Reducing Falls and Preventing Fractures Strategic Framework Fusion Consultation December 2012 Executive Summary 1.0 Background NHS Devon and Devon County Council have developed a strategic framework for Reducing Falls and Preventing Fractures, in partnership with new Devon locality commissioning teams, Torbay Commissioning Team, NHS providers and voluntary sector representatives. The framework provides a comprehensive action focussed plan for reducing falls, fractures and other related injuries among older people living in Devon. Fusion coordinated a consultation event on the 13th December, with the purpose of gathering the views of service users and carers on their priorities in relation to reducing falls and preventing fractures. People with physical and sensory disabilities, older people, people with learning disabilities, people with mental health issues and carers took part in the consultation. A total of 21 people took part. (Please see appendix 2 for equality and diversity information.) 2.0 Key messages Participants had a considerable amount of experience and knowledge to share at the consultation event. Service users and carers were broadly supportive of the Reducing Falls and Preventing Fractures strategic framework, but had some important concerns and strongly felt views and opinions with regard to their own priorities for reducing falls and preventing fractures. Key messages from the consultation are summarised below. Reducing Falls and Preventing Fractures Fusion consultation report December 2012, Executive Summary Kelly Mavro Fusion/Engagement Contract/ Gateway/ Consultations/ GR-1012-RFPF 1 Key Messages from Reducing Falls and Preventing Fractures consultation The considerable emotional and physical impact of a fall for individuals, families and carers. The need to address the psychological and emotional impact of a fall as well as the physical impact. The fundamental importance of people having access to information (in various formats and locally available) both to prevent falls and for people who have experienced a fall. The need for integrated ‘joined up’ services and improved care pathways. Improved follow up care and support after a fall. More consistent and thorough assessment of all individuals who present at A & E with a fall related injury. Routine bone density scans. Regular assessments and reviews – including risk assessments in the home. Promotion of exercise – specific falls prevention / strengthening exercises (individual and one to one). Recognition of the financial impact of a fall for individuals, families and carers and the unequal resources people have to prevent falls. The need to address the ‘built environment’ – housing design, maintenance of pavements etc. Population based approaches – education, healthy diet, exercise, promotion of breastfeeding. The need to flag up the effects of medication. The need to consider the high proportion of older people in Devon who live in rural areas and to address access and transport issues within the framework. The need to consider the particular needs of carers i.e. increased care responsibilities following a fall or if a carer themselves falls. The essential role of the GP to provide information, referrals and support. Reducing Falls and Preventing Fractures Fusion consultation report December 2012, Executive Summary Kelly Mavro Fusion/Engagement Contract/ Gateway/ Consultations/ GR-1012-RFPF 2 Appendix 1 – participants top 4 priorities Information is well distributed. Ensure assessments after fracture ARE undertaken Joined up services and information between Health and Social Care, GPs, Voluntary Sector when needed. Integrated services Holistic treatment of patients (to include carer) Education – school curriculum, GPs, mums (new births) Provision of specialist referrals /medication reviews/OTs recruitment/Consultants/Quality of products Money for falls prevention awareness day that is already being carried out by Devon Senior Voice. Integrated services including clinics for several potential risks under the one roof. Perpetual information and advice Follow up services after incidents and/or falls Make a standard blood test of bone density. Automatic knowledge of the effect of multiple medications such as wooziness. Introduce physical exercise Make a publication available about falls prevention Promoting good bone density with adequate provision for breast feeding. Disability adaptations Promotion of exercise especially Tai Chi Equal attention given to the emotional and physical limiting effects of a fall. Communication and information Training Prevention work not follow up Better understanding of impact Testing of people who are postmenopausal age, possibility of using a mobile clinic More falls prevention exercise classes Education of children about diet and food. Assessments Follow up Information Financial help Training by information Education by information Communication by information Action through information Bone state House and garden state Breast feed Exercise Appendix 1 Reducing Falls and Preventing Fractures Fusion consultation report December 2012 Fusion/Engagement Contract/ Gateway/ Consultations/ GR-1012-RFPF 3 Information / education Review Torbay Fracture Liaison Service to try to implement it as it stands or what could be taken out and used, Monitoring on going follow up Regular reviews and any new information/techniques to be incorporated. Improve dropped kerbs, the drainage to avoid the water splash and reduction in height of pimples or a half and half paving. Greater awareness of what is available as shown by Dementia pathways for carers or sufferers of dementia. Improve exercise and diet education in schools at all ages. Enable greater self help facilities to be available. Magic wand Scanning for all post menopausal women for osteoporosis Better information for GPs to pass on to patients More support for people who suffer from loss of confidence or depression as a result of accident Promotion of exercise especially Tai Chi as good for balance. Services to work together for the good of everyone Follow up support for people who have had falls. Difficulty with finances for person who has had fall. Routine blood tests for signs of osteoporosis Home [sp. Assessments?] Bone strength Diet and exercise balance Follow up after hospitalisation – GPs Joined up services (so saving monies).This must include hospitals e.g. two way exchange of information Implementation in every A & E department of assessments on those presenting with fractures. Information - Good pathways, Care Direct Better or improved testing for Osteoporosis – e.g. bone density checks at same time as mammograms Improve ways of awareness and information Improve inter service communication Financial costs implications Fracture Liaison Services all over Devon eventually but start with highest evidenced first Useful to have assessments Reason Fracture Liaison Service is in Torbay and not throughout Devon? Lack of information – not knowing where to go as a carer when I go to hospital Costs of all this?? Provide Wii Fit type exercise equipment on loan – for people in their own home after tuition from physiotherapists Fracture Liaison Service everywhere Appendix 1 Reducing Falls and Preventing Fractures Fusion consultation report December 2012 Fusion/Engagement Contract/ Gateway/ Consultations/ GR-1012-RFPF 4 Clear pavement edges for visually impaired GPs to provide cards to patients on medicine that may cause dizziness Include hydrotherapy pools at all new build swimming pools Councils target those households with over 60s with awareness leaflets Maintain paths drop kerbs cut back hedges. Encourage GPs to run health awareness groups in their surgeries Awareness campaign about services already available like the Fracture Liaison Service and Care Direct Osteoporosis test for people with conditions or medication that makes a fall more likely. More local and affordable Falls Prevention exercise classes. Quicker response from OT department after a fall (3 months is too long) Free fall alarms for those unable to pay, particular in villages with no mobile signal Prioritise spending (at this point) on what has already been proved to work in other areas of the country Appendix 1 Reducing Falls and Preventing Fractures Fusion consultation report December 2012 Fusion/Engagement Contract/ Gateway/ Consultations/ GR-1012-RFPF 5 Appendix 2 Equality and Diversity Monitoring Information All participants indicated that their ethnic origin was ‘white British’. All participants were either retired or did not indicate their employment status. Appendix 2 Reducing Falls and Preventing Fractures Fusion consultation report December 2012 Fusion/Engagement Contract/ Gateway/ Consultations/ GR-1012-RFPF 6 Appendix 2 Reducing Falls and Preventing Fractures Fusion consultation report December 2012 Fusion/Engagement Contract/ Gateway/ Consultations/ GR-1012-RFPF 7