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Regulator launches investigation into prevalence and cost of patient falls

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NHS Improvement has launched an investigation into the cost and prevalence of inpatient falls across the health service in a bid to better understand the problem and help trusts tackle it.

The regulator’s economics team is gathering data on the number of falls recorded in 2015-16 and will use the data to calculate the estimated cost of falls to the NHS, which could be as much as £15m a year.

Inpatient falls can lead to harm and even death, and vulnerable patients identified as being at risk of a fall often require one to one nursing – or “specialling” – which when unplanned means hospitals rely on costly agency staff.

Preventing falls – best practice case studies

Alongside the research, NHS Improvement will set up “falls collaboratives” and highlight examples of good practice that could be replicated across the NHS.

The work fits into efforts by the regulator to focus attention on the four most prevalent harms in hospitals – pressure ulcers, falls, urinary tract infections, and problems linked to blood clots or venous thromboembolism.

The regulator said that tackling these could release resources equivalent to 3,900 extra nurses being employed in the health service. Examples where trusts have made improvements include:

  • University Hospitals Coventry and Warwickshire NHS Trust employed a permanent team trained to provide “specialling” for patients deemed at risk from falling. As a result use of agency staff fell 33% and saved the trust £162,000 over a year.
  • East Lancashire Hospitals NHS Trust introduced ward based therapists as part of its nursing team to help patients with washing, dressing and using the toilet, and to assess the patient at the same time. The effect saw a reduction in falls and freed up nurses’ time.
  • London Ambulance Service introduced a community nurse to work in emergency response to assess more patients at home. Seventy per cent more patients are treated at home with the number of hospital admissions reduced by 30 patients a week.

Ruth May, executive director of nursing at NHS Improvement and deputy chief nursing officer for England, said: “A key part of NHS Improvement’s mission is to help the NHS share good practice, and these examples of reducing patient falls and improving care are clearly helping frail and vulnerable patients.

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“Everybody knows that this is a critical year for the NHS,” she said. “As a service, we are throwing everything at the challenge we have been set and already starting to see signs of improvement, both clinically and financially.”

The research on patient falls will be published in coming months and used to develop new guidance on caring for vulnerable patients at risk of falls. NHS Improvement will also host an event on falls prevention later this month.

  • 8 Comments

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Readers' comments (8)

  • Sort out the Staffing issues first then ultimately falls can be prevented.

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  • When I read about new initiatives like this I feel two things:

    1) Joy that the issue of falls is being addressed
    2) Weariness that once again the problem of falls has been highlighted, that will no doubt result in another report with the same common recommendations that will sadly provide little real change on the ground.

    I am not cynical but a realist. There is a real sense within the NHS that we're very good at identifying problems and potential solutions but very bad at actually implementing true innovative change. If change does result it is normally a very watered down and compromised version of what was actually first identified as being the solution. Fear of getting it wrong trumps the desire to implement real change at Bands 8 and above in most Acute Trusts.

    Lets face it, the reason older patients fall has not changed over the last few decades- weakness, hypotension, polypharmacy and certain co-morbidities (Dementia) spring initially to mind.

    I do not think staffing is the sole problem, it is a factor of course, but I believe the real harm is caused through admitting older people to hospitals where they sit, lie and fester for 10+ days and get weaker and weaker. Hospitals and their sedentary practices causes more harm than any other factor. Patients come in medically unfit and mobile, and leave medically fit but immobile.

    We need a culture change that seeks to redress the 'rest is best' mantra as it is plain wrong. Hospital are not places where we should 'care' for older patients (we have care homes for this), instead we should just provide medical input and then get patients home asap. In many circumstances the medical input can beprovided at home too, hence the slow development of 'Hospital at home' services and Frailty services.

    If this report provides further recommendations as to how to reduce the incidence of falls then it should also come with proper support and funding to implement it from the Government. Otherwise it'll just be another report to add to the swollen pile and very little change will result.
    To identify failings and the solutions but then not provide the correct support to address these seems to me to be a dereliction of duty.

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  • michael stone

    CHRISTOPHER TUCKETT

    I read your piece - you are clearly involved in this, I'm not - after I had read the headline, and immediately thought to myself 'prevent falls, yes - but, don't elderly people rapidly lose 'independence' if you stop them from walking about ?'.

    So it interested me that you wrote:

    'I do not think staffing is the sole problem, it is a factor of course, but I believe the real harm is caused through admitting older people to hospitals where they sit, lie and fester for 10+ days and get weaker and weaker. Hospitals and their sedentary practices causes more harm than any other factor. Patients come in medically unfit and mobile, and leave medically fit but immobile.'

