27 November, 2009
Judith Mills, Blackpool Primary Care Trust
Of the local authority areas in England, Blackpool has the worst life expectancy for men.
The NHS Blackpool analysis of the causes of poor life expectancy highlighted that falls were a major cause of hospital admission, ill health and premature death in Blackpool. Older people on multiple medication, in an unsafe environment who have problems with their balance and gait and have fallen once, are at significant risk of falling again with worse outcomes.
This costs ambulance time, hospital Payment by Results (PBR) rates, has an impact on the capacity of community nursing, increases residential and nursing home costs and most importantly costs the individual, their family and friends through ill health and early death. In addition, older people were more likely to die or be injured on Blackpool's roads and more likely to die in a house fire.
A review of existing service provision identified that high-risk housebound people were excluded from the local falls prevention programmes that targeted medium-risk mobile patients. International evidence on effective interventions led to the commissioning of a range of cost effective and collaborative interventions in association with or through our local HIA (Blackpool Care & Repair), targeting those in greatest need.
These included the following measures.
Developing a Blackpool Decent Homes standard so that all new-build homes and refurbishment of RSL housing includes consideration of accident prevention
Joint training between agencies on falls, accident prevention, road safety, and home security, so that all frontline workers entering the home of a vulnerable adult are thinking beyond their own remit, to reduce accidents and hospital admissions
Changing the nationally developed Housing Hazards Assessment to develop a tool that a range of grass-roots workers can use to identify vulnerable people living in high-risk environments
Referral protocols and SEASHORE service established to make changes responding to the hazards assessment - Care & Repair deliver the SEASHORE project, a full environmental home safety check including risk factors for falls and fires. All staff are trained to undertake falls risk assessments and refer into the Falls Service. Interventions and practical measures include hand and grab rails, minor adaptations, security and falls prevention measures, draught proofing, smoke alarms, and replacing old or faulty electric blankets.
Care and Repair also organises major housing adaptations and link to the Affordable Warmth projects. This provides a quick response to home adaptations rather than people having to go on the waiting list for an assessment from an occupational therapist.
What were the results?
We have seen a reduction in hospital admissions from falls every year from 2005 to 2008.
What additional resource has this collaborative approach cost the NHS and the council? What are the savings being achieved?
The reduction in admissions for the period 2006/7 compared to 2005/6 (the date from which falls-related admissions were recorded) has saved £104 000. This has increased year on year.
The cost of this additional service commissioned from Care and Repair is £25,000.
As a commissioner
As the public sector purse comes under more pressure, NHS commissioners will need to further review how they spend the resources that they are responsible for, looking to identify ways of reducing hospital admissions and reducing length of stay in hospital and residential care. Home improvement agencies are in a fantastic position to be able to deliver cost-effective interventions to assist the commissioner to meet their targets of improving health, improving the quality of life of people in their area, and reducing the burden of ill health on primary and secondary care.
Hot tips from a fellow believer in HIAs
Times are hard at the moment, but it could be a good time to explore your contribution to PCT objectives.
Work with Public Health, use your Joint Strategic Needs Assessment (JSNA) and be sure of the need.
Build a relationship with PCT commissioners (older people, long-term conditions) and the Acute Trust - you can help them both make savings.
Ensure you research your evidence base (meta-analysis of randomised controlled trials - RCTs - is the best evidence).
Invest to save - cost it out.
Are there any services currently commissioned where you could do a better job, more cheaply?
If you would like to comment on this article, please contact Laura Ripper.
