An Overview of Falls Assessment Clinics in Gloucestershire

1. An Overview of Falls Assessment Clinics in Gloucestershire Denise Frost Irene Hardisty

2. The National Perspective “Despite the good mechanisms in place for identifying falls, it is not clear how widely used or effective they are, as the numbers attending falls clinics are surprisingly low (median 5 per week in consultant physician led clinics) considering that about 10,000 falls occur annually in the average sized PCT.” National Audit of the Organisation of Services for Falls and Bone Health for Older People 2006

3. Gloucestershire Falls Services Clinics • Clinics rural and urban • Leading professionals vary • Collaborative working practices • There are significant variations in how Falls Clinics are funded Patients • On average, 2-3 patients seen in each clinic • Patient groups predominantly female over the age of 75 • We estimate that about 700 patients are seen annually • Appointments can take anywhere up to 2½ hours

4. Key Physician Led Elderly Care Clinic Physio Led Coordinator Led 9 Clinics Countywide

5. The Falls Clinics

6. Referral Protocols • Referrals from a wide range of professionals, but mostly from GPs • Time from referral to assessment varies anywhere between 2-8 weeks • Inappropriate referrals are being made • Links are being made in some areas with A&E, hospital wards and fracture clinics, but these are inconsistent • Ambulance services have no strategy for referring patients

7. Services provided at Clinics * Elderly Care Clinics

8. Towards an understanding of the bigger picture Total number of patients who have fallen – unknown! ? 228 patientsseen inFAC 571 ambulancecallouts 548 hospital admissions ? ? June, July and August 2007

9. Issues for consideration (1) Standardisation of: • Referral procedures • Referrals from ambulance services • Screening procedures • Paperwork • Access to a physician • Waiting times • Patient experience at a clinic • Funding streams

10. Issues for consideration (2) Equity of service provision • Identification of fallers • Funding streams Developing sustainable pathways • Location of clinics defined by need • Links with A&E, wards and fracture clinics • Assessments in primary care • Doing things differently, e.g. using care homes

11. Active Balance Classes (1) • Referrals mostly from FACs • Waiting times anywhere from immediate start – 10 weeks • Transport is an issue in some areas • Classes are either on a rolling programme or run in blocks • Many have an educational component • 60% completion rate

12. Active Balance Classes (2) • Initial improvement in strength and balance • Improvement is not sustained if activities are not continued • Access to community activities limited • Anecdotal evidence from patients suggests that this type of activity is beneficial

13. Issues for consideration • Transport issues • How can mobility be maintained following the Active Balance Classes? • Making links with community based activities that are appropriate to needs and affordable

14. Thank you for listening We are based at the Triservices and can be contacted: On global email or Telephone: 01452 753014/3015