Midlothian Health and Social Care Partnership are forging a path to change frailty identification and management. The journey began by using existing Primary Care records to stratify the population in Midlothian using the eFrailty Index (eFI), and this has led to new insights concerning the scale of the challenge of supporting citizens identified as living with frailty (~9,500 citizens). Through innovative partnerships with the British Red Cross and VOCAL, new ways of supporting people living with frailty and carers have been developed, which support people to navigate the system and access support to live well. Alongside this, Midlothian have developed new ways for health, care and third sector professionals to collaborate and work in multidisciplinary ways to identify people at risk and prevent crisis.
In order to push forward on this path of innovation, Midlothian Health and Social Care Partnership have successfully applied to the Technology Enabled Care (TEC) Pathfinder programme at the Scottish Government to fund the current project which seeks to explore how digital technology and design can act as transformation enablers. They have partnered with the Digital Health and Care Innovation Centre (DHI) to help them to use design-led approaches to engage with citizens and stakeholders and involve them in innovating the frailty system of care. The project benefits from strong clinician involvement, a range of key partners including the Red Cross and VOCAL, and robust senior management support.