The register

Patterns

The longitudinal record: cross-domain patterns confirmed, updated, or discarded month by month

How a pattern moves

A pattern is a claim that holds across domains and across time. It enters low, climbs only on stated tests, and when evidence goes against it the downgrade is published, never made quietly. How we grade →

Emerging 0 A single occurrence the register is watching. Not yet a pattern.
Provisional 13 Every pattern enters here, never higher. Its first entry names what evidence would qualify, contest or discard it. The publication's own inferences stay here until external evidence or events move them.
Established 0 Promoted only when all three tests are met, and the promotion names what earned it.

Before these rules. The register's first 7 patterns were recorded in June 2026 as established on entry, before the promotion tests were written in July. They are marked Founding below. Since then every new pattern has entered as provisional.

Re-graded October 2026. Every pattern was graded against written rules by two independent passes, which agreed on 15 of 18 statuses. Where the pipeline's register has not yet caught up, the statuses below are the re-graded ones, and each pattern's page says what changed. The register itself moves at its next monthly review.

What a grade means. Confidence measures how certain the evidence we have assessed makes each claim as worded: the pattern's own sources and the settled evidence for its domains, not the whole literature. Low means unproven, not implausible; where a claim is strong in principle but thin in trials, its parts are graded apart. More →

When evidence goes against it

Qualified 3 Narrowed — evidence limits where or how far it holds.
Contested 0 Credible contrary evidence is on the record.
Discarded 2 Failed, with the reason given. Kept on the register.
Superseded 0 Replaced by a later pattern.

18 patterns · Register as of 2026-10 · Generated 2026-10-10 · How we grade → · The evidence timeline →

Qualified 3

Narrowed — evidence limits where or how far it holds.

