OLDER PEOPLES FALLS PREVENTION SERVICE REVIEW FOR EARLY INTERVENTION AND INPUT INTO PATHWAY REDESIGN

SUBMITTED BY: DATE: CONTACT DETAILS:

Mike Parker 3rd April 2012 HM Partnerships Burlington House Crosby Rd North Liverpool L22 0QB Tel: Mob: E: W: 0151 9287830 07789 935865 mike.parker@hmpartnerships.co.uk www.hmpartnerships.co.uk

NHS ALW FALLS REDESIGN DRAFT 2 03/04/12 1.0 COMPANY BACKGROUND

This proposal is put forward by HM Partnerships (Company Number: 6258842. VAT Number: 973609487), a social enterprise, with a strong track record in delivering public health organisational development services to support local, regional, national and international organisations and alliances in public health development. Our delivery is designed to increase the reach and capacity of organisations to plan for, design, implement and evaluate comprehensive health programmes and strategies. As a social enterprise, profits are re-invested into the prevention of cardiovascular disease through the internationally recognised CVD prevention charity Heart of Mersey (Parent Company Number: 5382971)

2.0

INTRODUCTION TO SPECIFICATION

Falls and fractures among older people in England are a serious and growing public health issue. In England, between 1998/99 and 2008/09: The number of men admitted to hospital for a hip fracture increased by 77%1 The overall rise for both men and women was 17%1 The number of bed days attributed to hip fractures increased by 32%1.

Projections show that based on current trends, by 2036, there could be as many as 140,000 hospital admissions for hip fracture a year in the UK - this would be an increase of 57% on 2008 admissions1 2 3 4. According to the Department of Health, for a primary care trust with a population of around 300,000 (similar to ALW) this means: 15,500 older people will fall each year 2,200 of those will attend an accident and emergency department or minor injuries clinic, and a similar number will call an ambulance 1,100 will sustain a fracture 300 of which will be of the hip.5

An effective falls and fracture prevention service in a primary care trust with a population of around 320,000 can make NHS and social care direct savings of 263,636 over five years. NHS ALW is currently reviewing their falls care pathway in line with the QIPP challenge. As well as making efficiency savings were possible, increase quality particularly in relation 2

NHS ALW FALLS REDESIGN DRAFT 2 03/04/12 to integrating the patient journey across health and social care; we are also keen to increase preventative activity, promote earlier intervention to reduce current and future costs on the local health economy. A number of pieces of work have already been commissioned including: A falls service review and pathway redesign of the two commissioned falls prevention services run by Bridgewater and WLCT (to be delivered by CAPITA) A piece of qualitative customer insight work to build insights amongst frail older adults and their attitudes towards the falls prevention programmes and identify the most effective means of encouraging them to participate in these types of programmes in the future (to be delivered by Unravel)

This third commission is focused on scoping options for an extended care pathway focusing primarily on the prevention of frailty through the delivery of services outside of the NHS. It is anticipated that these services will have a potential to engage with a younger age range (50 70yrs) and encompass a broader range of preventative interventions, primarily by encompassing the delivery of Adult Health and Social Care into the overall falls prevention pathway, being developed by CAPITA.

3.0

OUTLINE OF PROPOSAL

HM Partnerships are aware of the detail of the other commissioned work in the area of falls, currently being delivered by CAPITA and Unravel and will seek to learn from and compliment this work engaging with the other two companies on a weekly basis.

Work Package 1: Contextual Audit and Review of Existing Delivery Exploration of relevant literature, recent reviews and consensus documents conducted across other local authority area, to scope the current range and capacity of evidenced based falls prevention, outside of the mainstream NHS funded services. With a bias towards social care Review of existing local delivery of non-NHS funded services linked to the falls agenda with a strong social care bias - including o Adult and social care services o WLCT Services o Wigan and Leigh Housing Services o Other voluntary sector provision 3

NHS ALW FALLS REDESIGN DRAFT 2 03/04/12 Approximately 10 X semi-structured interviews with local service leads based within Adult Social Care, Wigan and Leigh Housing, WLCT and the Voluntary Sector (face to face or telephone)

Work Package 2: Assessing Unmet Need Collaborate with the wider team of external consultants to compare existing delivery against the evidence base of best practice to assess current unmet need including the needs of specific sub groups. Assess the ability of the existing range of services to address the unmet needs identified and identify potential gaps in current falls prevention service offerings focusing on non NHS services (rather than mainstream NHS falls prevention services), in particular those utilizing new technologies.

Work Package 3: Options Review Develop a range of options for how we can more effectively connect services with the people in need and develop a service response tailored to individual need that restores and maintains independence and reduces the risk of future falls. Some operating models should be built on /link to the existing heath and social care 3 locality model, in particular o single accessible information points o integrated and responsive teams of professionals o maintenance and development of social capital The options should have a focus on the primary prevention of falls and fragility fractures, promoting healthy lifestyles and strong bones amongst older adults under 70 years, considering the needs of specific high risk groups e.g. post menopausal women

Work package 4: Final Report Writing Make recommendations based on the review about the potential effectiveness and practicability of the various options considered. Input into the work of the wider Falls Pathway being developed by CAPITA Produce final comprehensive report detailing all above actions

NHS ALW FALLS REDESIGN DRAFT 2 03/04/12 4.0 LIMITATIONS

Scope A study of this type and complexity could take many months. However we are aware that there are very limited time constraints on this review. We will therefore conduct the study to the most appropriate level of detail available within the time constraints. For example when reviewing the literature we will not be able to conduct a full systematic review, but will rely instead on recently published review documents and key studies. We are aware of the work being conducted in this area by CAPITA in relation to a Falls Service Review and Pathway redesign. To avoid duplication we will liaise closely with CAPITA in all stages of this work to ensure the information collated is relevant to their overall pathway redesign and of a style that will enable CAPITA to integrate this work into their final output. HM Partnerships brief will focus on falls prevention activities delivered outside of the NHS for younger cohort of the Older population.

NHS ALW FALLS REDESIGN DRAFT 2 03/04/12 5.0 TIMESCALES

It is proposed that the work would commence in April 2012. It is anticipated that it be completed by mid June 2012.

Work Package Review Existing Services against Unmet need OPTIONS REVIEW Development and planning Options Review REPORTING, CONCLUSIONS Project Meetings Production of Draft Report for Capita

CONTEXTUAL AUDIT & REVIEW Scoping Desk research Develop interview brief and questions Develop interview schedule Conduct Interviews ASSESSING UNMET NEED Meeting with CAPITA to consider unmet need

Final Report presented to Group

Area HMP HMP/ ODS ODS MP

HMP Associate HMP Admin HMP Associate HMP and HMP Associate HMP Associate

HMP/CAPI TA MP

Lead Person(s)

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NHS ALW FALLS REDESIGN DRAFT 2 03/04/12 6.0 REFERENCES 1. The NHS Information Centre. Hospital Episode Statistics for England. Inpatient statistics, 2007-08. 2010 2. Northern Ireland 2007/08 Hospital Inpatient Information. 2010. 3. Data collected on discharges from non obstetric and non psychiatric hospitals in Scotland (SMR1/01). 2010. 4. Health Solutions Wales, PEDW Statistics. 2010. 5. Department of Health. Putting the case: Older peoples prevention services. 2009