bcda conference 22nd february
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The New World – Prediction, Prevention and Public
Health Strategies in Social Care
Jim McManusJoint Director of Public Health
bcda, 22nd January 2011
The World
• Health White Paper• Social Care Reforms• Public Health Changes• Health and Wellbeing Boards• GP Commissioning Consortia• JSNA• Less Money, more outcome
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Domains of Public Health
Health Improvement
Health Protection
ServiceQuality& Improvement
Prediction and Prioritisation sit here
What does this mean in social care?
What is your role?Prevention sits here
Prediction and Prioritisation sit here
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Continuous Process
RFBC
C.S.R
JSNA
5 COUNCIL Outcomes
Prioritisation What do we need to do?For whom?When?Who is most likely to benefit?Who is most in need?
Why Prediction and Prevention
• Quality of Life• Reduction in Cost• Avoids escalation in care• New Model of Care
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Prediction
forecast / target services
Secondary Prevention
Pri
ma
ry P
reve
ntio
n
Un
ive
rsal
& W
ell-
be
ing
LOWMODERATE
SUBSTANTIAL CRITICAL
Reduce numbers of people coming into high-cost services and
moving along FACS banding
Intensive Home Support
Residential Care
Community Equipment Services
Telecare Service
Tertiary Prevention
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Example - Falls Prevention• In Birmingham, over 40,000 older people have falls every
year.• 35% of over 65s experience one or more falls. • 45% of over 80 who live in the community fall each year. • By reducing the common risk factors and by providing
appropriate equipment, falls can be reduced by between 10 -40%.
• A person’s home environment can also contribute to the risk of falling.
• The prevention of falls scheme supports a proactive approach, to target individuals with low level prevention interventions which can have a measurable impact on individual’s quality of life and wellbeing.
• Low /moderates – savings
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For a typical PCT
• For each 10,000 people over 65• 3,500 will fall each year, 1500 twice or more• Most will not call for help• 700 will attend A&E or the MIU• A similar number will call the ambulance
service• 250 will have a fracture• 80 are hip fractures
• Ageing demography means all this will increase 50% by 2020
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Key Risk Factors include
people who have had a Previous fall1
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People who have a Long term condition
muscle weakness/balance/gait or who are taking multiple medications
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Three levels of focus
DefinedOutcome
s
Process & Procedures
Service User Evaluation
Targeted intervention
Benefits
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Falls Prevention multi-factorial toolkit
• checklist to identify people at risk at falls and link to services and information
• Working Neighbourhood Fund – funding secured until March 2011
• Start date of project – 20th November 2009- sort tools , plan etc
• Multi-agency: Birmingham City Council, Health Services, Third Sector
• Training for participants• Programme management –part of wider prevention• Public health evidence based • Referral to a selection of agencies
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Prevent Falls – project aim
By providing a pathway for people who may be at risk of falling to get the help they need :-
Raising awareness of falls and how to prevent them– Referring on to services to help prevent falls e.g.
equipment, handy persons scheme and/or foot care– Referring on to Telecare equipment (falls monitor) which
mitigates the effects of falls– Referring on for benefits entitlement guidance– Sign post to social activities and exercise classes such as,
“Keep Moving, or chi to improve their balance and to prevent falls and fractures
– Internal process ( timelines )
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The Process low/moderate• Falls Checklist
– Usually new to A and C - Unique numbering– Specific requests– Client to sign– Leave client with note– Send form to Co-ordinator– Destroy original when receipt confirmed
• Service Request Form – Details copied by Co-ordinator from Checklist– Sent to Service provider -5 days
• Visit /contact Follow up letterDetails copied by Co-ordinator from ChecklistSent to Client
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Prevention of Falls - Process• Target Population
• Persons over 50 years living in Birmingham
Complete Checklist and Questionnaire
Receives Checklist and Questionnaire
Record DataSend service
request to Service provider
Send Follow up letter to Client
Records Service delivery
Forwards checklist and questionnaire
Receives Follow up letter
Receives Service Request Forms
Visitor Agency
Citizen Receives Services
Service ProviderInitiates Services
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Results to date• Over 500 people supported • All received information on preventing falls• Average number of services requested per checklist – 2.6
requests per person• Number of people having a fall since – 14% (46% before
checklist)• Over 66% were very confident that the information and
services they received would help them prevent falls in the future
• There was a reported 3.7% improvement in quality of life• One woman £11k • Service User evaluation commencing
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Next Steps
• Ensure Benefits realised • Evaluation with Citizens • Explore other roles that maybe able deliver
this for low and moderates .• Shift thinking to Primary prevention • Embed prevention score cared • Support delivery of Peters New Offer • Build into GPs pathfinder
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