An integrated approach to injury prevention in Hertfordshire

Raymond Jankowski

Deputy Director of Public Health

Hertfordshire County Council

Falls prevention in older people

Falls - Nationally

• 33% of people over 65 years and 50% of those over 85 years old fall

• Costs estimated £2.2B per annum…….and Rising • No1 Serious incident in hospitals• No1 precipitating factor for long-term care

Falls – Hertfordshire

• No.1 reason for 999 ambulance calls in Hertfordshire (22%)

• Cost £40-50M per annum in Hertfordshire• Hip fracture rate in Watford worst in England in 2009/10• Hip fractures and falls admissions rising• 180 X variation in 999 calls from care homes

In Hertfordshire, falls in one year…..

Estimated 60,000 falls in > 65 year olds

22,000 emergency ambulance calls

5,100 emergency admissions

1,194 hip fractures

45-50 deaths

Forecasts of rise in hip fractures in older people in Hertfordshire

Projected % increase in population aged 65+ and yearly number of hospital admissions due to hip fractures in Hertfordshire

1% 4% 6% 8% 11% 13% 15% 18% 20% 22% 25% 27% 29% 32% 34% 36% 39% 41% 43% 46% 48% 50% 53%

0%

10%13%

16%18%

21%23%

26%29%

31%34%

36%39%

42%44%

47%49%

52%55%

57%60%

62%65%

67%70%

0%

4%6%

9%11%

14%16%

18%21%

23%26%

28%31%

33%36%

38%40%

43%45%

48%50%

53%55%

57%60%

0%

10%

20%

30%

40%

50%

60%

70%

80%

% increase in predicted yearly number ofhospital admissions due to hip fractures(FROM AVERAGE 05/06 to 11/12)

% increase in predicted yearly number ofhospital admissions due to hip fractures(FROM 2007/08)

% increase in predicted yearly number ofhospital admissions due to hip fractures(FROM 2011/12)

% increase in population aged 65+

Population projections source: ONS 2010-based population projectionsProjected hip fractures data: NHS Hertfordshire SUS

Forum of Fractures Falls Fragility

• Whole system for population of 1.1M• Prevention in the community through to acute care• Many stakeholders

Objective 1: Improve outcomes and improve efficiency of care after hip fractures – by following the 6 “Blue Book” standards

Hip fracture patients

Objective 2: Respond to the first fracture, prevent the second – through Fracture Liaison Services in acute and primary care

Non-hip fragility fracture patients

Objective 3: Early intervention to restore independence – through falls care pathway linking acute and urgent care services to secondary falls prevention

Individuals at high risk of 1st fragility fracture or other injurious falls

Objective 4: Prevent frailty, preserve bone health, reduce accidents – through preserving physical activity, healthy lifestyles and reducing environmental hazards

Older people

NSF, TA161, CG21, Blue Book & NHFD

NSF, TA161, CG21 & Blue Book

NSF, TA160& CG21

NSF, LTC programmesSocial care

DH Systematic approach to falls and fracture care & prevention: four key objectives

PRIMARY OBJECTIVES

• Prevent further falls, and the injuries and loss of independence that are often associated with them.

– Identify people at risk of a first or subsequent fragility fracture,

– Assess individuals’ risks and establish appropriate interventions to significantly reduce their risks.

• To be achieved through integrated working links between the East of England Ambulance Service, acute trusts, primary and secondary health care teams and the health and social care teams across Hertfordshire.

Source: DWP

Some of the key components of falls fracture and fragilities in Hertfordshire

• Community Falls Liaison service • Community pharmacy medication reviews• Community safety service• Falls car (National Health and Social care award 2010)• 2 Fracture and Falls Liaison nurses (in acute sector)• Use of DH best tariff• Multidisciplinary assessments and interventions• Raising awareness in the wider community

Key factors in success

• Clear strategy based on evidence and cost effectiveness• Using commissioning opportunities • Team work• Business plan• Innovation with Evaluation• Willingness to review and adapt• Leadership beyond authority

Hospital admissions due to falls in persons aged 65 and over, DSR per 100,000, Herfordshire GP registered population, 2009/10 to 2012/13

1,605

2,0422,205

2,047

0

500

1,000

1,500

2,000

2,500

2009/10 2010/11 2011/12 2012/13

Financial Year

Dire

ctly

stan

dard

ised

rate

per

100

,000

0

0.1

0.2

0.3

0.4

0.5

0.6

0.7

0.8

0.9

1

5 6 7 8

Block number

%

Percentage of class participants reporting >= 3 point increase in balance, functional capacity and confidence

0

10

20

30

40

50

60

70

80

90

100

5 6 7 8

Postural stability class number

%

May 2012 - June 2013

“A follow on course would be very helpful.”

Respondents’ comments after attending exercise class

“Brilliant! Thank you.”

“Gave me confidence.”

“Gave me confidence in all ways. Course was run with humour, friendliness and inspired confidence.”

“I wish the course was longer.”

“I found this class fantastic, exciting, helpful and a follow-on class would be great and helpful.”

“Very happy with the whole experience and personally believe that every senior would benefit from this.”

“I haven’t fallen since I have started the course and cannot thank you enough for helping.”

Objective 1: Improve outcomes and improve efficiency of care after hip fractures – by following the 6 “Blue Book” standards

Hip fracture patients

Objective 2: Respond to the first fracture, prevent the second – through Fracture Liaison Services in acute and primary care

Non-hip fragility fracture patients

Objective 3: Early intervention to restore independence – through falls care pathway linking acute and urgent care services to secondary falls prevention

Individuals at high risk of 1st fragility fracture or other injurious falls

Objective 4: Prevent frailty, preserve bone health, reduce accidents – through preserving physical activity, healthy lifestyles and reducing environmental hazards

Older people

DH Systematic approach to falls and fracture care & prevention: four key objectives

Promote physical activity in people aged 40 years and older

Health and Wellbeing Strategy: Life Course in Hertfordshire

* From pre-conception

Starting wellUp to 5 yrs*

Developing well5-18 yrs

Living well18yrs+

Working well Aging well 65 years+