ID	Pattern	Domains spanned	Trajectory
VF-P5 Founding	Sarcopenia as measurable treatable driver of frailty decline Combined exercise and nutrition improve strength and physical performance in people with sarcopenia. That this changes the course of frailty, or patient-valued outcomes, is not shown. Moderate confidence Register's basis, before re-grading: Qualified: confirmed by network meta-analysis for strength and physical performance in sarcopenia; the claim that remote delivery is optimal is narrowed to proximal outcomes with wide intervals The record, 2 entries 2026-06 · established Network meta-analysis (115 RCTs, n=10,967; PMID 41996930): remote delivery optimal for lean mass and physical performance; multimodal exercise plus nutrition is evidence-based protocol. Adjacent: perioperative prehabilitation (PMID 41518969; 10 RCTs; RR 0.72 for postoperative complications; high certainty). 2026-10 · qualified Qualified, narrowing stated. The register wording 'remote delivery identified as optimal modality' claims more than the source supports. The network meta-analysis (115 randomised trials) ranks general remote training highest for lean mass (SMD 1.35, 95% CI 0.41-2.29) and physical performance (SMD 2.39, 1.26-3.53): ranked, with very wide intervals, on proximal outcomes. The UK HERO trial (740 randomised, 24 weeks of home-based exercise) found no 12-month physical quality-of-life benefit (adjusted difference -0.22, 95% CI -1.47 to 1.03) and its authors do not recommend commissioning extended rehabilitation; frailty-targeted cardiovascular rehabilitation gained proximal function without mortality benefit at very low certainty; and home pulmonary rehabilitation fell short of the minimum clinically important difference on average. Restated: confirmed that multimodal exercise plus nutrition improves strength and physical performance in sarcopenia; remote delivery ranks highest for lean mass and physical performance with wide intervals, but remote or home delivery has not been shown to improve patient-centred outcomes. Disconfirmation condition: a head-to-head randomised trial of remote against supervised delivery showing inferiority on strength or function, or a patient-centred-outcome trial of remote multimodal exercise showing benefit (which would lift the qualification). 2026-10 · re-graded qualified, moderate confidence Combined exercise and nutrition improve strength and physical performance in people with sarcopenia. That this changes the course of frailty, or patient-valued outcomes, is not shown.
VF-P8	Structured identification and coding outperform usual identification practice Structured identification, screening and coding raise detection, assessment and documentation rates over usual practice. That they change patient outcomes is not shown. Moderate confidence Register's basis, before re-grading: Qualified: outperformance is evidenced at detection, case-finding and process level; evidence that it changes a patient outcome is not established The record, 3 entries 2026-07 · provisional A length-of-stay prediction tool outperformed standard frailty/functional scales in a single-cohort comparison (acute frailty); structured coding was associated with fourfold higher advance care plan completion and more deaths outside hospital than absent coding (palliative care); systematic depression/anxiety screening nearly tripled psychiatric diagnosis detection versus clinician-initiated referral alone (clinical psychology). Three domains, three independent evidence streams, one structural finding in the same reporting week. Caveats carried from the sources: the frailty leg is a single retrospective cohort (n=201) whose authors require multi-centre validation; the palliative leg is a single-site retrospective service evaluation (n=216); the psychology leg is a quasi-experimental pilot whose diagnostic-confirmation difference did not reach statistical significance — the detection gain stands, the confirmation rate awaits randomised testing. 2026-08 · established Promoted to established: this pattern has now been observed across two separate monthly cycles (July, August), with independent, verifiable evidence streams in each cycle, and no unaddressed contrary signal identified in either. This period's verifiable evidence comprises a reproducible case-finding rule identifying frequent-attender frail patients for proactive assessment, and a nationwide cohort finding that earlier specialist palliative referral in pancreatic cancer nearly halved end-of-life hospitalisation. This month's wider evidence flow (further studies in emergency-department-initiated palliative consultation, trauma-related missed diagnosis, and neurologist-led advance care planning, described in this month's Monthly review) is consistent with the pattern but is not counted toward this promotion, as no citable source for these specific studies was available to this register at the required evidential bar at time of writing. 2026-10 · qualified Qualified, narrowing stated. The register wording 'no contrary signal identified' no longer holds at outcome level. A Clinical Frailty Scale and a multidimensional index predicted mortality but neither predicted readmission; a digital geriatric assessment trigger agreed only modestly with clinician-led assessment (rho 0.38); a surgical verification programme raised assessment by 4.0 percentage points; and documentation gains in goals-of-care interventions did not reliably move utilisation. Restated: structured identification and coding outperform usual identification practice at detection, case-finding and process level (assessment, documentation, coding rates); evidence that they change a patient outcome is not established, and frailty tools predict mortality but not readmission. Disconfirmation condition: a controlled evaluation in which an identification or coding intervention changes readmission, time at home or place of death against usual identification; not met this month, the advanced-clinical-practitioner-led heart-failure model being uncontrolled. 2026-10 · re-graded qualified, moderate confidence Structured identification, screening and coding raise detection, assessment and documentation rates over usual practice. That they change patient outcomes is not shown.
VF-P12	Digital exclusion and carer capacity are the binding constraint on who benefits from remote and home-based care models Digital exclusion and reliance on unpaid carers recur as a constraint on who benefits from remote and home-based care, across several countries. Whether they are the binding constraint is untested. Moderate confidence Register's basis, before re-grading: Confirmed again this cycle, with a stated boundary case The record, 3 entries 2026-08 · provisional This publication's monthly deep-dive theme this period. The underlying observation was first described in this publication's 10 July weekly evidence coverage (four cross-country studies: housing instability and unemployment predicting psychiatric emergency re-presentation; carer education and resourcing predicting advance-care-plan completion; rural residence and lower socioeconomic status predicting 'burdensome' end-of-life care; US insurance status predicting OPAT-access-related length of stay and discharge-against-advice), but was not previously entered in this register. It enters now, on formal registration, as a new provisional pattern rather than being backdated, consistent with this register's append-only discipline. This month's evidence flow found the same mechanism recurring in narrowed form (a digital-exclusion caveat attached to nearly every remote-delivery evidence item) and in a new form (national professional guidance naming ambient voice technology's accuracy gap for diverse languages and accents as a direct equity risk, not yet linked to a citable named source at this register's evidential bar). Disconfirmation condition: a materially lower rate of structural-determinant (deprivation- or rurality-linked) findings across an equally wide domain and country spread in a subsequent monthly cycle would indicate this month's clustering was a source-selection artefact rather than a genuine pattern, and would qualify or discard it. 2026-09 · established Promoted to established: observed across two separate monthly cycles (August, September) with independent evidence streams in each, and no unaddressed contrary signal. This period's independent streams are a UK service evaluation of virtual wards in Cornwall (Consolidated Framework for Implementation Research), which found organisational trust and digital access -- not clinical suitability -- the binding constraint on uptake even where the technology functioned adequately, and a US research letter finding rural hospice patients receive less intensive, more unpaid-family-reliant support than urban patients. Both corroborate, independently of each other and of August's carer-resourcing evidence stream, that the populations a remote or home-based model is meant to reach most are the ones whose access and whose unpaid carers absorb the largest share of the resulting burden. 2026-10 · established Confirmed, with a boundary. In a Sydney virtual hospital, carers acted as extensions or substitutes for patients with low digital literacy, language barriers or reduced mobility; nursing-home telehealth interviews reported digital-literacy gaps and 'a bridge, not a replacement'; and 29% of telehealth-eligible patients took part in an NHS-based model. Boundary case: remote-monitoring use was highest in remote and rural regions of Australia and New Zealand, but those are passively transmitting implanted devices, which do not test digital exclusion. Disconfirmation condition (tested, not triggered): a materially lower rate of structural-determinant findings across an equally wide domain and country spread; a rural uptake gain for a non-passive, patient-operated technology would qualify the pattern. 2026-10 · re-graded qualified, moderate confidence Digital exclusion and reliance on unpaid carers recur as a constraint on who benefits from remote and home-based care, across several countries. Whether they are the binding constraint is untested.