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  • Hi Michael,

    Thanks for your response.

    I am sure I made my argument too convoluted but the point you make that older people lose their independence if they are prevented from walking about is entirely correct. Just put much more succinctly than I managed!

    Hospitals enforce sedentary behaviours on older people when they are admitted and this results in a loss of independence. Purely because the focus is on a patients' medical fitness at the expense of their physical fitness.

    I would be interested to hear your thoughts on my other point about good solutions being developed within the NHS but failing to be implemented to their original design. Instead becoming watered down versions due to an innate aversion to risk amongst 'decision makers'.

    Happy to continue any discussion on social media: @HealthPhysio

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  • michael stone

    Hi Christopher,

    You made the point very clearly - more clearly than I did.

    I don't do Twitter (I joined Facebook recently) and I'll put something together in answer to your other question, and post it here. We probably agree with each other.

    I exchange e-mails with Rachel Griffiths (CQC MCA person) and she has blogged at:

    http://www.scie.org.uk/mca-directory/forum/blogs/20160725.asp

    In that piece, Rachel pointed out:

    'For an older person wrongly assessed as lacking capacity to decide where to live, the option to return to their own home may well have vanished by the time this injustice is put right - if it ever is: their home may have been sold, or their health may now have deteriorated to the point that they can no longer live independently. The ship of their autonomy may have sailed.'

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  • michael stone

    Hi again Christopher,

    re:

    'I would be interested to hear your thoughts on my other point about good solutions being developed within the NHS but failing to be implemented to their original design. Instead becoming watered down versions due to an innate aversion to risk amongst 'decision makers'. '

    I sent an e-mail to a consultant geriatrician on 27 September. I included in that e-mail this:

    'The problem with the other things - the huge amount of evidence - is that there is so much variation across regions, staff, communities, etc, that for the NHS and even social care, it isn't obvious that what appears to work [or does work] in one place, can be transferred to [and would work in] another place. Even for your 'filtering at the front door of the hospital issue' what works well in one hospital might be less successful in another.

    And I'm not convinced that 'trials' of 'behaviour/process' are invariably as conclusive as they are sometimes presented: I suspect that often trials are conducted in an enviroment of 'we want this to work' and sometimes with adequate resources to get them to work - then they are rolled out, often with less resources and within more 'unsympathetic' enviroments, and what worked in a trial doesn't necessarily work when you roll it out.'

    And Fiona Godlee, editor in chief of the BMJ, recently started an article

    http://www.bmj.com/content/354/bmj.i5123

    with:

    'It may not feel like it just now, but what we have is doctor centred care. Perhaps also institution, manager, and nurse centred care. What we don’t yet have is patient centred care, despite this being obviously what healthcare should be. But things are slowly shifting in the right direction, and The BMJ aims to help keep up the momentum.'

    There is also an assumption [it appears to me] that 'best practice' will spread through the NHS by a sort of 'Darwinian Selection process'. My observations about the beliefs and practices which spread during end-of-life (my interest) is that in reality what 'most easily spreads' is 'what the professionals see as 'right' from their particular perspective(s)' and that isn't the same thing as a neutrally-assessed concept of 'best'.

    I'm not sure if that has answered your question - I don't have much online time today - but if it hasn't, I'm happy to 'expand' if you ask me to. I'm sure that 'an innate aversion to risk amongst 'decision makers'' is one of many factors in play - although 'self-protection against future blame' might be more relevant (the 'I'm not going to do that - if it goes horribly wrong, then I'll get blamed [even if it only goes wrong because of bad luck or things outside of my control' factor].

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  • Hi Michael,

    Thanks for the blog link, very interesting and relevant. I'll definitely follow this in future.

    Also I think your point about 'self-protection against future blame' is probably very true. In reality I think the potential 'future blame' is actually the risk they are so keen to avoid.

    And thanks for elaborating, you've certainly provided a more than adequate response to my question.

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  • michael stone

    Christopher, just in case you were not already aware of this. The BMJ has some articles which are open-access, and others which you must pay to get at. But ALL BMJ (online) articles can have 'rapid responses' submitted to them, and the responses are open-access even if the original article was subscription. I can recommend BMJ rapid responses, as often being very interesting.

    For example, I'm currently involved in a series of responses at:

    http://www.bmj.com/content/354/bmj.i5195/rapid-responses

    The rapid responses often make it much clearer 'what people are thinking' than the original papers, which tend to be 'very balanced and evidence-based'.

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