Case study list

Carmarthenshire Local Health Board

01/10/2008

The strategy proposes a future model of service provision with an emphasis on falls prevention utilising an integrated falls care-pathway. It aims to ensure that those who would benefit most from a comprehensive assessment and specialist input are identified and able to access the service they require based on their individual needs.

At the beginning of 2007, a falls project pilot was completed within a GP practice at a small village in Carmarthenshire. The falls project targeted individuals over 75 years old and provided a holistic proactive assessment and response to individuals who were at risk of falling, the aim being to reduce the numbers of hospital admissions because of falls. Any individual deemed at risk was referred to the Community Intermediate Care Team (Canllaw) for intensive short term rehabilitation or preventative intervention.

The initial findings were a 64% reduction in the number of people over 75 years presenting at A&E with falls. Of the four individuals who attended A&E during the months following the falls pilot, three of these individual had neither attended the event nor been referred by the GP practice. The numbers of individuals over the age of 75 who attend A&E due to falls from this area continues to be low. The pilot has been fully evaluated.

The pilot was extended to other areas within Carmarthenshire with a number of falls events within the county.

The falls events are held monthly and have the commitment of a number of organisations including: Canllaw, Age Concern, Care and Repair, Care Line+, Chronic Disease Management Team, Community Health Council (CHC), CAVS, District Nursing, Expert Patient Programme, Foothold, Fire Service, Housing Services, Low Vision Scheme, Pharmacy, Social Care, The Carers' Project and the Pensions Agency.

As a result of the success of the pilot and the falls events. funding has been secured from the Promoting Independence and Wellbeing grant scheme of 2008-11 to create a specific team within Canllaw dedicated to falls. This includes a falls coordinator and two support workers who would work with existing services, leading and coordinating events, linking with primary and secondary care and developing new falls projects.