Reflective Blog: NHS England North West Improvement Collaboratives

Last month marked the exciting launch of our partnership with NHS England North West to deliver three new Improvement Collaboratives, focusing on urgent and emergency care, elective care, and adult mental health, where we aim to transform care pathways across the region. Together, we’ll focus on key priorities such as preventing frailty, enhancing advice and guidance, and reducing in-patient length of stay to improve outcomes for both patients and staff.  

Delivered through Aqua’s tried-and-tested Collaborative Model, each programme will include team coaching, action learning events, tailored sessions, and data-driven support designed to turn insight into meaningful change. Over the next 12 months, we’ll work with over 300 participants across the three collaboratives, driving improvements that will directly benefit patient outcomes and staff experience. 

Jump to the latest update

One of the first major milestones in our Collaborative programme was the launch of the Northwest Learning and Improvement Network (LIN) event, focused on supporting people living with frailty through neighbourhood-level care.

Jennifer Hopes, Aqua’s programme manager, joined over 90 colleagues at the event and shared her reflections: 

Last week, I had the privilege of being a part of the first North West Learning and Improvement Network event. Commissioned by NHS England and supported by Aqua, this initiative is focused on improving outcomes for adults aged 65 and over, particularly those living with frailty, by working upstream at neighbourhood level, where we can work together to keep people feeling safe and independent in their own homes, rather than requiring extended hospital stays. 

The event was designed to bring us together as a region and build consensus around our aims. We began by introducing the LIN and its overachieving goals, then explored data and evidence to better understand the scale of the challenge as well as the opportunities ahead. It was a real chance to challenge our thinking around frailty, to ask what needs to change, and to begin shaping person-centred goals that reflect the realities of neighbourhood-level care. 

Together, we identified three key drivers that will guide our work, including medicines optimisation, admission avoidance, and optimising care at home. We also recognised the importance of enablers like digital infrastructure and workforce development, which will be essential in supporting these efforts. The energy in the room was incredible, and it was clear that we’re beginning to form not just neighbourhood teams, but a true regional collaborative. 

What stood out most to me was the depth of expertise across the region. From clinical leaders to service transformation specialists, there’s a wealth of knowledge and experience to draw from. There was a strong appetite to take a system-wide approach to frailty care, one that includes agreeing on shared definitions, using consistent stratification tools, improving access to data, and scaling best practice across the North West. 

Looking ahead, we’re keeping the momentum going. Dates for the next three learning events are being confirmed and shared. Aqua will be meeting with each team to reflect on what they took from the event, explore their areas of interest, and identify the support they need. We’ll also be recruiting clinical and operational senior responsible officers to help lead the collaborative and co-designing future events with NHSE, Aqua, and regional UEC leads, guided by feedback from delegates.

Learning Event 2: Building a Shared Purpose and Shaping Improvement Together

Our second learning event brought the collaborative together with a clear ambition: to agree our shared purpose and to give teams the space to shape, plan and refine their improvement goals for the months ahead. Although the day began with a memorable challenge, a bitterly cold St Helens conservatory that forced the entire group to squeeze into a smaller, unexpectedly cosy room — the energy, participation and collective spirit more than made up for the temperature.

Despite the weather, representation across the region was strong, with 14 teams from across the North West attending alongside several regional leaders. The room was rich in experience and professional diversity: over half of attendees were clinicians or other professionals, spanning doctors, nurses, AHPs, social care, and pharmacy. This blend of expertise created an ideal environment for meaningful discussion and the co‑production ethos that underpinned the entire day.

A central focus for the event was the opportunity to confirm our shared purpose as a collaborative. Working together, the group agreed:

“We collaborate to co-produce person-centred pathways that improve dignity, independence, and wellbeing for people living with or at risk of frailty.”

This collective statement now provides a strong foundation for the work ahead.

Throughout the day, several subjects sparked deep interest and lively discussion. The challenge of poly-prescribing and the importance of reducing anti-cholinergic burden in older people resonated strongly across teams, as did conversations about shared care models involving adult social care providers and district nursing teams. Topics such as advance care planning and meaningful co-production with people and families also generated momentum, reflecting the collaborative’s commitment to person‑centred approaches.

