frailty across and within Integrated Care Boards (ICBs). There is significant and unexplained regional variation between areas – 32 out of 106 local NHS areas assessed less … Read more NHS England is not reducing the unacceptable variation in support for people with frailty across and within Integrated Care Boards (ICBs). There is significant and unexplained regional variation between areas – 32 out of 106 local NHS areas assessed less than 10% of patients aged 65 and over. The NICE’s guidelines specify that any patient living with frailty who has fallen in the past year should be offered a comprehensive falls risk assessment and comprehensive falls management. However, in 2024–25, only 30% of local NHS areas could have followed NICE guidelines. NHSE acknowledges that there is variation and told the Committee that it is asking ICBs, particularly those who stand out as poorly performing or with low numbers of people assessed and supported, to tackle this under-performance. recommendation NHS England should seek to reduce variation in support for people with frailty by establishing a threshold for intervening in areas of poor performance. Alongside its response to this report, it should write to the Committee to set out the nature of that intervention. 2 Show less

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NHS England’s existing oversight arrangements are not improving GPs’ assessment and support of people with frailty. It is not clear exactly who is responsible for improving performance. NHSE considers that ICBs are responsible for commissioning services to meet the needs … Read more NHS England’s existing oversight arrangements are not improving GPs’ assessment and support of people with frailty. It is not clear exactly who is responsible for improving performance. NHSE considers that ICBs are responsible for commissioning services to meet the needs of their population; and that the service providers must ensure that the services they are commissioned to provide are delivered. We are concerned that this divided system could lead to no-one being responsible. NHSE is aware that this system of accountability is challenging for ICBs given the large numbers of providers in general practice and community services. In the future, NHSE intends to hold ICBs to account for commissioning against the promised modern service framework, and expects there will be data from a national frailty dashboard to support the framework. However, it is still finalising details of how this will work. recommendation The Department of Health & Social Care and NHS England should set out how new accountability arrangements will improve how GPs assess and support people living with, or at risk of, frailty. Show less

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NHS England has overloaded GPs, who have limited capacity, with new and expanding priorities. NHSE has prioritised improving patients’ access and digital access to general practice. It recognises that pushing to improve one aspect of care inevitably causes consequences to … Read more NHS England has overloaded GPs, who have limited capacity, with new and expanding priorities. NHSE has prioritised improving patients’ access and digital access to general practice. It recognises that pushing to improve one aspect of care inevitably causes consequences to appear elsewhere, in this case, support for people with frailty.NHSE is looking at interventions that could be done by other healthcare professionals in primary care. For example, NHSE is looking to step up the clinical service provided by community pharmacists including undertaking medication reviews for people with frailty, rather than being just a dispensing service. If this is to be case, community pharmacists must be properly funded to do this work. The Committee is reporting separately on the New Hospital Programme which makes assumptions about the level of work that will be shifted to primary care and which is heavily dependent on more care being delivered in the community. We expect the Department to demonstrate joined-up thinking on capacity and patient flows for primary, community and acute services. recommendation a. NHS England should set out the basis on which it considers GPs and general practice have the capacity to deliver the full ranges of services and responsibilities expected from them. 3 b. Alongside this, NHS England should write to the Committee with details on what they have done to assess of the expected impact of new and expanding priorities on continuity of care for patients with frailty and for digitally excluded patients with frailty. c. NHS England and the Department of Health & Social Care should also set out how neighbourhood health teams will share responsibilities and balance the load of assessing and supporting people with frailty. Show less

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The frailty policy landscape is confusing and fragmented. NHSE and the Department are planning and developing several frailty specific initiatives, such as a national frailty dashboard, and a Modern Service Framework for frailty and dementia. There are also a number … Read more The frailty policy landscape is confusing and fragmented. NHSE and the Department are planning and developing several frailty specific initiatives, such as a national frailty dashboard, and a Modern Service Framework for frailty and dementia. There are also a number of broader developments which may affect service provision for frailty, such as neighbourhood health, new funding models for ICBs and a refresh of the Better Care Fund. It is unclear whether or how these different initiatives will overlap and interact. It is encouraging that NHSE has commissioned a National Institute for Health and Care Research-led evaluation of frailty pathways and interventions, because it understands that it needs more evidence about which interventions work best. However, it is also concerning that NHSE does not have a clear idea as to whether the range of frailty interventions currently available actually work. recommendation The Department of Health & Social Care should write to the Committee within six months with an update setting out how all frameworks, policy initiatives and dashboards relevant to frailty provision interact and support one another. Show less

