The Needs Assessment Was Carried out Because Preventing Falls Is a Priority Within The

The needs assessment was carried out because preventing falls is a priority within the Ageing Well theme of the Oldham Health and Wellbeing Strategy. On a National level falls are also a priority with a number of related indicators in the NHS, Public Health and Adult Social Care, Outcomes Frameworks.

Key Findings

A significant gap was found in Oldham between the current provision of falls assessment and prevention services and national guidance on best practice.

Although there are pockets of excellent practice, falls prevention and assessment services do not have sufficient capacity to meet need resulting in inequity of access and long waiting times.

There are delays in osteoporosis assessments for people who have had a fracture and issues with the referral process.

Referral rates for assessing bone densitometry (DXA scan) are lower in Oldham than the national average.

The prescribing rate of bisphosphonates (the commonest bone sparing range of drugs used in the prevention and treatment of osteoporosis) is also lower than average in Oldham.

Both of these suggest room for improvement in identifying people with or at risk of osteoporosis in Oldham.

Key Implications

Evidenced based falls prevention programmes are cost effective ways of reducing falls and falls related costs.

The current falls prevention model needs to be built on and improved so that it is in line with best practice.

The current investment needs to be used effectively to redesign services to ensure integration, quality and efficiency.

The identification of people who have fallen or at risk of falling needs to be improved.

Work is needed with care homes, intermediate and respite care to reduce falls and fall related injuries.

We need to raise awareness amongst health professionals and the public of the dangers and consequences of falls.

Introduction: Why are falls an important issue to consider?

Falls are a significant public health problem, particularly for older people. Around 30% of over 65’s and 50% of those over 80 living in the community will fall each year (Cryer and Patel, 2001).

Falls are associated with high levels of morbidity and mortality, have long term impacts on quality of life and have huge associated costs for the individual, their families, the NHS and social care services. This problem is set to get worse in the future as the population ages.

Preventing falls is a priority within the Ageing Well theme of the Oldham Health and Wellbeing Strategy. On a national level falls are also a priority, within NHS Outcomes Framework (NHSOF), the Public Health Outcomes Framework (PHOF) and the Adult and Social Care Framework.

It is estimated that in Oldham 8,700 people over 65 fall each year. The North West Ambulance Service attends approximately 204 calls from older people, for falls per month in Oldham. In 2012 Oldham residents had 1,183 unplanned hospital admissions due to falls or fall related fractures in the over 65s. This is a 48% increase in the number of admissions compared to 2006/2007 and cost £3.5 million. In addition the Local Authority helpline response and key safe services were called out 2083 times due to falls in 2012.

Apart from economic costs, falls and fractures and their consequences affect both the physical and mental wellbeing of individuals. Falls, and the fear of falling, are a major cause of loss of confidence, loss of independence and social isolation for older people.

Falls, or fear of falling, is a common precipitator for the need for social care support including reablement, helpline and response service, domiciliary care or admission to residential care. Supporting relatives who have lost confidence after a fall also places a large burden on families who often become informal carers.

The proportion of people over 65 in Oldham is projected to increase in the future. Projections suggest that by 2022 the 65 and over population will increase by 9,500 to 40,400, which will represent almost 18% of Oldham’s population. The implications of this are that impacts of falls will increase.

What has been done for the JSNA?

A full health needs assessment (HNA) has been carried out which looked in detail at the current situation in regards to the number of fallers and the cost to services. In addition the HNA looked at the current levels of provision and identified where there are gaps and where improvements could be made.A falls and osteoporosis strategy has also been developed.

As part of the HNA a number of focus groups with older people were carried out to discuss their thoughts on falls and falls services available to them and the impact of both on their quality of life (QOL).

Main Findings

Needs and gaps

Although Oldham is currently performing around the national average in falls significant gaps have been identifiedbetween the current provision of falls assessment and prevention services and national guidance on best practice.

There are pockets of excellent practice and the specialist services are delivered, in the main, in line with the evidence base and have good feedback from patients who have accessed the services.

However, the falls assessment and prevention programmes have not been commissioned to have sufficient capacity to meet need resulting in inequity of access to the services and long waiting times.

There is also a lack of publicity for the services; lack of referral pathways from all relevant services and suboptimal multidisciplinary working.

What use can stakeholders make of the findings?

Stakeholders such as the CCG, OMBC, Pennine Care, Pennine Acute and Age UK should consider how to use the findings from the JSNA to improve prevention of falls and reduce the economic, social and health impacts of falls.

Those who do fall need access to high quality and integrated services that are evidenced based and follow good practice models.

Based on the JSNA a strategy has been developed to improve prevention and care.

The strategy’s recommendations provide an opportunity to put in place changes that will enhance the quality of care and QOL for older people who fall. It will also help to mitigate the rising costs from the increasing number of falls over the next ten years. Key to the strategy is the commissioning of a single comprehensive, community based, multidisciplinary falls and osteoporosis service, which delivers care in line with the NICE Clinical Guidelines, and has sufficient capacity to have a population health impact.

A full copy of the JSNA and the strategy is available from the public health department.