BETTER CARE TO PREVENT
FALLS AND FRACTURES WILL IMPROVE LIVES AND SAVE THE NHS BILLIONS
Thousands of
hospital admissions for falls and fractures among older people
could be prevented by better, more integrated care. If significant
improvements aren’t made to prevention services, admissions will
double and the NHS and Local Authorities will need to spend £6
billion a year on hip fractures by 2036.
Almost 90,000 hospital admissions a year are caused by falls and
fractures – primarily in older people – and the situation will
only get worse if the NHS doesn’t change, according to a new
report published today by Age UK and the National Osteoporosis
Society.
The report, commissioned by Care Services Minister Paul Burstow,
looks at how the NHS can improve care and reduce falls. This would
improve the lives of many older people and save the NHS money that
can be ploughed into other essential services.
The report also sets out how the future NHS structure will give
opportunities to improve care of people who suffer falls and
fractures, notably that:
clinicians will be able to design services to suit their
patients; Health and Wellbeing Boards offer an excellent
opportunity for holistic approaches to health, social care and
public health to be taken across local areas;financial incentives
for delivering better outcomes for patients will be available to
the NHS;
Paul Burstow said:
"A fall or a fracture can turn a person’s life upside
down. Action to prevent trips and falls is critical to turning the
rising tide of hospital admissions and costs."We also
know that the best practice in treating fractures can make a huge
difference to a person’s recovery both physically and in terms of
self confidence."Both prevention and treatment are at
their most effective when social care and the NHS work together.
Integrated care can go a long way to improve services for older
people. The Coalition Government is putting in place the legal
conditions and financial incentives to drive greater
integration."I look forward to continuing to work with
AgeUK and the National Osteoporosis Society to make progress on
reducing falls and improving the care of people affected by
them."
The report, Breaking Through: Building Better Falls and
Fractures Services in England, recommends that:
Local GPs and hospitals must work together with local
authorities to put in place better care programmes for older
people who suffer from falls and fractures.Local health leads
should run health campaigns on how people can look after their
bone health and prevent falls themselves.Local health leads should
offer financial incentives to improve care.A national database
should be set up to monitor non-hip fractures.
Michelle Mitchell, Charity Director General of Age UK said:
"Falls and fractures are a serious threat to older
people's health, wellbeing and independence, affecting
one in three people over the age of 65. Falls cause pain, distress
and loss of confidence and can be life threatening, yet they are
preventable."It is extremely worrying then that in many
areas of the country, people are not receiving all the care,
treatment and support they need to help them back to recovery and
prevent further falls from happening in the future."In
addition to the pain and distress caused to the individual, there
is an economic impact too; we have seen a 32% increase in the
number of bed days attributed to falls from 1998/09 – 2008/2009.
We know that by investing in specialist services that help older
people to avoid falling and breaking bones we can save the health
service money."The Government's has committed to
addressing this issue and we hope by working together we will see
an improvement to the current disparate services that exists;
enabling access for older people who are at their most vulnerable
to receive the help they need."
Claire Severgnini, Chief Executive of the National Osteoporosis
Society said:
‘1 in 2 women and 1 in 5 men over the age of fifty will break a
bone but many of these fractures are preventable. I am pleased
that the Minister is taking this widespread issue, with its
devastating consequences seriously, and welcome his commitment to
work with us to prevent falls and fractures.The National
Osteoporosis Society and Age UK are taking action and now we want
a commitment from others. We need health professionals, patients,
those who commission services and the Department of Health to work
together to reduce falls and fracture rates. Only by working in
partnership can we lessen the devastating effects that falls and
the resultant broken bones have on older people.
Finbarr Martin , Consultant Geriatrician at Guys and St
Thomas' NHS Foundation Trust said:
"The lynchpin of our secondary prevention approach is a
specialist nurse, who is able to perform both a brief falls risk
assessment and fracture risk assessment. Then they can directly
advise on treatment, or link up to other services in the hospital,
community health and primary care. This connects patients
initially presenting in one place such as the emergency
department, to the services they need elsewhere."
Guys and St Thomas’s offer an osteoporosis and falls screening
clinic which runs in conjunction with the daily fracture clinics.
This reduces the number of clinic appointments the patients have
to attend.
All patients that attend the fracture clinic are screened by the
specialist nurse and surgeons, for risk factors of osteoporosis
and recurrent falls. All patients over 50 years old are invited
for review by the specialist nurse. Those under 50 years old are
referred if risk factors are identified. This ranges from 25-100
patients per day depending on the season.
If identified as at risk, an in depth assessment is made, bone
density scans and blood tests are taken. The results are then
collected and the patients are either recalled for further
intervention, or contacted to be given the all clear.
The clinic has been running for the past four years and the role
has now expanded to cover all patients admitted under the
orthopaedic teams.
Bone health assessment and preventative treatments are measures
that can reduce the likelihood of a patient getting a fragility
fracture and should be prescribed for patients clearly at risk.
One of the cleverest signs is having a herald fracture. By
following best practice guidelines clinicians can reduce both the
number of patients having an initial fracture and the number who
go on to have a secondary fracture.
Following the best practice guidelines has driven up standards at
Kingston Hospital in Surrey which since 2010, has had a full-time
specialist bone doctor for older people. This along with doctors,
nurses, surgeons and anaesthetists working better together, has
led to improvements in hip fracture care. The average time to
surgery fell from 41 hours to 23.71 hours and average length of
stay from 21 to 14.5 days. Ninety-eight per cent of all patients
in the orthopaedic unit now have both fall assessments and
osteoporosis care.
ENDS
Other examples of hip fracture care improvement:
In Wansbeck and North Tyneside hospitals, Northumbria, a quality
improvement programme for hip fracture care began in October 2009.
90 per cent of patients in both hospitals now have surgery within
36 hours; all medically fit patients are mobilised on the day
following surgery; and by March 2010 90 per cent of patients were
meeting BPT care standards. In Wansbeck 30-day mortality has
fallen from 11.7 per cent to 7.7 per cent.
In Torbay, South Devon, a five-month project beginning in
November 2010 worked to redesign the entire hip fracture clinical
pathway in order to deliver prompt, patient-focused,
cost-effective care. Average time to theatre went down from 48 to
16 hrs; and acute length of stay from 10 to 7 days. Pain control
was improved, complications were fewer, and substantial efficiency
savings were achieved through reduced length of stay. Patient
satisfaction with the care provided was high.
Notes to Editors:
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Contacts:
Department of Health
Phone: 020 7210 5221
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