Provisional 13

On the register, not yet tested across cycles.

ID	Pattern	Domains spanned	Trajectory
VF-P1 VAT Founding	Earlier specialist input → better outcomes Specialist geriatric assessment and care from the start of an acute hospital admission improve outcomes older people value, and long delays in an acute episode are linked to harm. That giving the same input sooner than it is already given helps has not been shown. Specialist care from the start of an admissionModerate confidenceLong delays harmLow confidenceMoving the same input earlierVery low confidence Register's basis, before re-grading: Confirmed at five independent system levels: clinical, operational, planning, parliamentary, and Board governance The record, 2 entries 2026-06 · established Clinical evidence (PMIDs 42100443, 41665982, 41562579, 42105048, 41911440, 42237014, 40260522, 41996930); operational (PRN02404; BSAC 2026 GPRs); planning (NHS operational planning 10% non-elective reduction mandate); parliamentary (PAC frailty inquiry); NHS England Board governance (Board Item 8, 4 June 2026). 2026-07 · established First boundary test published: the HERO trial (740 participants, 15 UK sites) found extended therapist-delivered home exercise AFTER discharge — input extended later, downstream of the acute episode — produced no quality-of-life benefit at 12 months despite high-fidelity delivery. Read as the pattern's boundary, not a contradiction: earlier specialist input is the claim; more input later is what HERO fails to support. The pattern's scope is correspondingly narrowed to timing, not volume, of specialist input. 2026-10 · re-graded provisional, very low confidence Specialist geriatric assessment and care from the start of an acute hospital admission improve outcomes older people value, and long delays in an acute episode are linked to harm. That giving the same input sooner than it is already given helps has not been shown.
VF-P2 Founding	Information infrastructure as clinical necessity Structured information entry, such as forecast discharge dates and digital frailty triggers, goes with process gains in single systems. That it is necessary for clinical outcomes is untested. Very low confidence Register's basis, before re-grading: Confirmed at the level of association; neither new source tests necessity as distinct from usefulness The record, 2 entries 2026-06 · established SPR legislation, NHS operational planning, NHS England Board Item 8 aligned. PAC found NHS England digital access priorities displaced frailty work. GP collective action on voluntary data-sharing unresolved. 2026-10 · established Confirmed at the level of association. Earlier entry of a medically-ready-for-discharge date was associated with fewer unnecessary bed days (112,930 visits, observational), and a digital assessment trigger reached 71% assessment within four days. Neither source tests necessity as distinct from usefulness. Disconfirmation condition: a comparable system shown to deliver equivalent outcomes without the infrastructure. 2026-10 · re-graded provisional, very low confidence Structured information entry, such as forecast discharge dates and digital frailty triggers, goes with process gains in single systems. That it is necessary for clinical outcomes is untested.
VF-P3 Founding	Community settings structurally underequipped UK palliative virtual wards depend largely on charitable funding. National reports, not yet read at source here, are consistent with community capacity shortfalls. Low confidence Register's basis, before re-grading: Confirmed again at service and national-audit level this cycle The record, 3 entries 2026-06 · established National scale: PAC data (17% vs 100% GP frailty assessment; 32 of 106 areas assessed fewer than 10% of patients aged 65+). OPAT preservation (PMID 41301668: frailty index stable, cognition improved 8.5%); clinical psychology (PMID 41681059: hospitalisation normalised within 2 years); palliative care (PMID 42072943: 89% preferred place of death with team continuity and family carer support). Preservation function currently unmeasured and uncommissioned. 2026-07 · established A community palliative care triage-tool audit, a qualitative account of community nursing's unrecognised injectable-medication workload, and a new research protocol targeting deprivation-linked palliative access inequity all located the binding constraint in workforce and system design rather than treatment availability. Corroborated at policy level: a new government community-services waiting-time target (80% within 18 weeks by 2028–29), and a national dataset now tracking, daily, patients held in clinically inappropriate acute settings for want of upstream community capacity. 2026-10 · established Confirmed. Three-quarters of 22 UK palliative virtual wards are charity-funded and two have closed; 29% of telehealth-eligible patients took part in an advanced-clinical-practitioner-led palliative heart-failure model; only 9 of 36 OPAT patient-education resources met quality criteria; and the National Audit Office reported a delayed-discharge cost of 2 billion pounds from August 2025 to April 2026 and an average of 2,241 patients in A&E corridors in a 24-hour snapshot in May 2026. Disconfirmation condition: a national community-capacity measure showing equipment and staffing at or above specification. 2026-10 · re-graded provisional, low confidence UK palliative virtual wards depend largely on charitable funding. National reports, not yet read at source here, are consistent with community capacity shortfalls.
