1. www.hertsdirect.org FALLS PREVENTION HERTFORDSHIRE Barry Fearon Senior Commissioning Manager Community Support Health and Community Services

2. www.hertsdirect.org CONTENT Falls Data What is being done –Promotion of Falls Prevention –Care Homes –Falls Project –Herts Home Safety Service –Telecare –Pilot work with North Herts Care Line Falls Liaison Service

3. www.hertsdirect.org FALLS DATA Falls in the over 65’s In Herts cost between £40 - £50 million 1/3 of people over 65’s will fall once a year 15% to 33% of falls are preventable = £2.5 million Savings at 15% In Herts 45 to 50 deaths per year resulting from falls in Herts Over 65’s will increase by 10% by 2015 49% by 2030

4. www.hertsdirect.org PROMOTION OF FALLS PREVENTION Falls Campaign

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6. PROMOTION OF FALLS PREVENTION Falls Campaign Self assessment

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8. PROMOTION OF FALLS PREVENTION Falls Campaign Self assessment Day Centres Hertfordshire Community Equipment Service (HES) Talks to groups as requested Links to Public Health Forum of Fractures Falls and Fragility

9. www.hertsdirect.org CARE HOMES / HOME CARE Contract Management Monitoring –Activities offered –Safe use of medication –Monitor falls –Monitor complaints for reference to falls –Report accidents to Care Quality Commission Range of training offered in partnership with HCPA

10. www.hertsdirect.org FALLS PROJECT Emergency Care Practitioner & Social Worker Overview Joint funded project – Health & Community Services and East of England Ambulance Service NHS Trust First of its kind in the country Service is accessed by 999 call Social Worker assess older persons need and establishes ongoing support required to help them remain independent – equipment - telecare

11. www.hertsdirect.org FALLS PROJECT Aim of Project Report in 2009 – a fifth of all 999 calls to the ambulance service was a result of someone falling at home Circa 70% were for older people Prevent further falls Reduce repeat 999 calls Reduce the number of people admitted to hospital following a fall

12. www.hertsdirect.org FALLS PROJECT Data – West Herts –O–Operational between 8:00am and 4:00 pm –4–448 operational days –S–Successful preventions to hospital – 1,112 (82.74%) –P–Patients taken to hospital – 231 95 fractures 136 acute medical / serious injury

13. www.hertsdirect.org HERTS HOME SAFETY SERVICE Service is for vulnerable people Home Security Fire Safety Falls Prevention Joint funded by Community Safety / Community Support Service Provided by -

14. www.hertsdirect.org HERTS HOME SAFETY SERVICE Work Carried Out Home Security – advice, fitting window locks Fire Safety – checks / advice, fitting smoke alarms Falls Prevention Advice Fitting grab rails Replacing light bulbs Clearing trailing wires Marking edges of steps Clearing pathways of potential hazards

15. www.hertsdirect.org TELECARE Telecare is a service that enables people, especially older and vulnerable people, to live independently in their own home. It is a way of enabling them to call for assistance, at any time of the day or night. Depending on the equipment installed, it may also be able to summon help automatically when sensors in the home are triggered by unusual behaviour patterns, or lack of them.

16. www.hertsdirect.org May be a weekly charge for the lifeline connecting to call centre (£2 - £4 per week) All sensors are provided free under FACS Carer linked telecare – no charge under FACS Telecare can be accessed privately TELECARE

17. www.hertsdirect.org PILOT WITH North Herts Care Line (NHCL) NHCL – respond to lifeline/telecare alerts Calls data is recorded and falls Use data as early prevention Currently with Legal and Data Protection Links to Falls Liaison Service

18. www.hertsdirect.org FALLS LIAISON SERVICE, NHS HERTFORDSHIRE Introduced in October 2011. It was recognised that whilst there were some great services across the county there was a lack of knowledge of what was available. The idea of a Falls Liaison Service introduced a vision of a single point of contact for both healthcare professionals and patients to support them in falls prevention and intervention..

19. www.hertsdirect.org FOCUS Middle tier of non-hip fragility fracture patients and individuals at high risk of 1 st fragility fracture or other injurious falls Creation of cohesive links between existing falls prevention services in acute, secondary and primary care setting to deliver Government agenda for falls in the elderly.

