1. www.shropscommunityhealth.nhs.uk Current Situation for Shropshire Falls Services/ Pathway Sandy Lockwood SCHT Falls Prevention Service Team Lead Whole System Approach to Falls Prevention Workshop 2 nd Sept 2014

2. www.shropscommunityhealth.nhs.uk History of Specialist Falls Service Pre 2005 ad hoc falls prevention work around County 2005 Falls prevention Pilot in South Shropshire 2007 Draft care pathway and service spec for delivering a Falls Prevention Service within Shropshire County 2009 Team Lead appointed to FPS

3. www.shropscommunityhealth.nhs.uk Specialist Falls Service What is it? MDT – 4.8 x wte covering whole of Shropshire SPR Accept referrals from anyone including self referrals Standardized screening, Ax, documentation, treatment Falls prevention programmes across Shropshire County Exercise delivery (PSI and Otago) Facilitate discussion group to make lifestyle changes, peer support Outcome data collection Specialist Falls Prevention Resource for County, Patient information leaflets, website Mandatory falls training for SCHT Falls awareness training for other organisations / older people groups LHE wide Falls Champion Forum / Falls Task Finish Group

4. www.shropscommunityhealth.nhs.uk We need help Preventing Falls is everyone’s responsibility What is the basic aim? To be proactive – Make every contact count To reduce the number of falls - community, hospitals, care homes To reduce the number of fractures To reduce the consequences of falls and fractures To use strategies researched to save lives and be cost effective To implement a coordinated approach across Shropshire

5. www.shropscommunityhealth.nhs.uk Coordinated Approach What do we have now that follows best evidence based practice? Can we optimize what we have ? Can we do things differently ? Can we identify gaps that we have in achieving best evidence based practice? Do we know how big the problem is in Shropshire?

6. www.shropscommunityhealth.nhs.uk Best evidence to prevent falls What should we be doing? Identify patients over 65 who have fallen / at risk of falling What are we doing ? Who’s doing it Level 1: Falls risk screening and referral form - Community Level 1: Falls pathway Falls and injury risk screening and management plan - Hospitals Care Homes – no standardised screening

7. www.shropscommunityhealth.nhs.uk

8. Best evidence to prevent falls What should we be doing? Identify patients requiring focussed medical assessment What are we doing ? Who’s doing it Level 1 identifies patient and shows pathway to: DAARTs in Shrewsbury, Oswestry, Bridgnorth Locality GPs where no DAART available Consultant in specialist services as appropriate

9. www.shropscommunityhealth.nhs.uk Best evidence to prevent falls What should we be doing? Assess falls risk factors in patients who have fallen / at risk of falling including physio led gait and balance assessment using validated outcome measures What are we doing ? Who’s doing it Level 2: standardised mutifactorial falls and fracture risk assessment (MFFRA) SCHT nurse/ therapists in IDTs, DAARTs, FPS Falls and injury risk screening and management plan - Hospitals Care Homes – no standardised Ax SCSWIS package available on SPIC website

10. www.shropscommunityhealth.nhs.uk Best evidence to prevent falls What should we be doing? Assess risk of fragility fracture in those who have fallen / at risk of falling What are we doing ? Who’s doing it FRAX ( Fracture Risk Assessment Tool) included in Level 2 MFFRA Physios Geriatricians GPs QOF register for those with fragility fracture Trauma nurse PRH reviews bone health of hip fracture patients RJAH dexa scans, Bone Health dept / consultant NOS

11. www.shropscommunityhealth.nhs.uk Best evidence to prevent falls What should we be doing? Action interventions identified to reduce individuals falls risk factors What are we doing ? Who’s doing it Community, Hospitals – health related with onward referrals to appropriate services memory service, dementia support workers, podiatry, vision, hearing services, continence, voluntary agencies, social services, handy person groups, fire services etc. Opportunistic low level interventions by individuals in contact with older people Hospitals / Care homes – action interventions to keep safe in that setting

12. www.shropscommunityhealth.nhs.uk Interventions proven to reduce risk What should we be doing? Home environment assessment in those that have fallen in previous year- OT led What are we doing ? Who’s doing it Home environment checks done by wide range of agencies including OTs FCF – OT members developed locally validated Home Safety Check booklet – available for use by all (SCHT website)

13. www.shropscommunityhealth.nhs.uk Interventions proven to reduce risk What should we be doing? Falls specific Medication review for those patients on 4 or meds What are we doing ? Who’s doing it Falls Medication review completed by clinical pharmacist on all hospital admissions Practice based clinical pharmacist / GP review those highlighted as high risk of falls in community Care Home – variable frequency?

14. www.shropscommunityhealth.nhs.uk Interventions proven to reduce risk What should we be doing? Deliver evidence based postural stability falls prevention exercise programmes Prevent “long lie” scenarios by training how to get up or by alarm technology What are we doing ? Who’s doing it FPS deliver 9x evidence based 13 week postural stability falls prevention programmes in 7 localities across Shropshire / 1:1 at home where appropriate Transport offered for those unable to access independently – NSL service IDT therapy deliver 1:1 Otago for very frail

15. www.shropscommunityhealth.nhs.uk Interventions proven to reduce risk What should we be doing? Provide ongoing exercise by suitably trained instructors Falls exercise pathway What are we doing ? Who’s doing it Variety of private community exercise classes available Extend, ( supported by Community Council Shropshire), some Otago trained, Walking for Health, leisure centres, exercise on prescription, Active 4Health but only one PSI instructor to maintain/ build on benefits gained from FPS

