Programme Case Studies

Healthy Ageing Collaborative


A Healthy Ageing Collaborative has been established to support the development of new, evidence-based models of care for older people with frailty. The Collaborative is a network of primary care clinicians, health and car proffesional, academics, Clinical Commissioning Groups (CCGs), local authorities, voluntary sector representatives and industry partners.

Networking, shared learning and knowledge transfer opportunities across the Collaborative are supporting primary care and commissioners to improve the quality of care for people living with frailty and better target resources to offer people with frailty evidence-based interventions and more appropriate, proactive, goal-orientated care to help improve their health and wellbeing


  • 18 months following the launch of the Collaborative, 90% of the Yorkshire and Humber (Y&H) CCGs are using the electronic Frailty Index (eFI). 
  • The Collaborative has engaged with 56 of the 211 CCGs in NHS England to support the development of interventions or new models of care for people living with frailty at a GP practice, CCG and/or Whole System/Integrated Care level.
  • Activity has extended to NHS Scotland, NHS Wales and the Health and Social Care Board in Northern Ireland.
  • The extent of engagement with the Collaborative highlights the value of a peer-led support community which has come together through a shared vision to improve the quality of care for people living with frailty, and recognition of the need to transform how health and care services are provided for this vulnerable population
  • Health and care professionals from across primary and secondary care, ambulance services, CCGs, adult social care, voluntary and community services, and patients and public from across the region have added to the understanding of what works for people with frailty and are benefiting from the Collaborative.
  • There has been significant leadership engagement with the Collaborative and the opportunities for partnership working created are helping to drive up integration across services through the development of frailty pathways.
  • The Collaborative is helping to broker relationships between primary care clinicians and commissioners and help them meet the needs of older people with frailty and their carers whilst attempting to address funding gaps.
  • People living with frailty and their carers have become engaged – helping health and care professionals find ways to talk about frailty in a way that people find acceptable.

The Future

The Healthy Ageing Collaborative will continue to support health and care professionals to improve the quality of care for people living with frailty. The Collaborative will evidence improvements using data routinely collected in primary care. We are currently supporting a return on investment analysis of three frailty interventions in partnership with the York Health Economics Consortium (YHEC).

Healthy Ageing Collaborative

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