Agenda item

Prevention of Falls Work

Meeting of Health and Care Scrutiny Committee, Friday, 25th October, 2024 10.00 am (Item 6.)

To receive and consider a presentation on the Prevention of Falls Work.

Minutes:

Background:

Item presented by the Head of Adults Services.
The Falls Prevention work carried out in Powys was a collaborative approach with Powys County Council’s Social Services, Housing Services and Community Equipment Store and Powys Teaching Health Board and the Third Sector.
Falls were the second leading cause of accidental injury or death worldwide. Each year in Wales 1 in 3 people over the age of 65 would fall and 1 in 2 people over the age of 80 would fall. The demography of Powys meant that this was a significant issue for the Service.
Routine enquiries and Assistive Technology would go through to the ASSIST team who would ask about falls and organise assistive technology such as careline alarms and falls alarms to prevent long lies on the floor. 361 people were signposted to Falls Service.

If people were reporting to be at risk, self-referral was encouraged or support to refer would be given by the call handlers to Powys Teaching Health Board’s Fall Service.
Out of the 720 individuals receiving technology, 361 were provided with technology-enabled care to help manage the risks associated with falls.

Mobility Assessment and Rehabilitation:

The process of support would begin with a Multifactorial Falls Risk Assessment by Powys Teaching Health Boards Falls Service.

Tailored interventions were then provided based on the results and necessary referrals to the relevant professionals made. This was a preventative approach which addressed possible causes of falls.

Strength & Balance Training

Powys Teaching Health Board were currently setting up new specialist training sessions. An example of this would be the ‘Confident Strides’ Group in North Powys.

Home Hazard Adaptations

Making modifications in the home was essential. Work with the sensory impairment team, housing services and care and repair work collaboratively to understand the needs of the resident to provide small, medium and large adaptations that could improve the accessibility of homes and significantly reduce the risk of falls.
Examples included the provision of grab rails, ramps, level access showers, lighting on stairs, stair lifts.
Enabled residents to stay in their homes significantly reduced the risk of lost independence and care costs for the Council.
According to a report from the UK Government, installing home adaptations could save Councils £4 for every £1 invested.
Home adaptations allowed quicker hospital discharges and support to domiciliary care providers to provide support in a safe environment.

Community Equipment Provision

The service worked with the Community Therapy Team, Occupational Therapy Team, Sensory Impairment Team and District Nurses to provide adaptations and reduce falls. All these teams accessed Millbrook; the Community Equipment Store so that mobility aid chair raises, toilet frames, community beds and other equipment was available to meet needs and reduce falls in the community.
In 2023-24 the Community Equipment Service visited 5,760 individuals in Powys.
The Service had their own domiciliary care providers and Sensory Impairment Team who worked with older people with visual impairments to improve mobility and reduce falls risk.
Mobility rehabilitation and encouragement of community participation were also methods for reducing falls.
Reablement Teams and the Social Worker Teams work with individuals, carers and care agencies to ensure that the right level of care and support was provided so that risks due to inadequate nutrition and hydration were reduced whenever possible.
Most people who receive a reablement intervention see a decrease in the package of support, so it was a priority service for the Council.
The teams also worked with GPs and District Nurses to provide help in a timely manner.

Exercise

Exercise could significantly reduce the risk of injuries and falls. Therefore, access to leisure facilities and activities could reduce the number of older people at risk of falls and reduce the cost of higher levels of support from Health and Social Care.
The National Exercise Referral Scheme and Access to Fitness Scheme ran in Leisure Centres throughout Powys and it was being looked at how this could be expanded to other community venues in Powys.

