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Better support for patients at risk of falling highlights greater focus on prevention

Health and social care leaders in Gloucestershire have highlighted a greater focus on preventing illness and injury in older age and on developing community support across the county to help people stay independent for longer.

Services have been working together to offer better advice and support to older people in particular, who are at the greatest risk of falling. In Gloucestershire, the number of older people is increasing, and about 35,000 people fall each year, often resulting in distress and loss of confidence, independence and mobility.

A number of initiatives to support people in their own homes are now in place. One great example of partnership working to reduce harm from falls is between the local NHS, county council social care and Gloucestershire Fire and Rescue Service (GFRS), who are advising people on how to make their homes safer on their regular visits.

Gloucestershire Fire and Rescue Service carried out over 6,000 home visits to people last year and all three partners have been keen to work together to ensure these home visits cover key messages.

Councillor Dorcas Binns, Cabinet Member for Older People at Gloucestershire County Council said:

“We know, across the country, that older people are at more risk of both falls and accidental fires at home. That’s why we brought together the council’s social care teams with our fire and rescue service, and with the NHS Clinical Commissioning Group, so we could all work together to fight both problems.

This partnership has enabled the Fire Service to expand what they cover during their Safe and Well visits. Along with the usual fire safety checks, they now make sure older people are safe at home from other risks. They identify potential trip and slip hazards and carry out basic falls risk assessments and refer to specialist teams when needed. They can also give advice on staying active and hydrated and help people link up with other sources of support in the community. Firefighters are brilliant at this – they’re both really well trusted and very experienced in spotting and explaining risks.”

Gloucestershire Fire and Rescue Service also now act as Telecare responders for people who don’t have anyone else that can respond for them. This service has enabled people to stay in their homes longer and reduced the need for care home placements.

Other initiatives across the county include activity and active balance classes, which can help people to maintain their mobility, as well as more intensive help, such as health assessments and medication reviews.

More emphasis is also being given to community-based services to support people when they do have care needs. Most patients prefer to stay independent and in their own homes, rather than be admitted to hospital, and the county’s Integrated Community Teams (ICTs) are helping people to do this.

These teams combine the skills of community nurses, occupational therapists, physiotherapists, social workers and reablement workers who work alongside GPs, mental health staff and voluntary and community organisations to provide care for people with a variety of issues, such as arthritis, diabetes and frailty. They can also give health advice, support and reassurance to patients and carers, actively supporting patients or their families to manage their own care.

Community Manager at Gloucestershire Care Services NHS Trust, Melanie Richmond, said:

“Our focus is on supporting and enabling patients to remain in their own home instead of going into hospital. In my community area, Tewkesbury, the team has over 1,200 face-to-face patient contacts per week, and across the county we have in excess of 10,000 patient contacts per week.”

The Rapid Response Service, known as a ‘hospital at home service’, also helps patients to remain in their own home. It provides urgent and specialist care, sometimes within one hour, in times of crisis, and is available 24 hours a day, seven days a week across the county.

Gloucestershire Care Services NHS Trust’s Clinical Lead for the Rapid Response Service, Kathy Cambell said:

“On average, the team is now caring for 60 patients per week, and over 80% of these people will avoid an admission to hospital whilst they recover. The team have advanced clinical skills to assess and treat people with conditions such as an acute kidney injury, COPD, bladder infections, blood poisoning (sepsis), and other infections which require oral or intravenous therapy.

The Rapid Response team also provides care for frail adults, terminally ill patients, and people who have had a fall that is likely due to an underlying medical condition.”

New hospital services have also been introduced to provide same day assessment and treatment and reduce the need for hospital stays.

The Older People’s Advice and Liaison Service (OPAL), led by Consultant Geriatricians, provides intensive medical support to older patients in Gloucestershire’s two large hospitals to improve quality of care and avoid hospital stays where appropriate.

Gloucestershire Hospitals NHS Foundation Trust Consultant in Older Person’s Medicine Dr Ian Donald said:

“Patients are assessed immediately so that they can be given the care and treatment that best suits their needs, often avoiding hospital admission. We can do this, for example, by putting arrangements for community support in place. For patients who are admitted, care planning and treatment start immediately. Many patients are seen and discharged either without staying or with just a one-day stay.

A short attendance at the hospital for some rapid investigations for those with frailty helps get an accurate diagnosis which then supports the community services delivering care back at home.”

Moving forward, we believe we will continue to place greater emphasis on prevention of illness, support more self-care, provide more joined up care and support in the community. This is reflected in Gloucestershire’s Sustainability and Transformation Plan (STP).

To read more about the STP, leave your views and find out about how you can get involved visit the STP website at: www.gloucestershireSTP.net

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