20. www.hertsdirect.org PRIMARY OBJECTIVES Primary objectives –prevent further falls, and the injuries and loss of independence that are often associated with them. –identify people at risk of a first or subsequent fragility fracture, –assess individuals’ risks and establish appropriate interventions to significantly reduce their risks. To be achieved through integrated working links between the East of England Ambulance Service, acute trusts, primary and secondary health care teams and the health and social care teams across Hertfordshire.

21. www.hertsdirect.org KEY TARGETS To reduce fractured Neck of Femur by 10% by 31st March 2013. To reduce hospital admissions for falls by 10% by 31st March 2013. To reduce 999 calls for falls by 10% by 31st March 2013. To contact all patients referred to Service within 7 days of referral. To operate a series of postural stability related programmes with at least 60% uptake To achieve gross savings on 2012/13 targets of circa £2.5m.

22. www.hertsdirect.org CURRENT SERVICE PROVISION 1. Two exercise programmes provided in partnership working with Herts Sports Partnership. i.The OTAGO accredited Strength and Balance Programme – in progress 16 week programme, which runs 5 blocks per year, each block overlapping by 8 weeks to reduce patient waiting time onto a programme. Programme accredited by OTAGO Programme led by qualified OTAGO strength and balance trained instructors. ii.Chair Based Exercise Classes to support and complement Strength and Stability programme have recently been introduced and will commence on 6 th July 2012

23. www.hertsdirect.org Both OTAGO and Chair Based Programmes are hour long sessions followed by complimentary Tea, Coffee and Biscuits and are facilitated by Hertfordshire Sports Partnership. Provision available to provide free or subsided transport for patients that meet certain criteria. –Lack of transport –No family member or friend to transport to venue –Living in outpost area Both exercise classes are commissioned across Hertfordshire in each of the 10 localities

24. www.hertsdirect.org 2. Coordination of falls prevention intervention for patients with more complex needs –This comprises evaluating the patient in the home, looking at what their health, social and wellbeing needs may be and making the appropriate referrals to those services tailored to patient’s individual need. –If further clinical intervention is required it is always discussed with the patients GP first.

25. www.hertsdirect.org 3. In addition to our core services we signpost both healthcare professionals and patients to other services in Hertfordshire depending on their need. This may include Adult Care Services, Home Safety Services, Telecare or physical activity classes such as Tai Chi and Yoga amongst others things “our vision is to provide a robust, innovative and comprehensive service with quality and patient care at the very forefront.”

26. www.hertsdirect.org PROGRESS SO FAR New referral form and pathway developed and implemented. This has been disseminated electronically to all GP’s and health teams in the locality. The referral form is system one compatible and work is in progress to code it for EMIS. Meetings with GP practices to create awareness of referral documentation and referral pathway commenced; to continue through July/September 2012. Work is in progress to develop a database for use and to be shared by the PCT, Acute Trust and other health professionals concerned with prevention of falls and falls management.

27. www.hertsdirect.org 2 WTE Falls Coordinator posts in the E&N Herts and WHHT Acute Trust hospitals funded by PCT; one based at the Lister and the other at Watford General. The post holder will work closely with the Clinical lead and falls coordinator of the falls liaison service and other community teams to support the achievement of the key targets of the service. Recruitment is due to commence shortly.

28. www.hertsdirect.org 100% of all patients referred to the service receive their first level contact assessment within the 7 day timeline. Second level assessment is undertaken for patients with complex issues who fail the first level assessment process. Following this assessment they are referred to the appropriate service for the required intervention after discussion with their GP. Approximately 90% of patients with complex issues have received second level assessments to date. Work is in progress to complete the remaining 10% by the end of July 2012.

29. www.hertsdirect.org 4 falls prevention awareness building sessions have been held in Watford for the Asian community. The activity booklet for the exercise programmes and the falls brochure have been translated into 4 languages namely; Guajarati, Hindi, Urdu and Punjabi for this cohort of service users. The Falls brochure has been amended to make it more culturally sensitive to the ethnic minority population in Hertfordshire.

30. www.hertsdirect.org WHERE DO WE GO FROM HERE? LAUNCH OF FALLS LIAISON SERVICE – JULY 18 th 2012, FEILDER CENTRE! CONSOLIDATION SERVICE DEVELOPMENT MORE JOINED UP WORKING AND YET MORE SERVICE DEVELOPMENT!