VF-P4 Founding	Acute-designed shortcuts carry material risk in community settings Risk scores calibrated in hospital discriminate poorly or overestimate risk when used in home-based acute care (NEWS2 on virtual wards; Padua and IMPROVE in hospital at home). Whether this harms patients is not measured. Low confidence Register's basis, before re-grading: Confirmed by a single further study this cycle The record, 2 entries 2026-06 · established NEWS2 AUC 0.55 in OPAT setting (PMID 42048369); ceftriaxone OR 3.33 for 30-day mortality in MSSA-BSI vs antistaphylococcal penicillins (11 studies, n=2,568; PMID 42112603); TROMBODOM VTE risk overestimation in Hospital at Home (46–75% vs actual 1.2% incidence; PMID 42002440). No new evidence in June 2026 invocation. 2026-10 · established Confirmed, single study. A wearable vital-sign monitor that performed on wards lost data at home (oxygen-saturation availability 39%, respiratory-rate availability 46%; n=45, one centre). Disconfirmation condition: a prospective home comparison showing an acute-designed score or device performing at ward-level accuracy. 2026-10 · re-graded provisional, low confidence Risk scores calibrated in hospital discriminate poorly or overestimate risk when used in home-based acute care (NEWS2 on virtual wards; Padua and IMPROVE in hospital at home). Whether this harms patients is not measured.
VF-P6 Founding	Converging mandates for community AHP investment Several professional and national bodies endorse community allied health capacity. No funded investment matching the endorsements is evidenced. Low confidence Register's basis, before re-grading: Qualified: institutional endorsement by seven authorities is evidenced; funded investment matching those mandates is not The record, 2 entries 2026-06 · established Seven independent institutional authorities: parliamentary committee; CSP; GIRFT (£3.225m); NHS operational planning framework; RCOT CCDs; RCOT Care Act 2026 guidance update (2026 version supersedes 2016 guidance; statutory framework for OT practice in NHS and local authority settings). OT named essential in NHS England community service specifications. 2026-10 · qualified Qualified, narrowing stated. The title says investment; the evidence recorded is institutional endorsement by seven authorities. The one concrete national deliverable in the window, the allied health professions framework for 2027 to 2032, closed consultation on 18 September with no outcome published at 14 days (status as of 2 October 2026). No source this month evidences funded investment matching the mandates. Restated: seven independent institutional authorities mandate or endorse community AHP capacity; as of 2 October 2026 no measured funding or workforce commitment matching those mandates is evidenced, and the national framework consultation has published no outcome. Disconfirmation condition: a published, funded national AHP workforce commitment would lift the qualification; a framework that omits community AHP capacity would contest the pattern. 2026-10 · re-graded provisional, low confidence Several professional and national bodies endorse community allied health capacity. No funded investment matching the endorsements is evidenced.
VF-P7 Founding	Mandate-capacity tension National mandates for community and specialist care expand faster than the funding and workforce to deliver them. The supporting reports are named but not yet read at source. Low confidence Register's basis, before re-grading: Moved from a general risk to a named, specific allocation gap — a national training-post commitment landed alongside anticipated staffing reductions, continuing-care eligibility erosion, and a named specialty supply-pipeline constraint, with the allocation mechanism itself still unconstituted The record, 2 entries 2026-06 · established PAC: 50% budget cuts to local health planning bodies; NHS Alliance: 57% anticipating staffing reductions; King's Fund: Continuing Healthcare eligibility declined from 31% to 17% since 2017 against unchanged criteria; active patient transport cuts confirmed. BGS geriatric medicine training report (4 June 2026): first supply-side constraint on the CGA delivery mechanism named in this series. 2026-07 · established A resident doctors dispute resolved, committing 4,000–4,500 additional specialty training posts over three years. In the same window: a national survey found 57% of NHS organisations anticipating clinical staffing reductions in 2026/27; a professional body's training report named a supply-side constraint on the geriatric medicine pipeline specifically. Three weeks after acceptance, the distribution mechanism deciding allocation remains unconstituted, with no published criteria. 2026-10 · re-graded provisional, low confidence National mandates for community and specialist care expand faster than the funding and workforce to deliver them. The supporting reports are named but not yet read at source.
