Preventing Falls and Frailty in Devon - Next Steps

The following information is based on the feedback from the 72 people who attended the Falls and Frailty Workshop  on 11th December 2024.

• Frailty MDT meetings in Primary care
• Identifying Frailty in Primary Care
• FAME
• Link NHS Strength and Balance Groups with other external groups that do similar but different forms eg MIOLI
• Strength and Balance PSIs are amazing
• Get up and Go Booklets
• Physical activity outdoors – linked to social events
• Working in a community garden is one of the most therapeutic activities
• Clinicians advising Physical Activity at every interaction
• Live Longer Better Programmes
• Time Banking
• Multigenerational programmes
• Digital enablement of older adults
• Intergenerational Digital Communities
• Falls prevention training (primary care, care homes, hospitals)
• Hydration and Bowel Management (Plymouth Care Homes)
• STAR Framework – Cost Effective Intervention Toolkit

What are the challenges?

• Non recurrent funding/ Unsustainable pilot services
• Rural isolation needs to be addressed better
• Care homes can discourage mobility due to risk of falls
• Care homes are overlooked in terms of provision of activity and they are expected to provide proactive activity from the bottom line – can find it difficult to access physio and OT services
• Traditional/historic divide between mental and physical health services – inequality of access for people with MH issues who need more support
• VCSE is not a single organisation – don’t lump them together
• VCSE need to be equal partners
• Ageism persists everywhere – negative messages about ageing and discrimination
• Falls prevention and dementia diagnosis waiting lists are too long
• Variation in approaches, services available, activity, accessibility and  terminology

Proposed Structure:

Click here to view the proposed structure.

What needs to happen at locality level?

• Understand the needs of the local population and bring together all partners to develop services to meet these needs
• Coproduction with local communities
• Ensure equitable access to services
• Training and awareness
• Mapping and signposting (including automated messages)
• Communications (Engaging with communities to mobilise to strengthen the message)
• Support for Carers
• Mapping outcomes, uptake and acceptability
• Challenge ageism and change the culture
• Co-ordinating communications across the community to deliver key messages
• Formulate specific project proposals and plans based on the needs of our older people
• Management of funding streams, and identification and enabling of ready-to-go projects to ensure maximising of opportunity  

Who needs to be involved at locality level?

• VCSE (including people with lived experience)
• Acute Hospital Clinicians
• Community Clinicians
• Mental Health services
• Care Home representatives
• Social Care Providers
• NHS Devon ICB
• Primary Care Networks representative
• Physical Activity / Leisure Providers
• Active Partnership locality officer

Roles of the Falls and Frailty Development Group:

• Provide support to localities by responding to escalations and facilitating solutions
• Funding – development of sustainable funding model (transparency and equity)
• Address Information Governance and data sharing issues
• Co-ordinate staff training and awareness
• Joining up information – qualitative and quantitative – and provide regular and adhoc reports
• Develop evaluation framework
• Facilitate sharing and learning between localities
• Develop resource library
• Lobby for active environments (e.g. co-ordinate response to  Local Transport Plans)
• Co-ordinate inputs to strategic planning/system-wide developments
• Have a strategic view of services across the whole frailty model and connect the different components for effective working and planning.
• Establish working groups (do it once) in key areas of work

Working Groups:

Digital Technology  - Identifying how we can use innovative approaches to prevent falls

Preventing Falls in Care Homes – Hydration, nutrition, education, medication, reconditioning and re-enablement

Data – Agreeing measurable metrics aligned with organisational and system priorities and developing a dashboard and reporting mechanisms

Physical Activity for Older People – agreeing a model for the delivery of movement and activity support for older people and developing a commissioning plan

Training and Awareness – Developing training resources for all professionals and awareness of services and interventions

Comprehensive Geriatric Assessment – Co-ordinating roll out of CGA as the recommended assessment and identification tool in Devon

Getting together:

• Six monthly face to face event
• Virtual working groups
• Monthly update from Development Group
• Become a Live Longer Better County
• South West Improvement Collaborative