Wiltshire Falls System DesignSue Odams

Consultant Public Health

Wiltshire Council

27th March 2014

Presentation

• Background- Wiltshire• Falls in Wiltshire• Current System• BVHC Work• Current position• Future

Background

• Large county• Population: 470,981 (2011 Census)• Retirement age population:

– 18.2% Wiltshire– 19.6% South West– 16.3% England– Ageing fast!

Falls in Wiltshire

• Falls and injuries:– 65+: better than England average– 65-79: better than England average– 80+: not significantly different from England average

• Hip fractures 65+ and 80+:– Not significantly different from England average

Patient Fall At Home

Ambulance

Hospital

A&E

GP- Risk Assessment

Medical Falls Clinic

NT Falls Clinic

Fracture Clinic

RHRD Fracture

Liaison Clinic

NT Falls Clinic

Medical Falls Clinic

1:1 at patient's

homeStrength

and balance classes

Admission

NT Falls Clinic Risk

Assessment

Medical Falls Clinic

Strength and balance

classes1:1 at

patient's home

GP Surgery- Risk

Assessment

No referral

Social Care/District

Nurse

GP- Risk Assessment

Call 111 111 Algorhythm

Current Wiltshire Falls System

• Communication and Documentation:– ‘Passport’– IT systems– Whose responsibility?

• Patchy coverage and multiple referral possibilities:– Neighbourhood Teams– Medical Falls Clinics– Community Falls Clinics– Fracture Liaison Service?

Better Value Healthcare

• Public Health Lead• Core Group

– Public Health– CCG– Healthwatch– AWP– Social Care

• 5 Domains• Falls Group

BVHC Principles• Define the scope of the system• Define the population to be served• Reach agreement on the aim and objectives of the service• For each objective to find one or more criteria• For each of the criteria identify levels of performance that can be used as quality

standards• Identify all the resources used in the system, thus creating a system budget• Define all the partners so that they need to be engaged in a Clinical Network• Produce a system specification • Prepare a plan to build the system

BVHC Falls Workshops

• First– BVHC philosophy– Scope– Population– Objectives

• Second– Revamp of objectives

• Third (9th April)– Development of criteria

Current Situation• Define the scope of the system• Define the population to be served• Reach agreement on the aim and objectives of the service• For each objective to find one or more criteria• For each of the criteria identify levels of performance that can be used as quality

standards• Identify all the resources used in the system, thus creating a system budget• Define all the partners so that they need to be engaged in a Clinical Network• Produce a system specification • Prepare a plan to build the system

Wiltshire Falls Group Objectives• Increase awareness of falling, promote physical activity in older people- increase number of

people self accessing services• To identify those at high risk of significant falls (incorporating osteoporosis) and appropriately

manage• To diagnose and treat quickly (need timeframe) accurately (on clear pathway)

– Those who have fallen (known and unknown)– Those at risk of falling

• In order to:– Reduce the number of #NOFs– Maintain the independence those who have fallen/at risk of falling in their own home/place

of residence– Reduce the number of people calling ambulance service having fallen– Reduce the number of people admitted to nursing homes as a result of falling– Improve quality of life- those at risk and those who have fallen (confidence etc)

Future

• Understanding of system• Patient pathway• Monitoring and evaluation of system• Fit into other priorities and objectives?• Other BVHC domains

Questions?