Aims and objectives:
Our service aims to reduce mortality and the health and social burden of falls in older people who have fallen, are at risk of falling or have a fear of falling. This is achieved by identification and targeted intervention of falls risk factors by a multidisciplinary team; integrated working between primary care, social services occupational therapy and day hospital teams; and partnerships with health care and social care providers, primary and secondary NHS Trusts, ambulance service, and independent and voluntary sectors.
This work is a vital part of the East Midlands Public Health Strategy and the Nottingham Guidelines and Joint Strategic Framework which has been developed in response to standard 6 of the National Service Framework for Older People.
Support for the change:
This change has been supported by the enthusiasm of the staff involved at an operational level. This has been demonstrated by the willingness to develop the service and embrace the changes in working practice. In addition, staff working at a strategic level have also been forward thinking by reorganising existing resources to allow for service development, for example the pooling of resources between social services and primary health care.
Patient and public influence:
Views of clients, families and carers gathered through patient satisfaction questionnaires indicate that for the often frail older person who is at risk of falling it can be unsettling to receive a fragmented services. In our experience this can often lead to refusal of services due to the multiple assessments, interventions and referrals made for any one client particularly in the transition between primary and secondary care. The integration of all services has led a more focused and efficient service for clients and hence has minimised unnecessary visits by multiple agencies.
Data collected at time points throughout interventions indicates that clients needs remain following the main intervention period. Data from retrospective audit indicates the successfulness of the follow-up contact we make with clients at 3 and 6 months. This review process allows time for clients to adapt and implement a greater number of treatment recommendations and hence maintain a positive change in their health behaviour.
Impact on the workforce:
There has been significant recent growth within the Primary Care Falls Prevention team from 1 WTE OT since March 1999 to the employment of 0.6 WTE nurse, 1 WTE Rehab Support Worker and 0.5 WTE Falls Co-ordinator in 2004. Additionally the skill mix of the team has increased through integration with social services and day hospital staff.
Measuring the results:
The Nottingham City PCT Falls Prevention Team has been contributing to ongoing national audit and evaluation measuring the implementation of Standard 6 of the NSF for Older People - 'Establishing an Integrated Falls Service'. Additional contributions to these evaluations have come from all members of the falls services in Nottingham, both primary and secondary health care, social services, and the voluntary and independent sectors.
Improved performance:
The most recent annual audit data demonstrates that at 12 month review 83% of recommendations made for clients to reduce falls risk factors have been completed.
The number of GP contacts resulting from falls has reduced by 94% from one year pre-intervention to one year post-intervention. Likewise, the number of A & E contacts has reduced by 85%.
27% of patients had suffered a falls-related fracture prior to intervention. At 12 months post-intervention only 1% of patients had sustained a fracture.
Reflecting diversity:
Clients that access falls prevention services are often frail and vulnerable. The integration of falls prevention services across service providers has minimised the number of visits from agencies into clients' homes and reduced unnecessary repetition of assessments. Not only does the client receive a more focussed and efficient service but also each professional can easily access a wide range of services to benefit the client in order to effectively intervene and reduce a wide range of falls risk factors.
15% Nottingham City population are black and minority ethnics (BME). The Falls Prevention Team work alongside Bilingual Co-workers during the assessment and intervention planning for BME clients in order to offer a service that is effective, equitable, appropriate and sensitive to the needs of these clients.
Through the large range of agencies that form the falls prevention service older people in a wide range of settings are accessing the service - not just those who present to healthcare.
Sharing the learning:
Much of the development and success of the falls service within Nottingham City PCT has been directly shared with the other three PCTs within Nottingham. This is to ensure that consistent messages are delivered to those working and living across Nottingham including staff in the acute trusts and voluntary sectors. This ensures a continuous service is available to clients, particularly when moving between primary and secondary health care.
Outstanding features:
Through the integration of the Nottingham City PCT Falls Prevention Team with other agencies which are involved in the care of older people and accident prevention, we have broadened the service we offer clients. Through this joint working we have been able to meet the increased demand for our service without additional resources. Our unique review system has improved treatment outcomes efficiently and effectively.
The enthusiasm and active involvement of the staff in enhancing these service developments has allowed these changes to occur smoothly and enabled important improvements in the service to arise in response to local needs and national objectives.
