Norfolk Falls Prevention and Management

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1 Norfolk Falls Prevention and Management Fiona Craig North Norfolk Integrated Commissioning Manager Tracey Sparks NFR Service Manager North Norfolk Kate Wyatt Care Home Practitioner South Norfolk CCG

2 Norfolk Falls Steering Group Chaired by Public health Role To bring together a range of organisations who have an influence in shaping, commissioning and providing falls related services in Norfolk. Aim To take a strategic overview of Falls, Falls prevention and Falls health services in line with national strategy and plan service developments to improve the falls position in Norfolk. Information Information on how to prevent and deal with a fall has been agreed and is published on NNCC website and links to falls health education Norfolk JSNA Executive Summary Falls Prevention in Norfolk (2014) Norfolk JSNA Falls and Falls Prevention Briefing document (2016) Norfolk and Waveney Falls Steering Group County Level Dashboard

3 Norfolk and Waveney Falls Steering Group Members

4 Falls, Dementia and Exercise Campaign

5 Fractured Neck of femur Norfolk as a county compare well with other areas and does not have unusually high rates of fractures in older people Trends for FNOF fairly steady but starting to rise Increasing ageing population likely to result in increased numbers of people at risk of a fall Need to improve the preventative offer Learning and Gaps Not utilising the information in the falls dashboard as much as we should Are we measuring the right things?

6 Falls prevention services Falls prevention services in Norfolk and Waveney are provided by East Coast Community Healthcare (ECCH) and Norfolk Community Health and Care (NCHC) They provide falls assessments and prevention interventions for specific groups Completed falls assessments have increased in 2016/17 but what impact does the falls assessment make? Learning and Gaps Are we assessing the right cohorts of people? Once we have assessed people what happens next What other preventative measures are in place?

7 Norfolk Swift Service Norfolk SWIFT Service is a 24-hour service that provides help support and reassurance to people with an urgent, unplanned need at home but who do not need emergency services 36% of SWIFT calls, around 300 visits per month are to falls related incidents Learning and Gaps Good links have been re-established with EEAST and SWIFTs so that EEAST refers uninjured fallers to SWIFTs SWIFTs need more support OOHs to prevent unnecessary hospital admissions Supported Care opportunity to fill this gap

8 Norfolk Swift Service in 2016/17

9 Emergency Ambulance and Acute Data CCG Number of callouts to Falls over 65+yrs Percentage of all callouts to 65+yrs, that are falls Percentage of fallers 65+yrs conveyed to hospital NHS North Norfolk % 44% NHS Norwich % 47% NHS South Norfolk % 43% NHS West Norfolk % 42% NHS Great Yarmouth and Waveney % 32% Total % 42% 20% of ambulance call outs to 65+ are falls related 42% of fallers 65+ were conveyed to hospital Hospital falls emergency admissions have reduced by -3.6% when compared to 2015/16 Short stay falls emergency hospital admissions have reduced by -11% when compared to 2015/16

10 Falls and Frailty Task and Finish Groups Physical activity to prevent falls Ryan Hughes Active Norfolk Steering group Each Area of Focus aligned to : Health Needs Assessment 2014 Nice guidance County Falls and Frailty Steering Meeting Group Care homes : Falls and Quality Fiona Craig Transfers of Care Jo Walmsley Medicines management (safety and falls) Chris Jones / Tony Dean Norfolk Care homes County Group NNUHT Falls Group NNUHT Frailty Group CSU NEL Medicines management Leads asked to : Collating current work and current planned work from partners (harnessed from feedback collected); Review good practice within Norfolk and in other counties/areas; Work toward an action plan of achievable goals that we as a partnership can take forward. Dates set for each of the 4 task and finish groups

11 Care homes Falls Task and Finish Group Working with care homes to prevent the first fall Encouraging use of a standard multi factorial falls tool to be used at the bedside Scottish Care Inspectorate have falls package for care homes and assessment tool adapted from this. Referrals algorithm to help carers direct referral to the appropriate clinical team and reduce repeat referrals to the falls team Pimp Up My Zimmer RAG rated tagging of walking aids to improve safety in care homes Emergency hospital admissions caused by a fall have reduced by -13% when compared with 2015/16

12 Falls A& E Delivery Plan Target KPI Action + progress notes Owner Reduction in falls related emergency admission to hospital Reduction in ED attendance for frail patients Acute Trust Management of frail patients The high level indicator of falls prevention activity is the number of Fractured Neck of Femur (FNOF). No KPI set at the moment North Norfolk falls target is to reduce falls by 12.4% for 2016/17 emergency admissions caused by a fall for over 65s when compared to 2015/16. ACTUAL REDUCTION OF 3.4% ACHIEVED To promote and use the County Falls Steering group and associated Falls Dashboard created by Public Health as a forum to identify and measure the impact of falls reduction and prevention activities Review completed on the impact of the enhanced SWIFT team based at North Walsham and decision made to absorb team into Supported Care model Falls audit to be conducted by ICCs via a review of emergency admissions to hospital to find out about support given to fallers Reduction in the number of NCH&C frailty CQUIN provided enhanced assessment using admissions for those patients with Rockwood frailty scale to patients aged between individualised care and support years. use of Rockwood scale promoted EEAST and SWIFTs plans in place. Increase the number of patients screened on arrival in ED for frailty. Reduce the number of patients converted to an admission Frailty screening commenced in ED/AMU in 01/08/16. 5 day audits run in September and November. Wider frailty screening across more wards in future Reasons for admission / potential community service gaps to be explored. Active Norfolk Exercise & Falls prevention NCC Falls in Care Homes NNUHT Transfer of Care NEL CSU Medicines Management Fiona Craig Falls target of 10 % above plan for M12 but significant decreases over the last 3 months and short stay admissions decreased by 11% Data Sharing Agreement for ICCs to become data processors in GP practices NCH&C Claire Ruff Frailty CEQUIN completed Jo Walmsley / Julie Barton Use of yellow frailty primrose to indicate frailty assessment completed John Mallet / Vanessa Hansell 3 month pilot of a Falls Vehicle Reduce number of non injurious falls conveyed to ED. A dedicated falls vehicles is available across the central belt which has an OT give immediate falls support EEAST Di Chan

13 Recommendations Assess they way in which we use, access and share the vast amount of data from the Falls & Frailty Steering group check that we are measuring the right things Ensure that OOHs solutions include appropriate responses to falls Encourage statutory and non-statutory services to support falls prevention Audit the historical service given to people who have had a fall to assess effectiveness of falls prevention practice Get the enhanced frailty work delivered by NNUH and NCH&C linked in to the new GP contract which includes management of people with frailty Use an appropriate tool such as the electronic Frailty Index (efi) to identify frail patients Keep a register of the number of people with a diagnosis of moderate frailty and those with severe frailty Record the number of people with severe frailty who have an annual medication review and have fallen within the past year