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We remain deeply concerned that cuts to ICBs are insufficiently thought through and will undermine their ability and capacity to carry out their functions. It is unclear what oversight roles ICBs will retain under NHSE’s plans to make them into … Read more We remain deeply concerned that cuts to ICBs are insufficiently thought through and will undermine their ability and capacity to carry out their functions. It is unclear what oversight roles ICBs will retain under NHSE’s plans to make them into strategic commissioners. On 1 April 2025, NHSE announced that ICBs had to make 50% cost reductions. To achieve this, ICBs are planning large scale redundancies and NHSE will transfer some of ICB’s current functions away from ICBs. The planned reduction in resource across all ICBs risks undermining well-performing ICBs while limiting the ability of poorly-performing ICBs to improve. This is a matter that we expect to return to during the course of this Parliament. 4 recommendation NHS England and the Department of Health and Social Care should set out what further reassurances they can provide to the Committee that ICBs’ cost reductions will not impact on ICBs’ ability and capacity to carry out their functions effectively. 5 1 Support and oversight of support and care for people living with frailty Introduction Show less

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On the basis of a report by the Comptroller and Auditor General, we took evidence from the Department of Health and Social Care (the Department) and from NHS England (NHSE).1

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For all patients diagnosed with severe frailty, the GP contract requires GPs to do a clinical review. This includes a review of the patient’s medication, a falls risk assessment and a discussion with the patient of the benefits of having an enriched summary care record that provides healthcare professionals with …

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NHSE pointed to the large proportion of people with severe frailty living in care homes and how it expected primary care networks to provide support such as weekly ward rounds.14 NHSE recognised that this care needed 8 Q 2 9 C&AG’s Report, para 3.2 10 C&AG’s Report, para 3.4 11 …

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In 2024–25, 32 of 106 local NHS areas (known as sub-ICBs) assessed less than 10% of their registered patients aged 65 or over. However, nine of 106 local areas assessed 90% or more of this group of people, suggesting that good performance is possible within existing resources.18 The National Institute …

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NHSE acknowledged the scale of variation and that tackling variation was one way it was trying to improve performance overall.20 NHSE told us that the reasons for variation will be different in different places. For example, some areas may have a disproportionately more frail population, may struggle to attract workforce …

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NHSE also highlighted variation in terms of the range of community services across the country that are not specified or described clearly or consistently. It explained that these services are coded, measured and counted in different ways and often funded through block contracts. NHSE is seeking to standardise community services …

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NHSE has set requirements for ICBs and GPs to provide health services that aim to assess and support people living with moderate and severe frailty.25 NHSE considers that ICBs are responsible for managing and measuring performance of many of the services that aim to support people living with frailty.26 NHSE …

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NHSE told us that it is working to improve accountability and that, in the future, it intends to hold ICBs to account for commissioning against the modern service framework and expects there will be data from its national frailty dashboard to support the framework.29 However, it is still finalising details …

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NHSE also told us that it was about to write to ICBs, as part of the framework for neighbourhood health, with the key requirements that ICBs need to have in place next year around enabling better, more appropriate care for the moderately and severely frail population. NHSE also agreed that …

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We were concerned that GPs might not be prioritising care for those with or at risk of frailty. NHSE acknowledged that GPs were not formally assessing enough of their patients for frailty.32 NHSE recognised that it had pushed GP practices very hard over the past couple of years to improve …

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NHSE was clear that the “ position we are in is not acceptable”.34 The Chief Medical Officer also explained that to understand GPs’ capacity, it is important to factor in geographic or demographic pressures. These could include rural or peripheral areas that have very large or increasingly large proportions of …

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NHSE told us that it is looking at interventions that could be done by other health care professionals in primary care. For example, enhancing the clinical service community pharmacists provide to include undertaking medication reviews for people with frailty.36 However, we have had written evidence from pharmacists who are keen …

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NHSE has put in place multiple initiatives that aim to help with frailty. It has set requirements for ICBs and GPs to provide health services that aim to assess and support people living with moderate and severe frailty. They include frailty assessments, healthcare for people in care homes (through the …

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NHSE informed us that it was establishing a national frailty dashboard which will take into account the range of interventions that NHSE expects ICBs to have in place. It noted that it does not intend to publish what it considered to be “experimental data” collected in its first year, 2026–27, …

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NHSE informed us that there are also a number of broader developments which may affect service provision for frailty including a forthcoming modern service framework, new funding models for ICBs, a frailty improvement collaborative involving seven sites around the country, the commissioning oversight framework and a refresh of the Better …

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NHSE recognised that it needs more evidence to understand which interventions make a difference for patients with frailty and has commissioned a National Institute for Health and Care Research-led evaluation of frailty pathways and interventions.42 Changes to ICBs’ responsibilities

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In March 2025, the government announced it would abolish NHS England and change the responsibilities of ICBs.43 In April 2025, NHSE announced that ICBs had to make 50% cost reductions.44 To achieve this, ICBs are planning large scale redundancies and NHSE will transfer some of ICB’s 38 C&AG’s Report, para …

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We heard of one element of an ICB that currently has 40 people in place but which will have one person discharging that responsibility from April 2026. We are not convinced that this reorganisation has been thought through properly and resourced adequately, since if ICBs currently do not have the …

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