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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