From data exhaust to finding frailty before crisis.
An animated guide to the Assistiv five-layer pathway — how raw NHS data becomes geographic intelligence, precision screening, and a learning feedback loop.
Data signals
Convergence & scoring
Geographic priority
Community screening
Feedback loop
Stage 1 of 5
Data exhaust from the NHS
Millions of data points exist across the NHS and public sector — prescribing records, falls rates, deprivation indices, census data. Individually they are noise. Together they are a signal.
The 17 signals — what goes into the FEP score
01 · 13% weight
Over-75s living alone
ONS Census 2021. The single strongest demographic frailty proxy.
02 · 12% weight
Falls admissions 65+
NHS Fingertips. Kent & Medway: 1,917 per 100k — above England average.
03 · 9% weight
Hip fracture rate 65+
NHS Fingertips. 543 per 100k vs England 491. Significant adverse variance.
04 · 8% weight
Deprivation (IMD 2019)
MHCLG. Strong frailty amplifier. Ward and LSOA level available.
05 · 8% weight
Winter mortality index
NHS Fingertips. 9.8 vs England 8.7. Fuel poverty and isolation proxy.
06 · 7% weight
Care home gap
CQC register. High FEP + low care provision = priority outreach zones.
07 · 6% weight
Loneliness rate
NHS Fingertips PHOF. Social isolation is a compounding frailty risk factor.
08 · 6% weight
Dementia diagnosis rate
Kent & Medway 62.3% vs England 66.3%. Lower = unmet diagnostic need.
09–17 · remaining
Prescribing signals ×7
NHSBSA EPD at practice level: hypnotics, antidepressants, bisphosphonates, anxiolytics, diuretics, ACE/ARB, bladder antimuscarinics.