1. An integrated approach to injury prevention in Hertfordshire Raymond Jankowski Deputy Director of Public Health Hertfordshire County Council

4. Falls prevention in older people

5. Falls - Nationally 33% of people over 65 years and 50% of those over 85 years old fall Costs estimated £2.2B per annum…….and Rising No1 Serious incident in hospitals No1 precipitating factor for long-term care

6. Falls – Hertfordshire No.1 reason for 999 ambulance calls in Hertfordshire (22%) Cost £40-50M per annum in Hertfordshire Hip fracture rate in Watford worst in England in 2009/10 Hip fractures and falls admissions rising 180 X variation in 999 calls from care homes

7. In Hertfordshire, falls in one year….. Estimated 60,000 falls in > 65 year olds 22,000 emergency ambulance calls 5,100 emergency admissions 1,194 hip fractures 45-50 deaths

9. Forum of Fractures Falls Fragility Whole system for population of 1.1M Prevention in the community through to acute care Many stakeholders

10. Objective 1: Improve outcomes and improve efficiency of care after hip fractures – by following the 6 “Blue Book” standards Hip fracture patients Objective 2: Respond to the first fracture, prevent the second – through Fracture Liaison Services in acute and primary care Non-hip fragility fracture patients Objective 3: Early intervention to restore independence – through falls care pathway linking acute and urgent care services to secondary falls prevention Individuals at high risk of 1 st fragility fracture or other injurious falls Objective 4: Prevent frailty, preserve bone health, reduce accidents – through preserving physical activity, healthy lifestyles and reducing environmental hazards Older people NSF, TA161, CG21, Blue Book & NHFD NSF, TA161, CG21 & Blue Book NSF, TA160 & CG21 NSF, LTC programmes Social care DH Systematic approach to falls and fracture care & prevention: four key objectives

11. 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.

12. Source: DWP

13. Some of the key components of falls fracture and fragilities in Hertfordshire Community Falls Liaison service Community pharmacy medication reviews Community safety service Falls car (National Health and Social care award 2010) 2 Fracture and Falls Liaison nurses (in acute sector) Use of DH best tariff Multidisciplinary assessments and interventions Raising awareness in the wider community

14. Key factors in success Clear strategy based on evidence and cost effectiveness Using commissioning opportunities Team work Business plan Innovation with Evaluation Willingness to review and adapt Leadership beyond authority

16. Percentage of class participants reporting >= 3 point increase in balance, functional capacity and confidence May 2012 - June 2013

17. “A follow on course would be very helpful.” Respondents’ comments after attending exercise class “Brilliant! Thank you.” “Gave me confidence.” “Gave me confidence in all ways. Course was run with humour, friendliness and inspired confidence.” “I wish the course was longer.” “I found this class fantastic, exciting, helpful and a follow-on class would be great and helpful.” “Very happy with the whole experience and personally believe that every senior would benefit from this.” “I haven’t fallen since I have started the course and cannot thank you enough for helping.”

18. Objective 1: Improve outcomes and improve efficiency of care after hip fractures – by following the 6 “Blue Book” standards Hip fracture patients Objective 2: Respond to the first fracture, prevent the second – through Fracture Liaison Services in acute and primary care Non-hip fragility fracture patients Objective 3: Early intervention to restore independence – through falls care pathway linking acute and urgent care services to secondary falls prevention Individuals at high risk of 1 st fragility fracture or other injurious falls Objective 4: Prevent frailty, preserve bone health, reduce accidents – through preserving physical activity, healthy lifestyles and reducing environmental hazards Older people DH Systematic approach to falls and fracture care & prevention: four key objectives Promote physical activity in people aged 40 years and older

19. Health and Wellbeing Strategy: Life Course in Hertfordshire * From pre-conception Starting well Up to 5 yrs* Developing well 5-18 yrs Living well 18yrs+ Working wellAging well 65 years+