Integrated Care Centre boosts wellbeing of patients with frailty

The Jean Bishop Integrated Care Centre

Image credit: The Hull Story / Neil Holmes Photography

Image credit: The Hull Story / Neil Holmes Photography

People in the UK are living longer, leading to an increase in long-term conditions and the need for more integrated health and social care. Frailty is one such condition that is now being acknowledged as a long-term issue that requires prevention, identification, and management alongside other long-term conditions.

The Jean Bishop Integrated Care Centre in Hull, run by the City Health Care Partnership CIC (CHCP), offers a unique approach to caring for older people living with risk of frailty.

Between April 2019 and September 2022, the Jean Bishop Integrated Care Centre contributed to a 13.6% reduction in emergency hospital attendances for people aged over 80 in Hull. Over the same period there was a 17.6% reduction in emergency department attendances for people living in care homes.(1)

And now, research by the Wolfson Palliative Care Research Centre at Hull York Medical School, has shown that visiting the Centre can improve the wellbeing of older people living with frailty.

Professor Fliss Murtagh (centre) with PhD students Sophie Pask (left) and Helene Elliott-Button (right)

Professor Fliss Murtagh (centre) with PhD students Sophie Pask (left) and Helene Elliott-Button (right), whose research has shown that visiting the Centre can improve the wellbeing of older people living with frailty

Professor Fliss Murtagh (centre) with PhD students Sophie Pask (left) and Helene Elliott-Button (right), whose research has shown that visiting the Centre can improve the wellbeing of older people living with frailty

Led by Professor Fliss Murtagh, Director of the Wolfson Palliative Care Research Centre, researchers from the University of Hull were invited to evaluate the impact of the Jean Bishop Integrated Care Centre on the overall wellbeing and quality of life of older adults living with frailty.

The PACE (Proactive Anticipatory Care Evaluation) study used an innovative approach to capture the wellbeing and quality of life of those receiving the service, providing a picture of the Centre's impact – as well as deriving evidence on whether this approach could be used elsewhere to drive positive change in healthcare.

The main part of the PACE study, led by Postdoctoral Research Fellow Dr Mabel Okoeki and funded by University of Hull and Hull Clinical Commissioning Group, involved a non-randomised controlled trial comparing the wellbeing and quality of life of individuals who received care at the Integrated Care Centre with a matched group in the community who did not receive the service.

Painted stones in the garden at the Jean Bishop Integrated Care Centre

Image credit: The Hull Story / Neil Holmes Photography

Image credit: The Hull Story / Neil Holmes Photography

Revolutionising care of people affected by frailty

The Jean Bishop Integrated Care Centre supports those with frailty by providing proactive out-of-hospital care; reducing unnecessary hospital admissions and enabling residents to keep fit, healthy and living independently in their own homes.

There are nearly 3 million people who can be described as living with frailty in the UK, and research suggests they require about 40% of all hospital beds and GP resources.(2)

Unlike a short appointment with a GP or an emergency hospital visit, people visiting the Centre undergo a comprehensive full-body and life ‘MOT’. They see a range of professionals, including medical and nursing professionals, pharmacists, physiotherapists, occupational therapists, and social workers; all of whom work together to understand and address the patient’s individual needs.

Opened in 2018, the Jean Bishop Integrated Care Centre is the first of its kind in the UK and represents a new era in the care of people living with frailty. It is a prime example of the NHS, social care, and voluntary services working together to provide person-focused care for mainly older people living with frailty.

Anyone at risk of frailty can be referred to the Centre by doctors, paramedics, or any health or care service in the area. Typically, people identified as eligible via their GP practice's Electronic Frailty Index are invited to attend the Jean Bishop Integrated Care Centre. This whole-population proactive approach is a significant departure from individual referrals reacting to needs.

This innovative population-based approach to whole, person-centred care is a revolutionary way of caring for patients, bringing together a range of specialists in one place to offer individualised care.

Evaluating the wellbeing of patients at the Jean Bishop Integrated Care Centre

The study found that the Integrated Care Centre significantly improved the overall wellbeing of older people living with frailty at 2-4 weeks, and that this improvement was sustained 10-14 weeks after the intervention. In contrast, the control group experienced a decline in wellbeing at both 2-4 weeks and 10-14 weeks.

