Agenda item

The Chairman welcomed Lindsay Pyne, Head of Adult Therapies – Bromley Healthcare (“Head of Adult Therapies”) to the meeting to provide an update on the Falls and Fracture Prevention Service.

The Head of Adult Therapies informed Board Members that all referrals to Adult Therapy teams were filtered via the Single Point of Access (SPA). If a referral was considered to be urgent, or required a quick response to ensure safety and reduce risk of attendance at an Emergency Department (ED), it was passed to the Rapid Access to Therapy Team (RATT). The RATT assessed patients in their own home within two hours, or two days, and then provided equipment/intervention and referred them on for ongoing falls specific intervention.

Since an update was last provided to the Health and Wellbeing Board, the Falls Therapy Clinic had opened with locations in Orpington and Beckenham although it was noted that there was reduced capacity due to infection control. A Falls Consultant Clinic had also opened, with reduced capacity, one morning per week; a Vestibular Clinic was open one afternoon per month; home visits for initial assessments and exercise/intervention were also available; and Balanced Lifestyle Groups (12-week programme) were held face to face in West Wickham and Orpington. In response to a question, the Head of Adult Therapies said that the locations were not based on areas that had a particularly high number of falls – there were limitations due to the spaces available, and they would continue to look for further options to deliver these programmes.

The Head of Adult Therapies advised that the Falls and Fracture Prevention Service received on average 80 referrals per month. At present, the caseload stood at 342 patients, which it was noted did not include the caseload of the Fracture Liaison Nurse. The waiting time was approximately 12 weeks, which was impacted by both staffing capacity and the capacity available within the clinics. Outcomes for patients were measured by TOMs and Tinetti and positive feedback was received from patients. (TOMs stands for Therapy Outcome Measures and was in use across many therapy services in Bromley Healthcare. It was completed during the initial assessment and then end of intervention to determine if improvements had been made in four areas in line with International Classification of Functioning, Disability and Health: Impairment, Activity, Participation and Wellbeing. Tinetti was also an outcome measure used predominantly by Physiotherapists to assess a patient's gait and balance and provided a score on completion which could be compared pre and post intervention to determine progress/improvement. In response to questions from the Vice-Chairman, the Head of Adult Therapies advised that it was acknowledged that the 12-week waiting time was too long and an increase in capacity and efficiency would be needed to return to the standard waiting time of 4-6 weeks. It was highlighted that the Rapid Access to Therapy Team (RATT) assessed patients at immediate risk and referred them on if necessary.

With regards to future plans for the service, the Head of Adult Therapies said that a Team Away Day had recently taken place to discuss some positive changes. These included:

-  Increasing the capacity of Falls Therapy Clinics to reduce waiting lists;

-  Increasing the Balanced Lifestyle Group to include a group in Bromley;

-  Streamlining the patient pathway (currently home working and measures put in place to reduce face to face contact need to be streamlined);

-  Improving responsiveness to reduce waiting list;

-  Increasing student numbers, aiming for 1 Occupational Therapist and 3 Physio students next academic year; and,

-  Ongoing review to ensure compliance with NICE Falls Guidance, best practice and research.

The Falls Prevention Working Group were moving from monthly to bimonthly meetings, which involved staff across Bromley Healthcare, to ensure they were thinking about risks when providing care, and the Falls Policy had been rewritten and implemented. An initial Falls Risk Assessment Tool (FRAT), which was included in all adult services’ initial assessments, would be  audited in March 2022. Other future work for this group would include reviewing the Falls Pathway in line with NICE Falls Guidance for all patients, piloting internal referrals into the Falls Team and implementing research to ensure the right team were seeing the right patient.

Members were advised that the NHS England ‘Falls Pick Up Service’ was to be implemented in Bromley. It aimed to avoid conveyance to ED, when appropriate, and to reduce pressure on the ambulance services in order to minimise long lies for those who had fallen. Bromley Healthcare were currently scoping potential service models to ensure that service delivery aligned closely with working partners, such as the London Ambulance Service, and to integrate into other urgent services within Bromley Healthcare (Home and Bed based Rehabilitation, Urgent Therapy assessment, Care agency involvement, Falls and Fracture Prevention Service). In response to questions, the Head of Adult Therapies said that patient referrals were received from GPs and other professionals, but they would be open to receiving referrals from other organisations, however patients could not refer themselves directly. With regards to falls awareness, it was noted that Bromley Healthcare was only commissioned to train its own staff – they would like to engage with the public more widely, however this would require further resources.

The Head of Adult Therapies informed Members that Bromley Healthcare would host the role of SEL Falls Programme Lead (a 6-month secondment, with some potential to be extended). The programme would include work to:

-  Understand the current SEL falls services;

-  Identify opportunities for improvement, especially in relation to strengthening the crisis component of these services; and,

-  Explore the feasibility and, if viable, develop an operational model for an alternative falls response service to be delivered by LAS in partnership with SEL UCR services.

The Rehabilitation research team at the University of Nottingham had conducted a FinCH randomised controlled trial to evaluate the Guide to Action Care Home (GtACH) falls prevention tool (2016-2019). The GtACH multifactorial tool was used to assess the risk of falling on an individual basis to enable the implementation of patient-centred fall preventative changes. The trial had concluded a 43% reduction in falls in care homes and was cost effective (peer reviewed) and had resulted in the ‘React to Falls’ resources, promoted by NHS England/Improvement and shared with care homes in Bromley. Following the success of this trial, the Head of Adult Therapies advised that the team would be conducting a falls prevention implementation study outside of trial conditions in preparation for nationwide implementation. The programme consisted of a training package for care home staff, information manual, and a screening and assessment tool.

Bromley Healthcare had worked alongside the ‘Living With’ group to develop a falls prevention app that could be used by patients in Bromley, which was still in the early stages of development. In response to a question from the Chairman, the Head of Adult Therapies said that the first phase of the app had taken a couple of months to develop, with the last update on this work provided in November 2021. A Member enquired if research had been undertaken with the current cohort of patients to see if they would use this app once it was launched. The Head of Adult Therapies advised that this was currently being discussed with patients. Work would also continue on the London-wide Digital Community Health Services Programme. This would include looking at high volume pathways (catheter and falls), mapping the Bromley falls pathway in relation to digital maturity and access to timely patient information, and creating a blueprint to be used across London.

In response to a question from the Chairman, the Head of Adult Therapies said that it was currently too early to estimate the number of falls prevented by the service – there were difficulties in collating data across the system, which made this hard to evidence. A Member enquired as to whether information was gathered on the circumstances surrounding a fall. The Head of Adult Therapies advised that a number of questions would be asked, and a report could be created to help inform which interventions were put in place.

The Chairman thanked the Head of Adult Therapies, Bromley Healthcare for her presentation to the Board and requested that a further update be provided at the end of the year.