Statistics show that while 50% of adults aged over 80 will fall at least once a year (National Institute for Health and Care Excellence), in care homes this is three times more likely to happen. In 45% of cases, the person who has fallen is uninjured (Cardiff University 2006) but the ambulance service is routinely called to assist with a lift. 

Older people falling accounts for more than 80% of all ambulance call outs (West Midlands Ambulance Service University NHS Foundation Trust) and ambulance wait times are on the increase. If a resident is uninjured, the ambulance service will appropriately categorise the call as ‘green’, which can lead to long delays before a paramedic arrives. 

Delayed recovery can lead to more serious health impacts for the resident. 20% of fall patients over 65 admitted to hospital have been on the ground an hour or more, and research indicates that 50% of these patients will die within six months (Vellas et al, 1997).

As a partnership, Powys Teaching Health Board, Welsh Ambulance Service Trust and Powys County Council developed a proposal which was successful in securing additional Value Based Health Care Funding in 2022/23. Familiarisation sessions were delivered to care home staff in Powys (led by WAST staff – see photo above) to reduce the number of emergency responses required by WAST for people who experienced a non-injury fall.

The sessions included the use of the I-STUMBLE app (to reduce the number of WAST calls by reducing the number of people who require WAST to pick them up, and to also reduce the number of people who are deemed 'long lay' and therefore are automatically conveyed to an Emergency Department). Noting that staff turnover can be high in some care homes, a closed familiarisation session was recorded to help staff retain their knowledge and to support new staff to understand I-STUMBLE. Qualitative data from care home staff was also collected as part of the shared learning and understanding.

In line with the non-recurrent funding, a total of 157 Care Home staff from 21 care homes attended falls familiarisation sessions across Powys in 2022/23 and were trained in how to use I-STUMBLE and how to safely lift a care home resident using a Mangar cushion. Feedback from care home staff about the familiarisation sessions was overwhelmingly positive. Six Goals for Urgent & Emergency Care Funding in 2022/23 was able to support the purchase of 15 Mangar Camel cushions for care homes which expressed an interested – these cushions allow care home staff to lift residents from the floor in certain circumstances.

Initial outcomes were positive: between November 2022 and April 2023, the data showed there were 25% less attended (by WAST) incidents for falls in the homes which attended familiarisation sessions versus those care homes that did not. Over the same period, data showed a 3% higher conveyance rate for homes which attended familiarisation sessions (60%) versus homes which did not attend (57%). The assumption that conveyance percentage indicates appropriateness of call to 999/WAST services; the higher the conveyance rate, the greater the suitability of that call in needing an emergency 999 response.

In terms of cost savings, the project identified that:

• the cost of attending an Emergency Department varies from £74 to £342 per patient (it is noted that Emergency Department is a hosted service and so this would not be cash releasing to PTHB but would be a system efficiency gain).
• Admission avoidance cost is based on £3,000 per admission.
• £259 saving to WAST per conveyance avoided plus additional non-financial benefits.

Over the intervening months and with the project ceasing in March 2023 due to non-recurrent funding, the number of calls related to falls and the number of conveyances has started to increase again. To provide a more sustainable approach, PTHB is now appointing to three Band 4 Assistant Therapy Practitioner Falls Prevention roles, part funded through the Six Goals for Urgent and Emergency Care, which will provide ongoing support to care homes. Initial discussions between WAST and PTHB have suggested targeting domiciliary care workers as the next cohort of staff should funding be identified.

In addition to the project above, PTHB has been working with partner organisations to revise its falls pathway, with the first phase looking at prevention. A single point of access, supported by a multi-professional, multi-disciplinary team is being established. An app has been developed to allow for a multifactorial assessment to identify which actions or services an individual may benefit from to reduce the falls risk. The PTHB Therapies Team is piloting the app, with the wider roll out of the revised pathway due to take place in early 2024.

Contact 

John.Morgan3@wales.nhs.uk, Transformation Programme Manager, Powys Teaching Health Board