Brent CCG is setting up a small new Consultant Geriatrician led Community Falls Prevention Service starting in November 2016. There will be a 3 year contract costing around £340,000 per year. The staff of 5 to 7 is to include an Occupational Therapist, Physiotherapist and Fracture Liaison Nurse.
Brent Patient Voice welcomes this new initiative. It appears to us to be just the type of incremental improvement to local healthcare that Brent CCG can provide quickly and efficiently for an important need for Brent patients. It stands in contrast to the grandiose “Sustainability and Transformation Plan” for NW London recently released by a reluctant NHS.
At a patient workshop on 4 August 2016 led by the Brent CCG Clinical Director and Cricklewood GP Dr Sameer Khurjekar and team leader Harrison Spencer it was reported that about 1,200 Brent patient falls fracture cases are admitted to hospital costing about £3.2 million a year. It is not nice for the patients and their carers since fractures can change your whole lifestyle.
It has not yet been decided where the service will be provided or whether it will include weekends to assist the working population take elderly relatives to classes and appointments. These accessibility issues will be important if the new project is to have a positive impact. Individuals will be referred to the service by GPs and similar for assessment. At the same time Brent Council with its public health responsibilities will have a key role in educating people to take simple precautions to avoid falls such as holding on to rails and wearing shoes and slippers with grippy soles.
More details about the medical background to falls and what a prevention service can do are in the Annex below.
15 August 2016.
Annex with more details for keen readers
A specification for the service has been drafted and the contract tender process to find a provider is being pursued . The service is to be provided only by healthcare professional referral into a ‘triage’ assessment within the service. It is not clear to us yet how this will fit in with the new Brent Referral Optimisation Service triage process, nor how it will fit in with the proposed new Brent over-arching primary care Accountable Care Partnership to be provided through the new Brent Care Limited set up by the 66 Brent NHS GP practices.
The context for this initiative is that the Department of Health 2009 statistics show 1 in 3 people over 65 experience a fall each year. 75% of falls result in injury and 10% of falls result in fractures of which 1% are hip fractures. Nearly 20% of people die within 3 months of having a hip fracture. It is hoped that this new service will prevent about 10 – 20% of Brent falls.
Referral to this service is likely to be mostly triggered by a fall. This service is not designed to raise general public awareness of the risk of falls. Brent CCG responsibility for this public health concern is shared with Brent Council. The NHS England new ‘Five Year Forward’ policy calls for a switch of emphasis to preventive healthcare. We believe that Brent CCG should be doing more towards prevention of falls and improving bone health.
There are clearly many reasons for such falls.
Amongst other reasons most elderly people will not realise how seriously their balance has deteriorated just from the ageing process. The 2007 paper by Springer and others of the Walter Reed US Army Medical Center showed how fast balance falls off with ageing on the timed one leg standing test. Carried out with eyes open for men aged between 18 and 39 the mean was 43.2 seconds, for men aged 50 to 59 this dropped to 38.1 seconds. For men aged 70 to 79 this had dropped to 18.3 seconds, and for men aged 80 to 99 it had dropped further to 5.6 seconds. For women here was a similar but not quite so steep deterioration.
Poor vision is often a large part of loss of balance. The NICE June 2013 ‘Falls in older people: assessment and prevention’ found no firm evidence that treatment of visual disturbance as a single intervention reduces falls but agrees it is good practice to treat impaired vision where found.(para. 188.8.131.52).
Harvard Medical School in 2015 ‘The health benefits of tai chi’ recommends this Chinese exercise for the elderly as improving balance and preventing falls.
Bone health clearly plays a part in the incidence of fractures on falls. On 21 July 2016 the National Institute of Clinical Excellence (NICE) recommended that all the UK population over the age of 1 should be taking vitamin D 10 microgram dietary supplements, for children all year round and for adults between mid October and April when there is insufficient sunlight in the UK for the body to manufacture enough vitamin D. Vitamin D is important in calcium uptake for the formation of healthy bones.
The link to the workshop paper is https://uk-mg42.mail.yahoo.com/neo/launch?.partner=bt-1&.rand=7056pkaulittr#mail