Physiotherapists are often found at the point where health and social care meet: their focus on improving the quality of life for their patients naturally bridges the two sectors, particularly when it comes to older people. For social care, this equates to reduced pressures and potentially big savings at a crucial time, writes Professor Karen Middleton...
FALLS PREVENTION SERVICES are a living example of how this integrated approach can transform – and even save - lives while cutting costs in health and social care. These physio-led services, which include professionals from a number of sectors, build strength and balance among people at-risk of falling – or those who have suffered a fall already - and take a holistic approach to limit risk factors in their home environment.
By cutting the number of falls and keeping people healthy and independent, the services help to reduce the need for expensive care packages and residential home places.
Now I appreciate that prevention can be a hard sell, particularly in such hard-pressed times. However, new economic modelling that is freely available on our website demonstrates why investing in falls prevention makes sound financial sense.
We – the Chartered Society of Physiotherapy - worked with Yorkshire and Humberside Commissioning Support to produce the data, which shows the impact that could be made by making physiotherapy available to everyone deemed at risk of falling using a standardised test. Across England, almost 200,000 falls could be prevented and £275m saved each year by providing this access to physiotherapy.
But the modelling also shows that failing to invest in those services could see care home admissions because of a fall rise by 19 per cent by 2020 – at a cost of £124.8m annually. These are significant sums, but for decision-makers the real value of our modelling – developed using published literature on falls and high-quality sources, including the Cochrane collaboration and Office for National Statistics - is that they can tailor it to find results for their local area.
For example, in the Dorset CCG area it shows that £5.6m could be saved each year and 3,705 falls prevented through physio-led services, but warns that care home places would need to rise by 11.2 per cent without that investment.
Of course, there are examples of excellence across the country already. The Westminster Falls Service offers assessments and targeted interventions to people who have fallen or are at risk of doing so. After the initial assessment, they are categorised based on need and receive either one-to-one physiotherapy or attend a 12-week strength and balance programme designed to increase their physical capability and confidence and reduce the fear of falling. Some attend both.
Having completed the course, clients continue to attend evidence-based exercise classes that are run in partnership with a voluntary organisation. This ensures that across the whole pathway they reach the recommended 50-plus hours of strength and balance required to prevent falls in the long-term.
When Care Minister Norman Lamb visited the service, taking part in an exercise class, he described it as “exactly the kind of community-based care that we’d like to see up and running across the country.”
If that was the case, the impact could be enormous. Clients followed up with one year after discharge from the service reported a 60 per cent reduction in falls, 55 per cent fewer fractures, 92 per cent fewer A&E admissions and an 80 per cent reduction in GP appointments. Beneath all of those statistics would have been a resultant saving for local social care services by supporting people to live independently at home.
So prevention is one of physiotherapy’s big calling cards, but the cure is too – not only for the patient, but for the system too. Physiotherapists work in multi-disciplinary teams that rehabilitate patients in hospital to get them ready for discharge as soon as they are well enough to go home. They also use their awareness of health and social care, along with their knowledge of what patients need to continue their rehabilitation after discharge, to coordinate that move from hospital to home. With delayed discharges at what is considered a record high, this integrated and cost-effective work can make a real difference.
It is then backed up in the community by rehabilitation teams who work with patients – who often have at least one long-term condition – to restore their physical capabilities and prevent a costly readmission to hospital or residential care.
Underlying all of this is a mindset focused on results; on getting people to the point where the can lead as full and active a life as possible. That is why I firmly believe as we seek ever-closer integration of health and social care against a backdrop of budget cuts and surging demand, that you will find physiotherapists to be essential allies.
Chartered Society of Physiotherapy
* Please visit www.csp.org.uk/costoffalls to find data for your area.