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 noted that a presentation had been delivered to the Board back in February 2022 – since then the team had expanded and all areas were back to full capacity. Falls Therapy Clinics were open and home visits for initial assessments were taking place – it was highlighted that the Falls Consultant Clinic was now also in a permanent location.
The Head of Adult Therapies advised that the Falls and Fracture Prevention Service received, on average, 90 referrals per month, which was an increase of 10% in the last year. It was noted that an increase in referrals had been anticipated following the pandemic and other background services had taken on some of these patients. At present, the caseload of the service stood at around 320 patients which did not include the caseload of the Fracture Liaison Nurse. The waiting time was approximately 12 weeks, depending on the pathway patients were referred through. Outcomes for patients remained the same and were measured by Therapy Outcome Measures (TOMs) and Tinetti. Patient feedback was gathered through the Friends and Family Test, and was extremely positive with 99.5% of respondents recommending the service. Board Members were advised that TOMs were completed during an initial assessment and again at the end of an intervention to determine if improvements had been made in four areas, in line with the 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.
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 2 hours, 24 hours or 2 days, and then provided equipment/intervention and referred them on for ongoing falls specific intervention. In terms of referrals for ongoing assessment and interventions to the Falls Team, work was underway to with other teams to ensure that referrals were streamlined, and unnecessary duplication reduced.
With regards to the prioritise of the Falls Team, work had been undertaken in relation to the roles and capacity expectations within the team, such as upskilling assistant practitioners to complete non-complex assessments, and streamlining and simplifying the assessment process. The team’s workstreams had been considered in line with some of the national data and models in place, and focussed on:
- multifactorial assessment and investigations;
- home environment and safety;
- prevention; and,
- compliance with best practice NICE guidance and World Falls Guidelines (published in October 2022).
It was highlighted that the team were keen to work more closely with partner organisations, such as CareLink and the London Ambulance Service (LAS).
The Head of Adult Therapies informed Board Members that she led the Falls Prevention Working Group, which involved all services across the organisation. Areas of focus included:
- standardising identification and stratification of falls risk questions to be asked by all clinical staff during initial assessments of those over the age of 65 (NICE best practice);
- auditing the compliance with these questions;
- internal referral template to simplify the process of referral to the Falls Team;
- Falls prevention training for clinical staff (this was a tailored and blended innovative approach, creating interactive online training); and,
- lanyard cards for staff in case of patient falls at home during their visit.
Board Members were advised that NHS England had requested that a Falls Pick Up Service be implemented by December 2022, which would be reviewed in March 2023. Bromley Healthcare had started a 4-month pilot of the service the previous week, which took referrals from 999/111 and ran from 8am-8pm, 7 days a week. Therapists and nurses were available to visit patient within 2 hours – they would use equipment, such as a Raizer to lift patients, complete assessments, step patients up to ongoing rehab/care packages or escalate to 999. Another request from NHS England related to ambulances and care homes. A system-wide approach was being taken with partners to identify and focus on Bromley care homes and Extra Care Housing settings where falls rates were high, and a bespoke approach was being used to reduce falls and conveyances. This work was being linked to the Falls in Care Homes (FinCH) Implementation Study, which was being conducted with the University of Nottingham. The Bromley Healthcare Falls Team were hosting two Physio Trainers who visited 16 of the care homes in Bromley to provide the ‘React to Falls’ checklist training, which helped identify fall risks and actions to reduce them. Phase 1 of the study was nearly complete, and data was being gathered regarding falls before and after the training. Phase 2 would be funded by the Bromley Integrated Care Board (ICB) and involve 40+ non-study care homes across the borough – training for their staff would commence from January 2023. An Action Falls collaborative event had taken place the previous week, involving the care homes participating in Phase 1 of the study – anecdotal feedback from one care home was that they had had zero falls since using the ‘React to Falls’ checklist.
Bromley Healthcare was hosting the SEL Falls Project Manager for a 6-month secondment, which had since been extended for another 6 months – a review would take place the following week as there was potential to extend it further. Project areas included:
- mapping the current SEL falls services in primary and secondary care, and third sector provision;
- supporting and streamlining implementation of the Falls Pick Up Services in all six SEL boroughs;
- working on a ‘Falls Core Offer’ for SEL and ‘Falls Best Practice’;
- identifying and successfully bidding for funded training opportunities for upskilling and bringing staff together; and,
- undertaking work linking Assistive Technologies across SEL into this project.
The Chairman asked if it was possible to identify how many falls may have been prevented and, if so, what the value of this would be. The Head of Adult Therapies said that in the community this was much more difficult to gage as there were a number of different aspects to be considered – some of this was due to the coding of the data, where patients may be coded with a fracture rather than having had a fall. However it would be much easier to look at this in relation to care homes, and the lack of ambulance call outs – this was something done as part of the original research, and once data was available the economic consequences of these interventions could be reviewed.
A Board Member enquired if there were other points of contact within health and social care whereby people could be spoken to earlier about prevention and the lifestyle choices that they made. The Head of Adult Therapies said there was always more that could be done in terms of getting the message out to younger cohorts about how quickly strength and balance could be lost, particularly following retirement. How to go about this was sometimes a challenge, but there were lots of resources, projects and research taking place. The Chairman noted that Mytime Active were delivering courses for the elderly, related to exercise and upper body strengthening, to help prevent falls. A Board Member highlighted that the Falls Service was an important element – the interventions delivered were vital in terms of reducing the impact on a number of hospital services. The Board Member agreed with the comments made in terms of preventing falls and thinking about strength and balance from a younger age. It was considered that it would be interesting to have an overall picture of the number of falls and an understanding of data on falls admissions and number of ambulance call outs.
In response to questions regarding the Falls Pick Up Service, the Head of Adult Therapies said that data had been provided by the LAS early in the pilot which had allowed the times of falls to be tracked through the calls made to 999/111. They had been conscious that the service was not provided through the night – some falls took place as people went to bed or as they got up in the morning, but there had not been as many as anticipated, whereas a significant amount of falls happened during the day time.
The Chairman thanked the Head of Adult Therapies, Bromley Healthcare for her presentation to the Board and suggested that this work be written up and publicised in journals to provide learning for others. It was noted that a summary of the work and observations undertaken by the Falls Service could also be included in the next Joint Strategic Needs Assessment (JSNA) report.
RESOLVED that the update be noted.