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News and updates from today's Falls Prevention and Management in Older People Conference

Following the chair's introductions, Dr Martin Vernon National Clinical Director for Older People and Integrated Person Centred Care NHS England Consultant Geriatrician and Clinical Director Central Manchester University Hospitals NHS Foundation Trust, presents a session on ' Changing care systems for people with frailty' covering:

• ensuring all clinicians acquire the knowledge and skills appropriate for safe and competent care of older people with comorbidities and frailty
• improving integration and joined up working

Dr Vernon comments ""What I want to talk about, what we’re doing at NHS England at the moment. What I can tell you is what’s out there already,

"I just want to talk through why frailty is important and where we are headed next. What we’re doing at the moment is really hard and where were heading in terms of population and their health demands means that is going to be increasingly difficult.

"It’s about trying to figure out the best way to meet the needs of the older health population.

"The thing about the ageing demographic is not just that the population is ageing, and there are more older people around - the 85+ end of the population is the most rapidly expanding point of the population as a whole - but, the new entrants into the population are falling off too. Those are the people we rely on to provide the future health workforce. Those are significant challenges and its worth looking at both ends of the population spectrum. 

"I’m interested in upstreaming some of what we do now, in terms of keeping people fit and healthy, to the older strata, and making sure they are fit and old. 

"In the next few years we will be looking at well over a million people over the age of 90 in England.

"Coping with the increasing demand within a system that is constantly trying to improve and reorganise itself is a constant challenge. 

"I think stopping people sustaining injuries is one of the most effective ways I can assist in dealing with some of the pressures on the system that we have got.

"People who sustain falls and injuries tend to have impacts, even if those injuries are not fracture-related. If we can prevent these things happening in the first place we can prevent the problems in front of us, including the difficulties in funding social care in this country.

The NHS was originally designed with a retirement age of 65 in mind.

"At the moment we are seeing an extension in life expectancy, but some of that is at the expectance of chronic disability. 

"One of the key challenges for older people is remaining connected to other parts of society and the community.

"This isn’t just about fixing the system now, some of the investments we have to make now should carry us forward. I’m invested in ensuring the health services is fit for purpose for the next 30, 40, 50 years. The only way we can do that is to reduce demand through prevention and to optimise the current care systems we have in place.

"Not all people who are old are frail and not all people who are frail are old. That’s an important thing to keep in mind. We characterise it as a long terms condition, it’s not curable, but it is manageable

Dr Vernon's Abstract:

The ageing population is everyone’s business. Frailty and multi-morbidity are here to stay and to address this we must align care systems accordingly. The new GMS 2017/18 contract in England represents a major step forward in enabling us to do this. By routinely identifying frailty at population level and understanding the trajectories of populations and individuals we will understand how to best design and scale service responses.  This will only be achieved sustainably if we  collaborate effectively together with everyone is playing to their strengths. This involves coordinating efforts across health and social care systems to achieve best return on investment and reduce unwarranted variation. We must  focus on the things most likely to benefit at scale and be aware of our blind spots.

Dr Martin Vernon's biography:

Martin qualified in 1988 in Manchester. Following training in the North West he moved to East London to train in Geriatric Medicine where he also acquired an MA in Medical Ethics and Law from King’s College. He returned to Manchester in 1999 to take up post as Consultant Geriatrician building community geriatrics services in South Manchester.

Martin was Associate Medical Director for NHS Manchester in 2010 and more recently Clinical Champion for frail older people and integrated care In Greater Manchester. He has been the British Geriatrics Society Champion for End of Life Care for 5 years and was a standing member of the NICE Indicators Committee.

In 2015 Martin moved to Central Manchester where he is Consultant Geriatrician and Associate Head of Division for Medicine and Community Services. He also holds Honorary Academic Posts at Manchester and Salford Universities and was appointed as Visiting Professor at the University of Chester in 2016.  In 2016 Martin was appointed National Clinical Director for Older People and Person Centred Integrated Care at NHS England.

Conference chair Prof Cameron Swift Emeritus Professor and Consultant Physician King’s College London & Specialist Committee Member Falls Prevention Quality Standard NICE, continues the morning with a session on 'Assessment and prevention before and after falling: The 2017 Quality Standard update for Falls in Older People' covering:

• the quality standard for falls assessment and secondary prevention in older people: where are we now?
• the new Quality Standard for Falls Prevention
• implementation challenges and successes
• monitoring progress against the national standard
• meeting the Quality Statements in practice

Prof Swift comments: "Guidance on falls prevention was first issued in 2004 and the focus then was primarily on ‘community dwelling’.

in 2014 there was an updated review of the evidence, and interesting enough, there wasn’t a lot of new evidence that changed the guidance. I want to stress the importance of evidence in underpinning any guidance.

"You will never be able to prevent 100% of falls in hospital wards, it cannot be done. What the quality standards are, are high-level audit measures for one to improve one’s own standards, and provide data to compare with others.

"They are are maximally evidence-based and that is one of their strengths. Evidence doesn’t go away with politics and where possible its tremendous to be seen in the context of national data collection.