Another notable area of emerging agreement centred on the use of the Rockwood Clinical Frailty Score (CFS). Teams recognised the value of the CFS as a core system-wide tool for identifying frailty and informing care planning. This alignment marks a positive step towards adopting consistent definitions and practices in line with the national frailty collaborative.

The heart of the day was the opportunity for teams to share their own improvement ideas. A common thread quickly emerged: a shared determination to strengthen whole‑system approaches that support people to remain well at home. Whether through prevention, proactive support or better coordination, teams were clearly motivated to design improvements that place individuals and their homes at the centre of care.

As the event concluded, teams left ready to begin shaping and delivering their improvement projects, supported by dedicated coaching from Aqua. A shared development need emerged around measuring impact, and this will be a key focus of upcoming coaching conversations.

Momentum continues to build as we look ahead to our third learning event on 4 March, where we will be joined by Dr Tom Downes, National Clinical Director for Older People and Integrated Personalised Care at the British Geriatrics Society, and clinical lead for the national frailty collaborative.

In addition, Aqua and NHSE will host a series of Lunch and Learn sessions on priority topics identified during the event — including reducing anti‑cholinergic burden and exploring blended care models, ensuring that teams have access to practical knowledge, tools and shared learning as they progress their work.

Spotlight on Frailty-Attuned Care: Learning Event 3

The third learning event in our programme focused on frailty‑attuned care, and we were pleased to welcome Dr Tom Downes, National Clinical Frailty Lead for NHS England, as our keynote speaker. 

Dr Downes delivered an engaging and thought‑provoking session exploring the evidence behind frailty‑attuned care, examples of best practice from across the UK, and the four key enablers of change: 

1. A shift from organisational to collaborative leadership 

1. People and culture that support new ways of working 

1. Robust use of improvement methodology 

1. System‑aligned finance to enable transformation 

Participants had dedicated time to reflect individually and as teams on their own strengths, challenges, and opportunities in relation to these enablers, and to identify practical next steps for their local work. 

The event brought together a rich mix of professionals from across regions and sectors, creating a genuinely multi‑agency environment. Geriatricians, nurses, social care leaders, ICB colleagues and voluntary sector partners all contributed to discussions, which helped ensure that the conversation around frailty‑attuned care reflected the reality of work across the whole system. 

Throughout the day, engagement was consistently strong. Participants shared personal and lived experiences that grounded the principles of frailty‑attuned care in real‑world practice. A recurring theme was the powerful message that “fix frailty, fix the NHS”, with Dr Downes highlighting how much of the cost of care for older people is linked to extended lengths of stay rather than active treatment. This underscored the importance of developing a shared, frailty‑attuned culture that spans neighbourhood, community and acute settings. 

Attendees were particularly inspired by the evidence demonstrating the impact of expanding Hospital at Home models and improving rapid neighbourhood-level discharge. These approaches have been shown to reduce emergency attendances and hospital admissions for people over 65 when embedded within a supportive frailty‑attuned culture. 

Discussions also explored the balance between improvement plans and the wider “four shifts” outlined by Dr Downes. While teams felt confident in describing their frailty improvement work, they were less familiar with the enabling shifts, though the event helped to strengthen this understanding. A recurring challenge is related to neighbourhood maturity, which remains a constraint for many areas and reinforces the need for frailty transformation to progress in parallel with broader neighbourhood‑level development. 

Several teams reflected that they do not always feel empowered to lead small‑scale tests of change that could provide early evidence before wider rollout. However, many recognised that their collaborative partnerships could create the right environment for this experimentation. A final reflection from the group was the absence of key system leaders, particularly at Executive level, who would have benefited from hearing the compelling evidence shared during the session. Engaging these leaders was identified as an important priority for the collaborative moving forward. 

Next Steps 

• Planning for Learning Event 4 is already underway. This will give teams the opportunity to reflect on their journey over the past 12 months, share impact, and celebrate progress. 

• Three further learning events will take place before June, including sessions on non‑medical alternatives and system‑wide education. 

• An action learning approach will be trialled, building on a recent Lunch & Learn session, to explore practical methods for reducing anticholinergic burden.