Earlier specialist input → better outcomes

The longitudinal record

1. 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).

2. 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.

   Evidence PMID 41557460Extended home exercise after acute admission does not improve quality of life in older people with frailty, HERO trial finds