16. www.shropscommunityhealth.nhs.uk Best evidence to prevent falls What should we be doing? Provide training for clinical staff involved in assessing / delivering falls strategies / interventions to older people at risk of falling in community, hospital, care home teams What are we doing ? Who’s doing it FPS deliver training to SCHT clinicians RCP e- learning Preventing falls in Hospital SCHT, SaTH, RJAH, SSSFT FPS delivered training to Care homes 2011/12 in partnership with SPIC. Care Home clinical educator to take up post Sept 2014 to link with FPS Falls prevention info, including Social Care Social Work Improvement Scotland (SCSWIS ) managing falls in care homes, identified and added to SPIC website as part of Safecare Shropshire work

17. www.shropscommunityhealth.nhs.uk What should we be doing? Falls awareness Training for care agencies/ Social services/ voluntary agencies Raise awareness : patient info leaflets, distribution / availablity Falls awareness events What are we doing ? Who’s doing it FPS delivered Falls awareness training past year to : AgeUK home support workers, NOS, GP education event Public / carers in partnership with Community Council Shropshire Senior Safety Days Dementia Patient self care programme Shropshire CCG Day Centres/ private groups Memory Service SSSFT FPS - SCHT website Shropshire Falls Awareness week Sept 1-5

18. www.shropscommunityhealth.nhs.uk What should we be doing? Sharing best practice/ cascading information Raising quality and standards What are we doing ? Who’s doing it Falls Champion Forum hosted by FPS Safecare Shropshire Falls Task and Finish Group GP education events

19. www.shropscommunityhealth.nhs.uk How can we add years to life and life to years How can we maximise resources we have? What can we do better ? Where are the gaps ? What are our opportunities ? What are our challenges ?

20. www.shropscommunityhealth.nhs.uk Some thoughts What can we do better? What are the gaps? Poor / non existent data on falls in Shropshire What are the opportunities? To develop Public Health intelligence for feedback to Primary Care team, CCG and Health and Wellbeing Board Use patient level linked data to understand how costs are distributed across Shropshire’s hospital, community and social care system for falls patients What are the challenges? What data do we need How do we get it

21. www.shropscommunityhealth.nhs.uk Some thoughts What can we do better? What are the gaps? Better screening of over 65’s at risk of falls What are the opportunites? Develop/ Strengthen engagement with Primary care teams– Level 1? NHS health checks for 50-74 yr olds to include falls ? Bone health ? What are the challenges? Increased screening leads to increased demand on already stretched resources

22. www.shropscommunityhealth.nhs.uk Some thoughts What can we do better? What are the gaps? Identify number of WMAS call outs for falls in Shropshire Community dwelling, Pendant alarm holders,Repeat fallers,Care Homes No single point of referral for WMAS to request MFFRA reduce risk of further fall What are the opportunities? Triage 999 request for fall – medical/ non medical need Consider alternative organisation to pick patient up from floor Work with pendant alarm providers / housing associations Work with manual handling training for carers- Manga Elk, etc? What are the challenges? Numbers? Need for adequate SPR provision Continuity of safety / Suitable training Demand on existing services

23. www.shropscommunityhealth.nhs.uk Some thoughts What can we do better? What are the gaps? Strengthen pathway from orthopaedics and fracture clinics to FPS Offer follow up Falls Assessment on fallers attending A/E but not requiring hospital admission to prevent future admissions What are the opportunities? Create easy link between A/E and DAARTs to instigate MFFRA and onward referrals Home safety check What are the challenges? Increased demand on community/ voluntary organisations?

24. www.shropscommunityhealth.nhs.uk Some thoughts What can we do better? What are the gaps? Raise awareness of falls pathway to all organisations in contact with older people Empower staff in those organisations to MECC to reduce risk factors Expand falls awareness training via coordinated approach with standard info What are the opportunities? Promote standardised training package for older people – train the trainer – use in Day centres/ Senior’s events Promote standardised training package for staff/ volunteers involved with individual older people. Refocus where falls awareness training is delivered in 2014-15 and by who What are the challenges? Standardisation Quality Content continually updated to reflect best practice

25. www.shropscommunityhealth.nhs.uk What can we do better? What are the gaps? Improve bone health to reduce fractures No full fracture liaison service What are the opportunities? Fracture liaison service spanning primary and secondary care Identify fragility fractures, those at risk of fragility fractures Refer for scan, offer treatment based on NICE guidance Link with RJAH, FPS for MFFRA, exercise pathway to improve balance What are the challenges? Some thoughts

26. www.shropscommunityhealth.nhs.uk What can we do better? What are the gaps? Improve exercise continuum to prevent entry to and strengthen exit strategy from FPS Increase numbers of PSI trained exercise instructors in community Develop coordinated approach to exercise What are the opportunities? Right exercise for different ages, health conditions delivered by appropriately trained instructors Public Health Healthy Shropshire Leisure centres - outreach Exercise on prescription Voluntary agencies - falls buddies ? What are the challenges? Patient adopting behaviour change and adherence to long term activity Transport / suitable venues Some thoughts

27. www.shropscommunityhealth.nhs.uk Summary Outcomes from assessing needs, strategic planning and commissioning should be 3 fold To reduce the number of fall - better health and wellbeing - improve an individuals balance by exercise - individual Ax of people who fall for underlying medical causes with a treatment plan to reduce risk - provide safer environment To reduce the number of fractures- better bones for all - after the first fracture, act to prevent the second - Improve balance and treating the bones To reduce the consequences After a fall – rehabilitate and get active again After a hip fracture – ensure high quality care to save lives and money Prevent “long lie” scenarios by training how to get up or by alarm technology

28. www.shropscommunityhealth.nhs.uk Non-hip fragility fracture patients The work starts here today! Individuals at high risk of 1st fragility fracture or other injurious falls Older people How are we going to do it?