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.
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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