Issues Raised by the Committee:	Responses Received:
What adaptations to properties were offered following a fall, who would complete the work and what would the budget be? How long would it take to install these adaptations from knowledge of the fall to completion of installation?	A large variety of adaptations were offered by Powys were described in the presentation. Larger adaptations would be sourced through the disabled facilities grant. The service was waiting for translation for an ‘aids and adaptations’ page for the website where residents could see the range of adaptations available for them to purchase themselves. Length of time was dependent on the work that needed to be done. Immediate requests could be received, with a turnaround time of 24 hours. Regarding the budget, there were several different budget sources from several grants, further details could be provided outside of the meeting.
The Committee requested a deep dive on this topic to analyse the costs of adaptations, budget streams and to receive an analysis on the relevant cost efficiencies.
The Committee asked if the timeframes were a challenge and if there were enough resources to meet time frames. How efficient was the system?	On the whole feedback was positive. Marketplace availability of equipment could cause issues at times. The Community Equipment Store Board oversaw the efficiency and effectiveness of the store, measuring timeliness by tracking from referral to the point of delivery. Led by officers from Powys County Council, Powys Teaching Health Board, Millbrook, Care and Repair.
Was support offered to residents who used the wrist and neck fall detectors to ensure confidence and competence in use?	Yes, each resident would have a review, and an officer would go through equipment with them. Feedback would be sought from family and canary systems could be in place to monitor movement to provide reassurance for families.
How did falls work harmonise with hospital discharge teams and how quickly could adaptations be implemented for further preventions?	24-hour requests usually came from hospital discharges. Teams were completely linked across the Occupational Therapists and the Reablement Teams.
The Committee requested assurance that the 24-hour requests were met and did not hold up hospital discharges.	Assurance was given. The Head of Adults Services sat on the Discharge Meetings twice per week and the Patient Flow Meetings on a weekly basis. Only once had a concern been raised regarding the provision of equipment over the last 18 months.
Were there other home adaptations which were not covered under ‘slips, trips and falls’ and so would be more complex and timelier due to being under a different income stream?	Yes, the Disabled Facility Grant would cover larger pieces of work where there were significant adaptations within the structure of the home and could take longer.
Would equipment be collected once it was no longer needed? Was there an infection control process in place if equipment was to be brought back?	Collection of used equipment was carried out, but further information would be sourced regarding which equipment. - ACTION
Was there assurance that Care Line Alarm systems were working?	The Care Line Alarm Systems were being reviewed constantly. Concerns were raised in the performance report regarding issues with sensory impairment equipment, so the service was working with the manufacturer to reduce impact.
The Committee requested further understanding of the arrangements between Powys County Council and Powys Teaching Health Board. Including the financial arrangements and the number of people who had gone on to fall following intervention of the Falls Prevention Service.	The Service could access central grants but there was a combined budget from Powys County Council and Powys Teaching Health Board that went into the equipment store for different levels of equipment. Details regarding the budget were not to hand. A Falls Group monitored and researched the number of people who went on to fall following support from the service. Officer to provide more information in writing - ACTION
The Committee requested an update on the Care and Repair Budget following concerns that there was a gap in the budget.	The demand for this service was increasing year on year and work was currently being carried out to understand what funding stream could cover this gap in funding. A meeting had been held last week and the Head of Adults Services was confident that this gap in funding could be covered.
Had Adults Services been involved in discussions around the review of the leisure services?	Yes, regular conversations were held around the Leisure Review. It fed into the work being done in Day Opportunities and Place Based Planning; making use of community assets across the county for ensuring the activities were connected to provide adequate information for members of the public to access.
The Committee requested an annual report containing the monthly data of equipment availability, stock on order, collection of used equipment and data demonstrating budget and availability.	The data was available and could be shared easily. ACTION
How much money did the service save by completing adaptations in a timely way?	Often cost reductions were seen elsewhere in the system, e.g. The Welsh Ambulance Service. There was a lot of data and modelling regarding this which could be shared with the Committee. The main highlight was that for every £1 spent, £4 was saved.
The Committee sought assistance from the Service during the deep dive to identify trends in the monthly performance reports that highlighted savings achieved through preventive measures.	This was looking to be developed in the new revised data which would be shown in future monthly performance reports. It was noted that savings were increasingly difficult to see due to increased demand on services.
The Committee asked whether the savings could be better demonstrated if data was presented as a population percentage.	Yes, there was modelling that could be used, it just needed to be applied. It was noted that there had been an increase in nursing home and residential beds commissioned this year and the service had supported 50% of residents who had fallen to return home due to reablement work, growth of the domiciliary marketplace and resources. This was a 40% increase from the previous year.
The Committee asked for guidance around how it could support the service during Deep Dives.
What role could Community and Town Councils have in sign posting?	The Service shared a lot of information with town and community councils and having Link Officers would mean that information could be shared more easily going forward.

Supporting documents: