What is the issue?
Across the United Kingdom (UK) there is an ageing population and a growing trend of older people falling and accessing emergency Ambulance Services through the 999 system.
Within Northamptonshire, the Ambulance Service was reporting an increase in calls from older people who had fallen. A fall can have a devastating effect and can precipitate accelerated admission to long term residential care.
How did you address this?
The aim of the Crisis Response Falls Service was to provide a person centred approach at the time of a fall, which enabled older people to remain at home, recover and regain independence through reablement. An initial clinical screening to identify emergency or acute needs that require health care interventions was key. This new service presents a range of educational challenges to prepare health and social care professionals working within the service. The developed educational approach addressed requirements around knowledge, skills and attitudes in keeping with the operational aims. Fundamental to the success of the project was the promotion of shared health and social care learning. A range of staff working within the service completed a Level 4 module, which was co-delivered by key professionals within the partner organisations and University based staff. The innovative approach of this service was to place clients at the centre of all support and interventions and work collaboratively to support a ‘seamless’ client experience, which was comprehensive, tightly co-ordinated and smooth.
Proposed education interventionThrough the development of the Crisis Response Falls Service educational development and provision that adequately prepare the professionals who are going to work within the service is a key factor in overall success.
Working across health and social care boundaries can be challenging and requires professionals and educationalists to openly discuss professional concerns, whilst challenging historical roles and practices.
Educational modules must enable people to explore roles and develop trust in one another.
Partnership working and the involvement of Workforce Team (HEEM) and Health Education East Midlands has been essential in building upon the vision of NCC and the wider dissemination of the service within the East Midlands.
Benefits to patients and serviceA drop in the numbers of patients who were conveyed to hospital following a fall was observed when conveyance rates were compared for the CRT service delivery timeframe with that of the previous year which was statistically significant. The conveyance rates for patients to hospital were lower during the hours that the falls ambulances were in service, than when general ambulances were running. The feedback from patients was overwhelmingly positive; interventions were considered timely and staff were considered friendly and well-informed. The majority responding to the questionnaire felt that they were respected, treated with dignity and appropriately consulted; 87% of CRT service users felt the team had enabled them to have choice, control and independence. The social support offered by the service was seen as a particular benefit to patients.
Although the Crisis Response Falls Service has been designed to respond to older people who have already fallen, it is acknowledged that primary prevention is an important aspect of health and social care approaches. With the support of HEEM and flexible funding, The University of Northampton has linked with partner organisations, including Acute Trusts to develop a cascade training package for registered and support staff working in older adult care. This package, ‘Falls Positive ™’ uses a patient story and service user representation to identify key risks for falls and a range of practical interventions to reduce risk.
Dr Michelle Pyer & Ashley Knights
Senior Researcher & Senior Lecturer Paramedic Science
Institute of Health & Wellbeing
The University of Northampton
Telephone: 01604 892831
Crisis Response Falls Service, Olympus Care Services
Crisis Hub, Highfield Centre
Crisis Hub (Older People), Northamptonshire Healthcare NHS Foundation Trust
Crisis Hub, Highfield Centre