1. Interface geriatrics Simon Conroy Head of Service/Senior Lecturer, Geriatric Medicine University Hospitals of Leicester Speciality clinical director, Leicestershire Partnership NHS trust

2. Why this is important Evidence-based, educational solutions –For frail older people Integrated whole systems perspective –‘Team without walls’ –Aligned to NHS priorities Holistic, generalist approach –Interdisciplinary team working

3. What we did… Vertically integrated services for frail older people Focussed comprehensive geriatric assessment, including social care –At and across the interfaces; –Coordinated and communicated Horizontal integration (emergency department (ED) and geriatrician (GER)) Whole system, collaborative leadership

4. Frail older person in crisis Intermediate care Bed-based rehabilitation/ reablement Specialist care In-patient CGA Liaison SPA – clinical discussion MDT Triage Trajectory Transfer Elderly frail unit (EFU)/Frail Older People’s Advice & Liaison Service (FOPAL) How we did it

5. Frail older person in crisis Intermediate care Bed-based rehabilitation/ reablement Specialist care In-patient Comprehensive Geriatric Assessment (CGA) Liaison SPA – clinical discussion Multi disciplinary team (MDT) Triage Trajectory Transfer Elderly frail unit (EFU)/Frail Older People’s Advice & Liaison Service (FOPAL)

6. ED performance 2010-12: people 85+

7. How we kept it going Whole system focus on frail older people –Clinical Commissioning Groups (CCGs), psychiatry, social care Cost savings –Acute - £0.5M –Community - £0.75M Profile and capacity raising –Fellowship in Emergency Geriatric medicine –GP fellowship in Interface Geriatrics –Emergency medicine curriculum changed –IHI fellowship, Harvard

8. Dissemination External visits Silver Book ED curriculum RCP acute care toolkit BGS activity Publications Today! How we spread the message Research Evaluation of interface geriatrician role Programme grant of emergency care of older people Health service & delivery research (HSDR) grant on acute care of older people Research

9. Summary Urgent care = older people Whole system solutions required –Vertically integrated –Holistic & interdisciplinary –Underpinned by robust communication and cooperation

10. Contact details http://www2.le.ac.uk/departments/cardiovascular- sciences/people/conroy/the-silver-book/the-silver- book/ or spc3@le.ac.uk Thanks!