Celebrating 75 years of the NHS

Spotlight on Faith Howard

Faith Howard

The NHS turns 75 this month. Time to celebrate this by putting the spotlight on one of the amazing NHS-focused projects that our PGRs are engaged in. Faith Howard (pictured) is a PGR in the School of Health Sciences. Her PhD project is PROFRAIL: Capturing and measuring what matters most to older people with frailty towards the end of life.

Faith explains her work here: “Since the NHS was founded, life expectancy has increased significantly.  Seven decades ago, only one in two people lived beyond 65, today that has increased to six in seven (1).  This great achievement needs to be celebrated but also means the NHS faces a different challenge to one when it was founded 75 years ago.  Today older people using the NHS are more likely to be living with multimorbidities, and have complex needs at the end of life such as frailty (2).

Frailty is a syndrome often associated with age related declines in the body’s physical reserves, but there is increasing evidence that what matters most to this group goes beyond just their physical health needs. Their priorities may include quality of life, maintaining and strengthening relationships, and being involved in conversations about their current and future care (3). The NHS, which historically has been oriented towards addressing specific physical health needs, today has to adapt in order to meet the multidimensional needs that are facing the population that it serves. 

To meet this new challenge, services need to be able to capture and measure the needs and priorities of this group in a systematic way. The PROFrail project has been developed to explore this issue and is particularly interested in the role of Patient-reported outcome measures (PROMs) and Patient experience measures (PREMs).  PROMs and PREMs are standardized and validated questionnaires which have been developed to identify outcomes and experiences from the patient’s perspective and are increasingly used within healthcare to improve quality of care (4). 

The PROFrail project is a mixed method, multi-phase study which has been broken down into two distinct phases. Phase One involves the development of a logic model to determine how best to capture the needs and priorities of older people with severe frailty using PROMs and PREMs, and to understand what is happening in current practice. This will be followed by Phase Two which involves consensus methodology and cognitive interviewing to collect preliminary data on the content validity of a prototype measure. 

The expectation is that this research will result in a prototype clinical tool, that then can be evaluated at a bigger scale. It will hopefully have an important impact, on how services, and professionals, capture and address what matters most to this group.” 

Faith is about to start the third year of her PhD at Surrey. She is supervised by Caroline Nicholson, Professor of Palliative Care and Ageing, and Jenny Harris, Senior Lecturer in Cancer Care and Health Statistics. We can’t wait to hear more about her findings!


1.           Age UK. The State of Health and Care of Older People in England 2023. London; 2023 Jul.

2.           Stow D, Spiers G, Matthews FE, Hanratty B. What is the evidence that people with frailty have needs for palliative care at the end of life? A systematic review and narrative synthesis. Palliat Med. 2019 Apr 18;33(4):399–414.

3.           Nicholson CJ, Combes S, Mold F, King H, Green R. Addressing inequity in palliative care provision for older people living with multimorbidity. Perspectives of community-dwelling older people on their palliative care needs: A scoping review. Palliat Med. 2022 Aug 24;026921632211182.

4.           Bausewein C, Daveson BA, Currow DC, Downing J, Deliens L, Radbruch L, et al. EAPC White Paper on outcome measurement in palliative care: Improving practice, attaining outcomes and delivering quality services – Recommendations from the European Association for Palliative Care (EAPC) Task Force on Outcome Measurement. Palliat Med. 2016 Jan 11;30(1):6–22.