OneWolverhampton selected as Black Country Lead in National Frailty Collaborative
Published: 3 October 2025
OneWolverhampton is leading the Black Country’s involvement in the National Frailty Collaborative, a 12-month national improvement programme focused on strengthening frailty care across Wolverhampton and the wider health and care partnership. The initiative is supported by the national team, with additional input from the Strategy Unit, providing expertise in data, measurement, and behavioural insights.
This builds on a lot of work already happening locally to improve care for people living with frailty. It offers an opportunity to review current services and pathways, understand what’s working well, and identify areas for further improvement.
As part of this, partners across the area have already delivered a range of successful interventions, including:
- Proactive Frailty Clinics identifying high levels of unmet need, optimising medications, and expanding into Community Geriatric Assessment clinics with full Multi-Disciplinary Team support.
- Healthy Ageing Coordinators reducing isolation, improving access to services, and supporting carers for people 65+ with mild–moderate frailty.
- Age UK community activities such as Tai Chi, daytime discos and social events, boosting physical activity, mood, memory and social connection.
- Hydration training across care homes, leading to significant reductions in falls, UTIs and hospital admissions.
The Collaborative aims to improve outcomes for people living with frailty — particularly around quality of life, independence, and overall patient satisfaction. Six frailty care bundles are being developed nationally to support this work:
• Proactive Planning and Prevention
• Urgent Care
• Hospital Discharge
• Rehabilitation, Reablement and Recovery
• Palliative and End of Life Care
• Acute Hospital Care
The initial focus in Wolverhampton will be on Hospital Discharge and Acute Hospital Care, working with the national team to assess current practice and identify actions to improve outcomes. At the same time, the partnership will continue to explore wider opportunities alongside ongoing work to enhance frailty care across the partnership.
A dedicated core team has been established to align this work with the Home First approach, ensuring people can return to and remain in their own homes safely, with the right support in place, and avoid unnecessary time spent in hospital.
A stakeholder event is planned for 6 November, where partners will co-design a shared vision for frailty care in Wolverhampton and agree local priorities.
In addition, the national team will also begin hosting a series of learning events to support shared learning, reflect on progress, and help teams shift from reactive, hospital-based care to more proactive, community-based approaches.