Collaborative Development of Perioperative Care for Older People in Wales: From Regional Partnership to National Planned Care Funding

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Abstract Introduction Older patients undergoing planned surgery benefit from Comprehensive Geriatric Assessment (CGA) via a Perioperative care for Older People undergoing Surgery (POPS) service. This cost-saving intervention that improves perioperative outcomes is only available in two of six Welsh health boards who provide surgical services. We describe how collaboration between local clinicians and national groups facilitates standardisation of perioperative care for older people in Wales. Methods A cross-health-board collaboration was established between two POPS services, supported by the Bevan Commission – a Welsh health and social care think tank. Through an ‘Adopt and Spread’ programme we developed an implementation toolkit to share learning and guide service models, workforce planning and outcome frameworks. This conformed to ethical standards. It was complemented by collaboration with NHS Wales Performance and Improvement funding to provide staff secondments and start-up costs in each health board for up to twelve months. Results All 6 health boards expressed an interest in developing or expanding a POPS service. Four health boards (67%) have utilised the support and funding thus far - 2 to start new services and 2 to accommodate a new surgical specialty. Limitations to uptake included capacity of geriatricians to support the service and hesitation due to a non-substantive funding model. Conclusion Regional collaboration can gain national traction and act as a catalyst for service development. This model provided implementation support and resources to accelerate POPS service mobilisation in new sites and an existing service expansion - an important step towards reducing unwarranted variation in perioperative pathways for older surgical patients in Wales.

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