Falls prevention: how to slash the NHS's £2bn bill

Falls devastate lives and place a huge strain on health and social care systems. They account for half of all accident related hospital admissions, up to a quarter of ambulance callouts, and have been estimated to cost the NHS in England more than £2bn a year.

‘A radical shift to preventative care is required to make the NHS sustainable – falls prevention must be a component’

One-third of people who suffer a hip fracture die within a year – and a tenth within a month.

The statistics go on and on, yet falls are often overlooked when we discuss how to ease the pressure on emergency departments and primary and social care.

Greater attention goes on finding immediate solutions to those pressures, but that simply treats the symptoms rather address the root causes of why so many people arrive at the hospital door.

It is widely acknowledged that a radical shift to preventative care is required to make the NHS sustainable in the future; falls prevention must be a component of this.

Physiotherapists assess and diagnose the problem then devise treatment plans to improve strength, balance and confidence among people who have fallen previously, or who are deemed at risk of doing so in the future.

The services, which include other health professionals, take a holistic approach to reduce the chances of a fall. They also feature education and home inspections to identify risk factors.

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Counting the cost

Now, for the first time, commissioners in England can see what the clinical and cost effectiveness of that approach would specifically mean for them.

‘Failing to invest in physiotherapy could see care home admissions caused by falls increase by 19 per cent by 2020’

We worked with the West and South Yorkshire and Bassetlaw Commissioning Support Unit to produce economic modelling that shows the dramatic impact falls prevention services can have in each clinical commissioning group area across England.

Nationally, almost 200,000 falls could be prevented and £275m saved each year through better access to physiotherapy.

The savings could be even greater because physio led services can reduce the severity of a fall should one still occur. But failing to invest in physiotherapy could see care home admissions caused by falls increase by 19 per cent by 2020 – at a cost of £124.8m annually.

These figures are held in a tool on the Chartered Society of Physiotherapy website that allows commissioners to search for their own specific results.

Dorset CCG, for example, will find that offering physiotherapy to everybody identified as being at risk using a recognised test could save £5.6m a year and prevent 3,705 falls.

The data was drawn together from published literature on falls and high quality sources, including The Cochrane Collaboration and the Office for National Statistics.

Tailored data

Commissioners can tailor it by inputting their own local data to generate results that show the potential net savings along with how many falls might be prevented. We believe this is a significant advance.

‘South Tyneside found that 512 falls had been prevented, saving £117,760 in ambulance callouts’

The tool can be a critical asset for commissioners to use when planning and purchasing services for their local population. It allows them to assess their level of need, identify a solution and see what the benefits of pursuing that would be.

It really is the kind of innovation using data and technology that the NHS must make full use of to address its most pressing challenges.

Of course, prevention can be a hard sell, as it is by nature predictive – and the outcomes aren’t seen immediately. But there are areas of the country where excellent results are already being achieved and these figures are coming alive.

‘We can ensure that falls are no longer written off as an inevitable part of ageing’

Physiotherapists at South Tyneside Foundation Trust assessed the effectiveness of their service for known fallers and those at high risk over the course of a year. They found that 512 falls had been prevented, saving £117,760 in ambulance callouts.

Of the prevented falls, 26 would likely have resulted in a hip fracture, at a cost of £149,344. Overall, 13 of the falls would have resulted in £318,396 being spent on care home admissions.

Real people, real prevention, real savings.

Dramatic effects

Elsewhere, care minister Norman Lamb last year visited the service run by the Central London Community Health Trust, which halved the number of falls across its area in the previous 12 months.

Mr Lamb joined in an exercise class and described it as “exactly the kind of community based care that we’d like to see up and running across the country”.

With our web tool, we can now help commissioners to make that happen. We can dramatically cut the number of people who suffer falls each year. We can ensure that falls are no longer written off as an inevitable part of ageing. And we can potentially save the NHS hundreds of millions of pounds.

The data is in place; the solutions are available. Now we need commissioners to work with physiotherapists and use the modelling to help hundreds of thousands of people each year avoid the misery and suffering that results from a fall.

Professor Karen Middleton is chief executive of the Chartered Society of Physiotherapy