The national Public Health Outcomes Framework Fingertips Data for 2020-2021 evidenced that Hounslow had the highest falls incidence of all London Boroughs. This incidence was also significantly higher than national data, and this pattern had been reoccouring for five years. Falls-related emergency hospital admissions were also higher than the national average and were increasing. Falls in Hounslow affect those in the 65-79 age group and 80 years plus group.
Research and engagement
Research was carried out with Falls Services in the London Borough of Hillingdon, London Borough of Barnet and Dudley NHS Foundation. These findings and insights informed the design of the new Falls Service in London Borough of Hounslow. Due to time constraints, engagement with the public and patients was not possible.
New Service
The Hounslow Falls Prevention and Bone Health Service launched on 31 January 2023 with a singular referral pathway for those at risk of falling, and those who have experienced a fall. The primary purpose is to prevent avoidable falls and subsequent admission to hospital in people aged 65-79.
The service is focusing on the over 65s, but referrals are open to residents 50plus for bone health.
All referrals go through a singular clinical referral pathway and are assessed by a triage team. Further referrals will then be made for the appropriate support e.g.: SDEC, Physio, Occupational therapy, dietitian, oral health, hearing/speech therapy, strength & balance classes, home safety assessments, home fire safety assessments, and social prescribers.
This model is the first of its kind in England, and its objectives are:
• Greater focus on prevention and early intervention and improved quality of life for residents
• Reduce incidence of first and subsequent falls amongst the over -65’s
• Reduce falls related emergency hospital admissions amongst the over -65s
• Be proactive and systematic by recognising and responding to the wider signs of frailty and increase social interventions.
• Reduce avoidable demand and cost within the health and social care system by investing in prevention and early intervention
Evaluation includes:
- Patient Engagement
The project is still in its first year and has just initiated its first round of engagement with service users. The Public Health Insight and Evaluation Team supported with the development of the questionnaire, a system for gathering feedback, plus analytical oversight.
- Baseline Data
• PHOF (fingertips) (nationally sourced).
• West Middlesex University Hospital falls data – includes a comprehensive coding system, which will help calculate all falls as opposed to the PHOF primary reason.
- KPI's
Monitored monthly; presented at monthly oversight meetings and quarterly steering group meetings. Patient engagement undertaken every six-months. The project will also undertake annual reviews.
Key Learnings
Learnings from the monthly monitoring and six-month patient engagement exercise has evidenced:
• Patients’ feedback was very positive overall; patients found the service and staff friendly, helpful, beneficial for their health and have experienced improvements in their balance and confidence for everyday tasks; Notes improvement requests were increasing the number of Strength and Balance exercise classes offered
• A September public engagement campaign resulted in many residents researching the London Borough of Hounslow falls website and the Falls Service experienced extra enquiries directly from patients during September.
Overall the Population Health Management Framework (PHMF) helped identify where additional research would benefit project development and once completed the PHMF is a quick and easy project reference point.