Preventing falls in Norfolk
Developing, testing and embedding a proactive intervention capability The programme centred on three elements, enabling the system to deliver a preventive service: A better understanding of residents: Through a secure digital platform, the team were able to harness natural language processing to ‘read’ the case notes for all residents known to adult social care and put this together with existing data about the person. Machine learning enabled the team to process millions of data points and words from a person’s record to extract meaningful insight on their strengths, needs and interests. This built up a previously unattainable depth of understanding, enabling them to predict who was most likely to have a fall. By testing the model on historical falls data, they were able to predict 7 in every 10 people who would have a fall and could therefore benefit from proactive support. Intervening to mitigate risks: Norfolk engaged two teams to complete a holistic conversation with participants identified by the predictive model. These teams completed semi-scripted conversations to talk to the at-risk individual and understand what support they might benefit from, then offer targeted interventions. Of those, 93% were eligible for a preventive service such as chair-based exercises from Occupational Therapists or home safety assessments from the fire service. In the first phase of the falls pilot, over 150 people took up at least one referral offered to them by the team and 70 people had interventions delivered.
Creating a service that is fit for the future – one that focuses on prevention and early help, rather than responding when situations reach a crisis point. Identifying opportunities to achieve their ambition The programme began with a thorough evidence-based diagnostic. The diagnostic demonstrated that there was a substantial cohort of people receiving care and support who could have benefitted from community services earlier in their journey, which could have prevented or reduced their need for support. Falls prevention was identified as an area with potential for preventative interventions to improve outcomes for Norfolk residents. Why falls? A third of people over 65 fall over every year, and over 5,000 people per year in Norfolk present to either health or social care with a fall. A fall can deeply impact a person’s confidence, mobility and wellbeing, and costs health and social care over £4,000 . Falls prevention for all adults at risk in Norfolk is worth up to £5.8m across health & social care.
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