VF-P10	Identification-tooling as a capacity substitute Digital frailty triggers can make systematic identification feasible but agree only modestly with clinician assessment. Whether they substitute for specialist capacity is untested. Very low confidence Register's basis, before re-grading: Qualified: a structured digital assessment agreed only modestly with clinician-led assessment; partially externally evidenced, awaiting further corroboration The record, 3 entries 2026-07 · provisional When specialist time is the scarce resource, coding, screening and triage tools function as a capacity multiplier by allowing non-specialist staff to correctly route patients to the specialists who remain — but only if identification triggers continuous specialist relationship rather than becoming a documentation end-point in itself. 2026-08 · provisional Reconfirmed this period: a paramedic-delivered structured end-of-life conversation protocol is among the non-specialist-led protocols this month's evidence flow associates with outcome shifts of a scale usually associated with specialist input. This month's Monthly review also describes physiotherapist-delivered and neurologist-led protocols producing comparable shifts this period, but no citable source for these specific studies was available to this register at time of writing; status is therefore held at provisional pending fuller citation reconciliation, rather than promoted on partially-verified evidence. 2026-10 · qualified Qualified. A digitally triggered, FINDNEEDS-based comprehensive geriatric assessment correlated at rho 0.38 with clinician-led assessment in a retrospective one-hospital pilot (March to November 2025), so it routes patients but is not shown to substitute for the assessment. Disconfirmation condition: validation in which structured digital assessment agrees closely with clinician-led assessment and is shown to release specialist capacity would lift the qualification. 2026-10 · re-graded provisional, very low confidence Digital frailty triggers can make systematic identification feasible but agree only modestly with clinician assessment. Whether they substitute for specialist capacity is untested.
VF-P13	Structural and measurement fidelity at the point of handover, not the underlying clinical evidence, is the binding constraint on delivered benefit Frailty measurement and coordination are applied and reported inconsistently across acute and admission-avoidance pathways. Whether this, rather than evidence or capacity, limits benefit is untested. Inconsistent in UK acute admissionsLow confidenceInconsistent in admission avoidanceVery low confidence Register's basis, before re-grading: Provisional: observed in two monthly cycles (September, October) with new evidence at process level only; eligible for promotion consideration on narrowed wording but not promoted this cycle The record, 2 entries 2026-09 · provisional First formal register entry. A 15-model international scoping review found only 4 of 15 Hospital-at-Home admission-avoidance models used a validated frailty measure at all; a retrospective cohort of 8,113 emergency-department attendances found that embedding comprehensive geriatric assessment at first contact, rather than after an admission decision, converted 63% of encounters to home discharge with support; a UK ethnographic study found dysphagia care processes on an acute stroke ward varied by ward resourcing and staff knowledge rather than by clinical-evidence uncertainty; and this cycle's own meta-analysis of 57 cohort studies confirms frailty status independently predicts functional decline, mortality and readmission, strengthening the case that consistent measurement, not model choice, is what makes an at-risk patient visible. Tracked qualitatively across six consecutive weekly evidence issues before this register entry; entering now, on formal registration, consistent with this register's append-only discipline of not backdating prior tracking. Disconfirmation condition: a national or large-system virtual-ward or admission-avoidance specification that requires and enforces validated frailty or outcome measurement, subsequently shown to deliver benefit tracking model choice rather than measurement or coordination discipline, would qualify or discard this pattern. 2026-10 · provisional Second monthly cycle. A digital frailty-triggered assessment system (71% assessed within four days, rho 0.38 with clinician assessment), emergency department frailty tools that predicted mortality but not readmission, and a surgical verification programme (assessment +4.0 percentage points) each evidence fidelity and coordination as the constraint at process level only. The register's two-cycle rule is met; promotion would need to be stated on narrowed wording and is not made this cycle. 2026-10 · re-graded provisional, very low confidence Frailty measurement and coordination are applied and reported inconsistently across acute and admission-avoidance pathways. Whether this, rather than evidence or capacity, limits benefit is untested.
