1. Specialist PSI Exercise Module Implementation Making it work and making it sustainable Different models, but similar principles

2. Specialist PSI Exercise Module IDEALLY - An Integrated Falls and Fracture Prevention Service multi-professional Medical and Nursing staff, Therapists, Social Workers, Exercise Professionals multi- agency Local health authority, Social services. Local authority, Leisure Services, Sports Development Service, Voluntary sector co-ordinated Working to agreed protocols, Working to agreed pathways, Utilising agreed communication pathways and integrated service Using a regular mechanism of meeting to agree strategy and review progress towards objectives

3. Specialist PSI Exercise Module What should a service consider? Aims of Service To provide a seamless service across all agencies To promote personal responsibility for healthy active ageing To pro actively identify those at risk of falls and osteoporosis To ensure appropriate assessment and interventions for those at risk

4. Specialist PSI Exercise Module 3-tiered inter agency assessment process:- 3. Specialist falls assessment 2. Determine risk factors 1. To identify a falls problem

5. Specialist PSI Exercise Module Getting falls and fractures on the map ? Trigger questions on falls and fractures in –A & E –GPs –Single Assessment process? Educating others –Pharmacy, Opticians, Chiropodists, Day Centres –etc

6. Specialist PSI Exercise Module Exercise Continuum 3 components:- 1. Community exercise opportunities that offer varied and progressive programme 2. Specific falls prevention (and injuries from falls) rehab class and 3. home based exercise programme

7. Specialist PSI Exercise Module How? Clinical Exercise Specialists creating links between health and leisure Nationally validated courses:- CBE, OEP, PSI available to all professional groups Additional ‘top up’ training to develop skills and standards of practice across all areas ‘Code of practice’ – agreed minimum standards for all instructors in both health and leisure List of approved classes (monitored and evaluated on a regular basis)

8. Specialist PSI Exercise Module Community Exercise Programme Aim: to ensure that all older adults have easy access to a regular, safe and effective local exercise class community sheltered housing complex day centre residential home

9. Specialist PSI Exercise Module Home based exercise programme OTAGO Chair Based Exercise Class (Community based) Exercise Referral Scheme 12 weeks PSI/Rehab based exercise group 12 weeks Community based classes for older people OTAGO exercise classes (Community based) Falls Assessment Identification of a falls problem and screening to determine risk factors Cambridgeshire Falls Prevention EXERCISE PATHWAY Motivation Screening Pathway

10. Specialist PSI Exercise Module Transport issues……Funding issues Link in with other services –Exercise Referral –Mental Health priorities –Social Care funding –Leisure Services Consider self funding after initial period? –Often more valued and attendance better! Consider ‘buddying’ shemes to aid travel –Going with people on the bus –Providing a lift –Bring along family (and their car!)

11. Specialist PSI Exercise Module Challenges for future Keeping falls and osteoporosis on agenda (different priorities across primary and secondary care and community) financial constraints - demonstrating cost effectiveness ongoing organisational changes staff - rapid turnover - low morale

12. Specialist PSI Exercise Module Conclusions Falls and Fracture Prevention Services have come a long way in past 6 years. In order to ensure ongoing funding locally, we must convince commissioners of cost effectiveness in terms of:- - preventing falls related injuries. - maintaining independence and improved QOL for those at risk of falls and fractures (eg. Evaluation!) Be clear about the specific needs of this group of people (Not all exercise is the same!)