1. Where Does Cornwall Go From Here
Non-Injury FALLS
Where Does Cornwall Go From Here

2. SWASFT falls training to Domiciliary Care Providers
Expensive – non discounted is £45 per half day - £95 per full day per candidate – only 100 discounted places at half normal cost Not pitched to one group – is offered to carers, manual handling trainers and managers Morning – death by powerpoint reiterating much of what is already on their website e.g. flow charts Afternoon – covered the use of a lifting cushion and mechanical lifting chair. Both very expensive and not available on lease. Four very basic role play scenarios Trainer not a Moving and Handling trainer or H&S trainer Managers were present at the training I was at and felt it was knowledge they already had Felt that they required more structured specific hands on training in assessing for injury And on risk assessing with moving and handling a person after a fall to assist up

3. Effect of Falls
A third of people over 65, and half of people over 80, fall at least once a year. Falls are the most common cause of death from injury in the over 65s and cost the NHS over £2bn a year and over 4 million bed days. Nearly 9 million, or one in six people in the population in England was 65 or over at the time of the last census, and the figure is forecast to rise by another 2 millionby 2021.[Public Health Matters [Gov.uk]

4. What Happens in Cornwall
Call to Ambulance Service – non-injury calls are relegated as low priority
Delayed responses can exacerbate these injuries and present secondary negative impacts for a patient
Avoiding unnecessary conveyance to hospital helps to avoid unnecessary admissions
These calls may come from:-
Health and Social Care professionals on finding the client on the floor
Care Agencies
LifeLine Companies
Nursing and Residential Care Homes
Family
Members of the Public
Often there is no further referral on or assessment of cause and prevention
This means falls will make up an even greater proportion of calls made to the ambulance service, placing a greater strain on frontline resources and staff. In addition to this, obesity levels in the UK are increasing

5. National Institute for Health and Care Excellence [NICE]
Guidelines from the National Institute for Health and Care Excellence (NICE) highlight interventions that are likely to be beneficial. They include a programme of muscle strengthening and balance training, as well as a comprehensive risk assessment that includes for example: a medication review, assessment of hazards in the home, assessment of visual impairment
Also –
Commissioners need to consider the benefits and impact of falls prevention interventions and how to integrate these with other commissioning decisions (across acute hospital, community and social care sectors)

6. Discussion
SWASFT say they are not commissioned to deal with non-injury falls [Neither are Domiciliary Care providers] Much has been implied about the Social Care sectors role in assessing and picking up these people when already in their care. What about the people not receiving care ! Neither SWASFT nor the Social Care sector are able to take forward the further referral on or full assessment of cause and prevention The impact that this has on the Ambulance Services, the A&E services and admission to hospital can be far reaching Why admit – should only be if there is an injury caused by the fall that requires emergency assessment and treatment or the fall was due to a condition that requires assessment in an emergency/inpatient department Very often this is not the case- people can also be admitted because of concern over their social welfare which may be remedied without admission Why does this happen – because there is no back up service in the Community

7. Domiciliary Care
Big push by SWASFT for the sector to assess and lift non-injury falls The expectation is that the sector will deal with non-injury falls !!!! Problem with this is – Staff not trained sufficiently to make safe assessments on injury or possible health reason for fall Lifting equipment not available in community No full assessment can be made of cause and for prevention Problems with insurance cover for staff who are not perceived to have suitable training – H&S issue Training offered by SWASFT – expensive – only 100 places offered at reduced rate to the sector Big Problem for the sector - NOBODY SEEMS TO BE LISTENING

8. Training Required !
Training offered by SWASFT is insufficient to cover employers for Health and Safety. In the training :- SWASFT suggest that providers need to have provided First Aid at Work courses for staff which they suggest enables them to make safe judgements on injury - very often these courses are 3 day courses that providers would not be able to send care staff to, SWASFT suggest that it is providers responsibility to provide equipment for the lifting of the person – the equipment has to be got to the person and the carer expense of another carer going to the person , mileage, time and availability this equipment costs between £2000-£4000,

9. What works in other areas of the Country ?
Connecting Care Hubs Urgent Falls Response Teams Programmes of muscle strengthening and balance training [ eg:- iCareIMove] both at home and in the Community to also help to alleviate social isolation Back up Domiciliary Care team to support the person at home if fall was caused by treatable infection or condition that can be managed at home with extra support ‘Employing a dedicated falls team was considered more economical than providing specialist falls training and equipment to all ambulance crews in Northamptonshire’ [NICE Case Study] East Midlands Ambulance Service. NHS evidence

10. What does the Domiciliary Care sector feel Cornwall should do now !!!
Looking at NICE guidelines again it states – Commissioners need to consider the benefits and impact of falls prevention interventions and how to integrate these with other commissioning decisions (across acute hospital, community and social care sectors There needs to be round table discussions with- The Social Care providers for Domiciliary Care as well as Nursing/Residential Homes Social and Health Care Commissioners SWASFT Occupational and Physiotherapy Team

11. Outcomes need to be defined !
These should include
Relieving the need for Emergency Ambulances to attend non-injury falls leaving more capacity for emergency calls
Relieving the need for admission to A&E unless there is an injury caused by the fall that requires emergency assessment and treatment or the fall was due to a condition that requires assessment in an emergency/inpatient department – thereby relieving pressures on these departments, also could prevent further admissions from serious injury.
Ensuring that the population of Cornwall receive a service that assesses , lifts in a safe manner, is able to assess cause and promote prevention both by practical solutions, and by referral on suitable options for prevention either in the community or to suitable departments
Ensuring that frequent fallers are identified and preventative actions put in place to try to prevent re-occurrence

12. Funding ??
Consider the Better Care Fund One of the requirements of the funding is that there is :- Agreement for the delivery of 7-day services across health and social care to prevent unnecessary non-elective (physical and mental health) admissions to acute settings and to facilitate transfer to alternative care settings when clinically appropriate. To prevent unnecessary non-elective admissions (physical and mental health) through provision of an agreed level of infrastructure across out of hospital services 7 days a week; The Better Care Fund is the only mandatory policy to facilitate integration. It brings together health and social care funding, with a major injection of social care money announced at Spring Budget Beyond this, areas have flexibility in how the Fund is spent over health, care and housing schemes or services, but need to agree how this spending will improve performance in the following four metrics: Delayed transfers of care; Non-elective admissions (General and Acute); Admissions to residential and care homes; and Effectiveness of reablement.