VF-P14	Real-world remote patient monitoring can redistribute rather than reduce clinical workload, without a matching outcome gain In heart-failure and cardiac-device remote monitoring, workload shifts to nurses, physiologists and carers without a measured outcome gain. Net workload is unmeasured. Low confidence Register's basis, before re-grading: Provisional: a second and third source add workload landing sites (alert desks, carers) but net workload remains unmeasured; stays provisional The record, 2 entries 2026-09 · provisional New this period. A retrospective real-world comparison of two Dutch hospitals in the same regional care network found remote patient management for heart failure significantly increased nurse-practitioner consultation frequency and duration compared with usual care at both a matched and an unmatched comparator hospital, with no significant difference in cardiologist consultation time or heart-failure-related readmissions. Disconfirmation condition: a second real-world (non-trial) comparison, in another condition or country, showing remote monitoring reduces or does not increase clinical contact time, would qualify or discard this pattern. 2026-10 · provisional Extended and partly qualified. A Dutch comparison (nurse-practitioner consultations 15.3 against 5.3 per patient, consultation time 233 against 121 minutes, readmissions unchanged; n=131) is joined by Australian and New Zealand device clinics spending 30.2% of workload on alert management (90.5% by cardiac physiologists) and a Sydney virtual hospital in which carers took technical roles. The Australia and New Zealand data also show remotely monitored patients attending in person less often (10.0 against 7.2 months), so the net effect on workload is unmeasured; this is a shift of contact, not a measured net increase. Disconfirmation condition: a comparative study showing remote monitoring lowers total clinical contact time once alert handling is counted, in a condition other than heart failure or cardiac devices, would qualify or discard this pattern. 2026-10 · re-graded provisional, low confidence In heart-failure and cardiac-device remote monitoring, workload shifts to nurses, physiologists and carers without a measured outcome gain. Net workload is unmeasured.
VF-P15	A capacity or equity safeguard is identified with precision and then left unbuilt A capacity or equity safeguard is identified precisely and then left unbuilt. This is the publication's own inference, and no source tests it. Very low confidence Register's basis, before re-grading: Provisional: the publication's own inference, evidenced by a third consecutive month naming a distinct mechanism (workforce distribution in July; AI-tool equity risk in August; carer and community-nursing capacity in September) with no corresponding commissioning or funding gate; per this register's grading discipline for self-referential convergences, not yet externally confirmed and not promotable by further restatement alone The record, 1 entry 2026-09 · provisional First formal register entry. The same institutional sequencing choice has now recurred across three consecutive monthly reviews under three different mechanisms: a workforce-distribution criterion left unconstituted while a training-post headline proceeded (July); an AI documentation tool's equity risk named in guidance but attached to no pre-deployment gate (August); and, this month, a caregiver- and community-nursing-capacity requirement identified independently across a UK implementation evaluation and a US national dataset, attached to no funding mandate in any source read for this edition. As a self-referential, publication-level inference rather than an externally sourced finding, this enters provisional per this register's grading discipline and cannot be promoted by further restatement of the same observation -- only by external evidence (a national commissioning specification that builds the safeguard, or a system shown to fail for lack of it) or by events. Disconfirmation condition: a national commissioning specification that explicitly requires and funds the safeguard it has previously only named would disconfirm this pattern as an ongoing habit. 2026-10 · re-graded provisional, very low confidence A capacity or equity safeguard is identified precisely and then left unbuilt. This is the publication's own inference, and no source tests it.
