A new report from the National Audit Office reveals that the NHS is failing to provide adequate support for people living with or at risk of frailty, leaving thousands vulnerable to medical crises and unnecessary hospital admissions.
Frailty, a clinically recognised syndrome linked to ageing, affects at least 1.5 million people aged 65 and over in England. It causes exhaustion, reduced resilience, and often leads to individuals becoming housebound.
Under the GP contract, practices must identify patients aged 65+ with moderate to severe frailty. However, in 2024–25, GPs assessed only one in six patients (1.9 million), down from one in four when the requirement was introduced in 2017–18.
Even when frailty is diagnosed, follow-up care is lacking. Of the 226,000 patients diagnosed with severe frailty in 2024–25:
- Only 16% received a medication review.
- Just 18% had a falls risk assessment.
- 29% gave consent for an enriched summary care record.
The report highlights regional variation and declining standards in care homes. Under the Enhanced Health in Care Homes programme, the proportion of residents with a personalised care plan fell from 76% in 2022–23 to 44% in 2024–25.
While urgent community response services are meeting targets to prevent hospital admissions, the NAO warns that frailty care remains fragmented. The 10 Year Health Plan prioritised frailty but introduced no major developments, and recent guidance calls for growth in community health services and neighbourhood health models.
The NAO recommends:
- Clear, consistent requirements for GPs to assess and support frail patients.
- A timetable for standardising community health services and aligning them with neighbourhood health frameworks.
- A systematic evaluation of frailty initiatives to ensure a holistic approach.
Gareth Davies, Head of the NAO, commented:
“With the need for health and social care services set to increase in our aging population, it is crucial that people with frailty are supported effectively and consistently across the country. Our report shows that many older people are not getting the support they need.
“The NHS needs to seize the opportunity of the 10-year health plan to build the more effective and sustainable service that it recognises older people need.”
With an ageing population, the NAO stresses urgent action to prevent avoidable hospitalisations and improve quality of life for older people living with frailty.
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