Frailty Service at Sunderland Royal Hospital

Our frailty service at Sunderland Royal Hospital provides an in-reach service to the Integrated Admissions Unit and Emergency Department. The aim of the team is to provide a Comprehensive Geriatric Assessment (CGA) to all frail patients admitted to hospital.

CGA is the gold standard for the management of frailty in older people. It involves a holistic, multidimensional, interdisciplinary assessment of an individual by a number of specialists of many disciplines in older people’s health and has been proven to improve patient outcomes in many settings. The frailty team aims are based on the ‘Fit for Frailty’ guidance, as set out by the British Geriatric Society (BGS). Patients are referred to the team when presented at Sunderland Royal Hospital.

Our frailty team work closely with our complex discharge team and interface (therapy) team and are comprised of:

  • Consultant Geriatricians
  • Advanced Pharmacist Practitioners (APP)
  • Specialist Nurse Practitioners
  • Junior doctors

Early comprehensive geriatric assessment has improved patient outcomes by ensuring frail patients get the right care in the right place at the right time. Close working with front of house services has raised the awareness of frailty and challenged attitudes to the inevitability of hospital admission.

Existing evaluation has shown that the interventions of the team have resulted in reductions in the length of stay in hospital, readmission rate, need for cannulas and catheters and improved review of patients’ medications. The team has established methods of communication with primary care (both GP and pharmacy) services via the discharge summary and care plan and the use of the newly established pharmaoutcomes link.

We have worked with Sunderland University pharmacy students who have completed undergraduate projects in frailty and the University is currently working on a research bid which will focus on the work of the frailty team.

Published work can be found here (p57)

and here (abstract no 31) .

Useful sites:

Fit for Frailty Campaign  


Contact Us:

Dr Debbie Mayne- Ext 42680

Lisa Ball- Ext 40127

Finding Us:

The Frailty Service is located at Sunderland Royal Hospital's Adult Emergency Department and Integrated Admissions Unit. This can be accessed through the Adult Emergency Department entrance on Kayll Road, or C level, Hylton Road Block.

Our Team:

Divisional General Manager- Angela Wadmore

Directorate Manager- Lisa Ball

Clinical Director -Dr Nik Majmudar

Matron- Carol Gibson

Matron- June Lawson

Falls Service

We are a team of specially trained nurses and physiotherapists. We have a specialist nurse for inpatients of the hospital, a specialist physiotherapist for community based care and have clinics based at the Moorlands Centre and Galleries Health Centre.

We see patients that have recently had a fall, or are at risk from falling or struggling with their mobility. We carry out a holistic assessment for falls or risk of falls including vestibular assessment for those with dizziness or balance problems.

These are some of the things we may arrange once we have seen patients

  • arrange a course of rehabilitation sessions
  • ask colleagues from occupational therapy to give advice on making things easier at home
  • provide walking aids or adjust the one they may already be using
  • ask the GP to look at altering medications
  • refer to Consultant Physicians for medical investigations
  • ask them to follow up with opticians, podiatrists, or chiropodists

Clinics are held in the Moorlands Day Centre on the main hospital grounds. Residents of care homes will be assessed at home.

Finding Us:

The Moorlands Day Centre is at South Tyneside District Hospital opposite the Outpatients department.
South Tyneside District Hospital
Harton Lane
South Shields
NE34 0PL
Community Falls Service
3rd Floor
Galleries Health Centre
NE38 7NQ

Contact Us:

Tel: (0191) 502 6810
Monday - Friday 8.30am - 4.30pm

Our Team:

Admin contacts for South Tyneside and Sunderland Falls Service are: Lynne Lowery and Kathleen Carruthers.

South Tyneside Community Falls Service

Dean Metz – Falls and Vestibular Specialist Physiotherapist

Sunderland Community Falls Service

Pam Vickers- Falls Lead Nurse