"I think you need, what I call ‘binocular vision’, when you are looking at the falls phenomenon. You need to perceive that it is a threat, but also, that it is a signal. It is one of the symptoms of frailty. We need to do that because there’s evidence falls can be prevented, and we can use these signals to identify underlying health needs. We need to take the evidence that comes out of the assessment process and treat it, and deal with it. Intervention at the right time."

Prof Cameron Swift's Abstract:

National Guidance on falls prevention has been in place since 20041,2,3, in spite of which national audits continue to indicate unacceptable variation and deficiencies in the commissioning, organisation and delivery of care4,5.   A further update of QS863 has been published in January, 2017. Provision of an effective falls service hinges on (1) A clear understanding of the significance of falls and falls risk as an age-associated syndrome; (2) Careful adherence to evidence in the interventions provided; (3) Crossing all necessary disciplinary and organisational boundaries in service configuration; and (4) Routine measurement and documentation of the results of the service.  The evidence for the contemporary importance and cost-effectiveness of progressive, well-run services is robust and compelling.  The challenges and opportunities for leadership are clear.

1. National Institute for Health and Care Excellence, 2013 (June). Falls in older people: assessing risk and prevention. NICE Clinical Guideline 161.

2. Swift CG, Iliffe S, 2014 (Dec).  Assessment and prevention of falls in older people – concise guidance.  Clinical Medicine 2014 Vol 14, No 6: 658–62

3. National Institute for Health and Care Excellence, 2015 (March).  Falls in older people.  Quality Standard (QS) 86.

4. Royal College of Physicians. Falling standards, broken promises.  Report of the national audit of falls and bone health in older people.  London: RCP, 2010.

5. National Institute for Health and Care Excellence, 2013.(March)

Prof Cameron Swift's biography: Cameron Swift is a physician and clinical pharmacologist, Emeritus Professor of Health Care of the Elderly at King’s College School of Medicine, London, a former Chair of the Editorial Board of Age and Ageing and former President of the British Geriatrics Society.  He served for 6 years on the Committee on Safety of Medicines and was a member of the UK Medicines Commission from 2001-5.  As Physician to the DOH External Reference Group for the England National Service Framework for Older People, he chaired the Working Party for Standard 6 (Falls & Fractures).   Subsequently he served on the NICE Clinical Guideline Development Group (GDG) for Falls Prevention (CG24/161; 2004/2013), and has been Chairman of the NICE GDG, & subsequent Quality Standard Topic Expert Group for Hip Fracture (CG124, QS86)(2011, 2012).  He remains involved as an expert member in current updates of NICE guidance (2014) and Quality Standards (2016-17) on both of these topics.

Afternoon chair SM Paul Burton Elderly Prevention Lead Hampshire Fire and Rescue Service, opens the afternoon with a focus on 'Reducing falls at home and in the community' looking at: 

• using Hampshire Fire and Rescue Service’s knowledge of prevention techniques to support local Health services
• helping elderly people stay happy, healthy and remain in their home safely
• STEER (Safety Through Education and Exercise for Resilience) course
• Falls Prevention Champions

SM Paul Burton comments: “For the last two and a half years I’ve been looking at how the fire service can be involved in various aspects of health. We’ve now got the tag line, 'fire as a health asset', and that’s not just in Hampshire, it’s used wider than that. So first off, I would recommend that you get in touch with your own local fire and rescue service and see how the work they are doing can help support you and your work.

"We’ve been visiting homes around the UK for about 17 years now. To start with, that was predominantly to fit smoke alarms.

"Our Falls Champions and Friends programme, is about increasing awareness in the community of why people fall in the first place.

“Although we have diversified the types of incidents we are going out to, we are now a fire and rescue service, not just a fire service. 

"Up to around about the 90s fires and fire-related death was increasing, so somebody somewhere said, how do we react to that. With more fire engines? More firefighters? More fire stations? Bigger and faster fire engines? Bigger water jets? do you see where I’m going with this? Or you could choose prevention. And we did.

“We recognise that there’s a demand for health and social care increasing, there’s lots more adults and children living with long-terms conditions, and we know there’s an ageing population. Placing prevention at the centre of that can only be a good thing. 

"One of the ways we came up with that we can approach that is through our Falls Champions and Friends programme. We sat down with our county council and partners at Southern Health, and we basically pinched the dementia friends model, and applied it to falls prevention. 

“We’re just a small piece of a massive jigsaw, and we know that, and we know where our boundaries lie. But I think that where we are at the moment sits perfectly with what we’re doing and where we want to go in the future.£

SM Paul Burton's biography:

Paul Burton is a Station Manager for Hampshire Fire and Rescue Service (HFRS). He is responsible for delivering the STEER and Falls Champions programme for older people in Hampshire. He explores and develops how HFRS can reduce the number of older people in the community sustaining injuries from falls and exploring ways fire and rescue can assist. He is also responsible for other prevention workstreams, run by HFRS, to help make Hampshire residents healthier.

Also of interest:

Falls Prevention Summit 2017: Reducing Inpatient Falls & Harm from Inpatient Falls
Friday 7 July 2017 
De Vere West One Conference Centre, London


10 May 2017


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