A new team are now in place at Stepping Hill Hospital helping to provide extra person-centred support for frail patients, including people in the last twelve months of life and those diagnosed with dementia.

The FIT (Frailty Intervention) Team aims to improve outcomes and the quality of life for these patients, ensuring they get the person-centred assessments they need to receive the right support, at the right time, in the right place. The team includes GPs, consultants, pharmacists, occupational therapists, physiotherapists, social workers,  and Age Uk’s Back Home team, all working together with community services to support our patients when they are ready to be discharged. They also help them to get home sooner , whether that’s their own home or a care or nursing home.

One example of a patient who’s been helped by the team is Bob Teers, 104, from Offerton. Bob lives alone with only one carer who visits him daily and additional family support. Bob was recently admitted to Stepping Hill Hospital’s emergency department (A&E) around midnight following a fall. Increased pain followed by a period of inactivity resulted in him developing a chest infection.

The FIT team’s GP, pharmacist and therapist assessed Bob the following morning. He received a full and detailed assessment, with Bob and his son David at the centre of all decisions made about his care and discharge planning. Bob was prescribed antibiotics to treat his chest infection and pain relief to aid his mobility. Bob was very happy that he didn’t need to stay in hospital and that his needs could be met in his own home, with extra support for him and his family.  The FIT team’s responsive service and intervention ensured Bob did not need to stay in hospital longer than he needed to.

Bob’s son David, 72, said “The care my Dad has had from the team has really been brilliant. I’m very glad they were able to assess him and get him the medication he needs, so he’s not stuck in hospital longer than he needs to be.”

The FIT Team was launched in November 2019 at Stockport NHS Foundation Trust, and is based in Stepping Hill Hospital’s urgent care departments.  They work together with Stockport NHS Foundation Trust Community services, Stockport Metropolitan Borough Council’s Social Services, Age UK and Primary Care. GPs from Viaduct Care are currently supporting the FIT Team daily to assist with additional winter pressures.

Margaret Malkin, Director Integrated Care Business Group, Stockport NHS Foundation Trust who manages the team said “Our frail patients may have a number of separate health and care issues which need a wider set of specialised skills to support their particular needs. Our new FIT team is able to give the additional support they require for their particular needs. It’s a great example of collaborative working between different organisations and professions, working together to enable the best outcomes for these patients, and ensuring the best possible quality of life.”