Explaining the primary outcome of the study, Professor Murtagh said, “We measured wellbeing using the Integrated Palliative care Outcome Scale (IPOS), which is a measure of symptoms and concerns that matter to people with advanced illness.

“We were thrilled to discover that people's wellbeing improved after receiving care at the Jean Bishop Integrated Care Centre”
Professor Fliss Murtagh, Director of the Wolfson Palliative Care Research Centre

“We also found that the improvement in people's wellbeing was still sustained three months after their visit to the Centre.”

Dr Dan Harman, a Consultant Community Geriatrician at the Centre, alongside colleague Dr Anna Folwell, were integral to developing the service model and leading the service.

“These are really exciting findings; we can now demonstrate the benefits of holistic community-based care"
Dr Dan Harman, Clinical Lead at the Jean Bishop Integrated Care Centre

He said of the findings, “Through a robust and continuous evaluation of the frailty service, we have consistently demonstrated that our collective approach has a sustained improvement on system outcomes. However, the PACE study has added further evidence as we can also now demonstrate the benefits that patients report through receiving this holistic community-based care.”

Dr Folwell said, “The in-depth interviews with patients and carers by the researchers, gave us early insight into what was working well in terms of communication before and after the assessments, and what could be improved. This helped us in continuous improvement of the service and would have been more challenging without the collaboration with the research team.”

While the study also measured quality of life as a secondary outcome, the improvement in quality of life was small.

Professor Murtagh explained, “Quality of life is influenced by many external and social factors, such as living circumstances and situation. It is hard, therefore, to change quality of life. In contrast, the IPOS measure is specifically designed to capture the health-related symptoms and issues of individuals with advanced disease.

“Our study confirms that the IPOS measure is very valuable in assessing the impact of care on people’s wellbeing and health status and provides important insights into the effectiveness of the Integrated Care Centre's approach to caring for individuals living with frailty.”

Dr Dan Harman

Dr Dan Harman. Image credit: The Hull Story / Neil Holmes Photography

Dr Dan Harman. Image credit: The Hull Story / Neil Holmes Photography

Exploring neglected symptoms in older people

The PACE study also included three sub-studies, each of which was conducted as a PhD project and funded by the University of Hull. These sub-studies focused on neglected symptoms in older people at risk of frailty, including pain, breathlessness, and unintended weight loss.

The survey data collected for the 250 patients that participated in the PACE study provided data for the three PhD projects, in which medical records were analysed and qualitative interviews were conducted.

The research showed that patients appreciated the opportunity to discuss their problems in-depth and that the care they received at the Jean Bishop Integrated Care Centre was very positively received.

(Left to right) Ugochinyere Nwulu, Helene Elliott-Button, Blessing Ukoha-Kalu, and Sophie Pask

(Left to right) Ugochinyere Nwulu, Helene Elliott-Button, Blessing Ukoha-Kalu, and Sophie Pask

(Left to right) Ugochinyere Nwulu, Helene Elliott-Button, Blessing Ukoha-Kalu, and Sophie Pask

Sophie Pask, whose PhD focused on pain and use of strong painkillers, noted that pain in older adults is not well-researched, and most of the evidence is in younger populations.

"People told us that the Jean Bishop Integrated Care Centre was the first time they could talk in depth about their problems and then bring them all together"
Sophie Pask, PhD student

She said, “Normally when you go to a GP, you only have 10 or 15 minutes, and you can only focus on one or two issues – but older adults tend to have several issues to discuss. So, the care given to patients at the Centre was really positively received.”

 The collaborative nature of the PACE study allowed for efficient working among the students conducting the research. Professor Murtagh remarked that the PhD studies on symptoms were embedded within the whole study, which made data collection easier.

 Sophie explained, “It was a lot of data to collect and shouldering the burden together made it a lot easier.”

A plaque commemorating Hull’s “Bee Lady” Jean Bishop at the centre which bears her name

A plaque commemorating Hull’s “Bee Lady” Jean Bishop at the centre which bears her name (Image credit: The Hull Story / Neil Holmes Photography)

A plaque commemorating Hull’s “Bee Lady” Jean Bishop at the centre which bears her name (Image credit: The Hull Story / Neil Holmes Photography)

The impact of the PACE study on the Jean Bishop Integrated Care Centre and beyond 

The Jean Bishop Integrated Care Centre was established with a vision to provide innovative and integrated care to older people at risk of frailty. The PACE study now provides solid evidence to support the effectiveness of the Centre's approach. The findings of the study will help to secure funding for the Centre to continue delivering this valuable service. 