VF-P16	Process measures move; patient-outcome measures are flat, untested or unmeasured In a cluster of recent process and identification interventions, process measures improved while patient outcomes were mixed or unmeasured. Low confidence Register's basis, before re-grading: Provisional: the publication's own inference, drawn from eight evidence streams across five domains in one monthly cycle; not yet externally confirmed and not promotable by restatement The record, 1 entry 2026-10 · provisional New this month. Across weeks from 11 September to 2 October, the measures a protocol, structure or device can move did move, while patient-outcome measures were flat, untested or unmeasured: emergency department frailty tools predicted 30- and 90-day mortality but not readmission (n=402); frailty status and hospitalisation within triage categories (3,127 visits) had a non-significant global interaction; a digital frailty-triggered geriatric assessment system reached assessment within four days in 71% with no patient outcome measured and modest agreement with clinician-led assessment (rho 0.38); frailty-targeted cardiovascular rehabilitation improved proximal function without a mortality benefit at very low certainty; home pulmonary rehabilitation fell short of the minimum clinically important difference on average; ReSPECT and DNACPR documentation rose from 2.55% to 5.57% in an uncontrolled report; a 41-trial review found goals-of-care interventions raise documentation without reliably changing utilisation; and a geriatric surgery verification programme raised vulnerability assessment by 4.0 percentage points across 20 hospitals. Each is individually honest about its limits; the shape is visible only when they are read together. Self-referential cross-domain inference, so it enters provisional and cannot be promoted by restatement. Disconfirmation condition: a controlled evaluation in which a process or identification intervention changes readmission, time at home or place of death against usual practice, across more than one domain. 2026-10 · re-graded provisional, low confidence In a cluster of recent process and identification interventions, process measures improved while patient outcomes were mixed or unmeasured.
VF-P17	Remote and virtual care reaches dispersed populations where the model is built around the distance problem, and loses reliability where a ward-validated device is sent home Telehealth built as a hybrid, locally anchored service can reduce travel and keep access local for rural populations. Device reliability at home is a separate question. Low confidence Register's basis, before re-grading: Provisional: four sources in one monthly cycle (a hub-and-spoke inpatient model, a national device-clinic survey, a single-centre wearable study and a rural telehealth scoping review); awaits a second cycle before promotion consideration The record, 1 entry 2026-10 · provisional New this month. A Quebec hub-and-spoke virtual inpatient unit preserved 786 hospitalisation-days with no on-site registered nurses; remote-monitoring use was highest in remote (88.4%) and rural (85.3%) regions of Australia and New Zealand against metropolitan regions (80.3%), though those are passively transmitting implanted devices; a wearable vital-sign monitor validated on wards had oxygen-saturation availability of 48% in hospital and 39% at home (n=45, one centre); and a rural telehealth scoping review points to hybrid, locally anchored access with low confidence in durable emergency department use reduction. Disconfirmation condition: a patient-operated, non-passive remote technology showing lower reach in remote and rural populations than metropolitan ones would qualify the 'designed around distance' reading. 2026-10 · re-graded provisional, low confidence Telehealth built as a hybrid, locally anchored service can reduce travel and keep access local for rural populations. Device reliability at home is a separate question.
VF-P18	Social and material disadvantage lengthens time in the system and lowers recovery In non-UK cohorts, homelessness goes with far more delayed-discharge designation, and greater social need with lower rehabilitation function. A UK deprivation gradient is untested. Low confidence Register's basis, before re-grading: Provisional: two independent non-UK cohorts in one monthly cycle (Ontario administrative data and a US physiotherapy cohort), neither testing a UK deprivation gradient; awaits a second cycle and UK evidence The record, 1 entry 2026-10 · provisional New this month. In Ontario, recent homelessness carried an alternate-level-of-care designation in 9.1% against 2.0% of matched patients from the most materially deprived neighbourhoods (rate ratio 4.51; 51,377 patients); in a US prospective physiotherapy cohort, greater social-need burden independently lowered discharge function (B=-2.35; n=164, with attrition). Both are non-UK. Rural hospice disparities already recorded under VF-P12 bear on the same observation. Disconfirmation condition: a UK analysis of delayed discharge or rehabilitation outcome showing no deprivation gradient after case-mix adjustment would qualify or discard this pattern. 2026-10 · re-graded provisional, low confidence In non-UK cohorts, homelessness goes with far more delayed-discharge designation, and greater social need with lower rehabilitation function. A UK deprivation gradient is untested.

