Focus on Frailty programme update: February 2026
Focus on Frailty programme 2025 – 2026
We support NHS boards and HSCPs to improve access to and experience of person led and coordinated health and social care for older people who are living with frailty.
The programme has a particular focus on:
- setting up hospital front door frailty pathways, and
- improving integrated care coordination in primary, community and acute care.
It supports delivery of the NHS Scotland Operational Improvement Plan and is grounded in the Ageing and frailty standards (2024).
What we do
We support participating teams to identify, test and spread evidence-based change ideas by:
- Providing one-to-one quality improvement coaching.
- Providing places at two in person learning sessions.
- Site visits from the Healthcare Improvement Scotland team.
- Providing access to clinical expertise on frailty.
- Advising on data and measurement, strategic planning and engaging people and families in improvement.
- Sharing a change package and measurement framework.
- Publishing tools and resources based on the best available evidence.
- Delivering a learning system that that enables people working in frailty services to share and learn.
Examples of impact so far
Access to specialist frailty teams
93% (14/15) of hospital sites that accept emergency admissions and are participating in the programme have access to specialist staff in frailty teams.
Frailty screening
1,460 older people (over 65s) screened for frailty in the community in Dumfries and Galloway HSCP since January 2025. This represents one in 25 people aged 65 or older in Dumfries and Galloway.
Screening has been spread to all community home teams in Dumfries and Galloway as of December 2025.
Spotlight on
National learning event: representatives from all 11 teams and Ulster Hospital, Northern Ireland came together to connect with colleagues, share their progress and consider next steps for their improvement work. They heard from Professor Rose Anne Kenny, Regius Professor of Physic Trinity College, Dublin. Professor Kenny delivered an engaging presentation titled “Age Proofing Scotland”. A similar presentation is available to watch on YouTube from the Trinity Development and Alumni.
94% of respondents rated the learning session extremely or very useful.
Achievements
11 teams participating in the programme
- NHS Ayrshire & Arran
- NHS Dumfries and Galloway
- NHS Fife
- NHS Forth Valley
- Glasgow Royal Infirmary
- NHS Highland
- NHS Lanarkshire
- NHS Lothian
- NHS Shetland
- South Ayrshire HSCP
- NHS Western Isles
We are sharing learning from the programme with a team at Ulster Hospital, Northern Ireland through learning sessions and project surgeries.
Recently completed milestones
Between October 2025 and January 2026 we:
- Published a report outlining hospital and community frailty services in Scotland.
- Held an in person learning session with 111 attendees.
- Held the second of two webinars on frailty in general practice with 471 attendees.
- Facilitated a project surgery focusing on community-based improvement work.
- Attended site visits with NHS Western Isles, NHS Lothian, South Ayrshire HSCP, NHS Forth Valley, NHS Dumfries & Galloway, NHS Ayrshire & Arran and Glasgow Royal Infirmary.
- Reviewed and provided feedback on data and progress reports submitted by teams in October and December.
Testing changes
Data collection
NHS Lanarkshire established a new hospital frailty unit in University Hospital Wishaw in December 2025.
They have since added a frailty icon to the Trakcare information system. This will improve reliability of frailty screening and access to frailty services across the three hospital sites.
Frailty identification
NHS Forth Valley established a process for recording the clinical frailty scale within one community team. Since November 2025:
- 21% of people over 65 who are on the district nurse caseload have been screened for frailty.
- 16% of people who have been screened and are living with moderate to severe frailty have received a general assessment.
Improved screening and recording will enable multidisciplinary teams to agree interventions for people who have been identified as living with frailty.
Sharing learning
In September and October 2025 we held two webinars on frailty in general practice – a team approach with a total of 955 attendees. This represents 58% of all general practices in Scotland (514/887).
The webinars were held for general practice frailty leads as outlined in the Scottish Government Directed Enhanced Service and members of the general practice multidisciplinary team.
To support the webinars we also published an identification and assessment of frailty in general practice toolkit which is available on our website.
Next steps
Between February and March 2026, we will:
- Open for applications for teams to join the Focus on Frailty programme for 2026/27.
- Review the final data and progress reports submitted by teams.
- Facilitate a project surgery with a focus on acute frailty services to support networking and connection between the teams.
- Participate in site visits with:
- NHS Highland
- NHS Lanarkshire
- Hold a third in person learning event where teams will have the opportunity to celebrate success, share impact and plan how to sustain their improvement work.
Email us at his.frailty@nhs.scot if you have a question about the improvement programme or would like a PDF copy of the progress update.