Dr Harman, Consultant Community Geriatrician at the Jean Bishop Integrated Care Centre said, “The findings of the PACE study really do strengthen the need for integrated care for people affected by frailty. As front-line clinicians we can see the impact of our care on the people we treat but to be able to measure the improvement in wellbeing in this way will provide a stronger case for similar models of care across our region and beyond.”

“The centre is truly an innovative service, and The research affirms that it works” 
Professor Fliss Murtagh, Director of the Wolfson Palliative Care Research Centre

Professor Murtagh explained, “The Jean Bishop Integrated Care Centre had the vision for integrated care, they understood the need for it. The team brings together primary and community services, and people from the acute services.” 

In addition, the study's findings can serve as a model for other places looking to offer similar integrated care. The Centre's approach can be locally adapted and rolled out in other locations to meet the specific needs of their communities. 

The researchers were impressed by the warm reception they received at the Jean Bishop Integrated Care Centre. Professor Murtagh noted that the staff there had a strong sense of community, all working together toward a common goal. They recognised the importance of research and were proactive in identifying suitable people for recruitment. 

Professor Murtagh explained, “They're like a family and they have all got the same common purpose. They recognise that research is not an optional extra; it is core to their work, it is part of what they do. They are very good at flagging people up for recruitment, and they are good at working with researchers. The whole team was very welcoming of us.” 

Sophie shared her experience, saying that the family-oriented atmosphere made her feel welcomed and supported throughout the study. She said, “It was a family-orientated ethos, you were welcome there. The Jean Bishop Integrated Care Centre helped to identify people suitable for the research. They put the feelers out first, before we then approached individuals. The team were so supportive. It was a nice study to do.”  

Continuing research collaborations at the Jean Bishop Integrated Care Centre 

One of the key findings from the research was the importance of follow-through at GP surgeries. The research highlighted that follow up, and planning ahead for future care, were both areas for development of the service. 

To address this issue, the Hull Clinical Commissioning Group (now part of the Humber and North Yorkshire Health and Care Partnership) provided funding for further research into the best way to ensure effective follow-through. The Wolfson Palliative Care Research Centre is currently conducting this research. 

The Jean Bishop Integrated Care Centre has continued to collaborate with the Wolfson Palliative Care Research Centre on other research projects. Mary Kimani, a PhD student, is examining the impact of advanced illness on social interactions and connections. 

Sophie expressed her admiration for the Jean Bishop Integrated Care Centre’s commitment to research and integration. She said, “It is really reassuring to see an organisation that values research so highly. At times, as researchers, we can feel like we are getting in the way, but the Jean Bishop Integrated Care Centre is exceptional in how well they integrate research around their service.” 

The memorial garden at the Jean Bishop Integrated Care Centre

Image credit: The Hull Story / Neil Holmes Photography

Image credit: The Hull Story / Neil Holmes Photography

For more information about this research, contact Professor Fliss Murtagh. Professor Murtagh is Director of the Wolfson Palliative Care Research Centre.

References 

1) 'Centre’s integrated services transform care for frail and elderly residents' - NHS England 

2) Fogg, C., Fraser, S.D.S., Roderick, P. et al. The dynamics of frailty development and progression in older adults in primary care in England (2006–2017): a retrospective cohort profile. BMC Geriatr22, 30 (2022). https://doi.org/10.1186/s12877-021-02684-y 

Wilson I, Ukoha-kalu BO, Okoeki M, Clark J, Boland J, Pask S, Nwulu U, Elliott-Button H, Folwell A, Johnson M, Harman D, and Murtagh FEM. Experiences of a Novel Integrated Service for Older Adults at Risk of Frailty: A Qualitative Study. Journal of Patient Experience. 2023;10.

Murtagh FEM, Okoeki M, Ukoha-kalu BO, Khamis A, Clark J, Boland JW, Pask S, Nwulu U, Elliott-Button H, Folwell A, Harman D and Johnson MJ. A non-randomised controlled study to assess the effectiveness of a new proactive multidisciplinary care intervention for older people living with frailty. BMC Geriatrics 23, 6 (2023).