Discarded 2

Failed, with the reason given. Kept on the register.

ID	Pattern	Domains spanned	Trajectory
VF-P9	Process and regulatory simplification as a capacity-recovery lever distinct from headcount expansion Process and regulatory simplification as a capacity lever distinct from headcount: no external source tests it. Very low confidence Register's basis, before re-grading: Treated as a pattern rather than a single signal because it spans two structurally distinct mechanisms converging on the same claim The record, 1 entry 2026-07 · provisional Two signals converge without being connected in any source: abolition of a long-standing legal test for deprivation-of-liberty assessment (freeing assessor/clinical time), and continuing evidence that antimicrobial stewardship and oral-switch protocols recover clinician and bed-day capacity without new headcount. 2026-10 · re-graded discarded, very low confidence Process and regulatory simplification as a capacity lever distinct from headcount: no external source tests it.
VF-P11	Process-simplification-as-capacity-lever meets the international benchmark Process simplification meeting the international benchmark: no fitting source survives. Very low confidence Register's basis, before re-grading: UK process-simplification evidence read against international standing-capacity-planning governance (VF-Synthesis); the international leg is cited, the convergence is the publication's own The record, 1 entry 2026-07 · provisional Several of the best-performing comparator systems treat workforce capacity as a function of how demand and process are structured, not solely of headcount — visible in this month's UK evidence (deprivation-of-liberty reform; stewardship-driven capacity recovery) and in international evidence (a comparator system's independent, standing capacity-planning function, which models demand rather than responding to headline settlements). No UK source names the international parallel directly. 2026-10 · re-graded discarded, very low confidence Process simplification meeting the international benchmark: no fitting source survives.