Section 1 is to be completed by Health and Social Care Trusts (HSCTs) and Primary Care Organisations (PCOs) as commissioners
1.1.1 Is there a written local commissioning strategy which covers issues pertaining to falls prevention?
(If yes answer 1.1.2, If no, go to 1.1.7)
Yes No
If yes, does this strategy include:
1.1.2 Commissioning an integrated specialist falls service?
Yes No
1.1.3 Consideration of care home residents?
Yes No
1.1.4 Commissioning medication reviews for care home residents?
Yes No
1.1.5 Consideration of patients within mental health services?
Yes No
1.1.6 Is this a joint falls strategy between the NHS and local authority?
Yes No
1.1.7 Is there a written local commissioning strategy for bone health?
(If yes, to 1.1.1 and1.1.7 go to 1.1.8, If no, go to 1.2.1) Yes No
1.1.8 Are the falls and bone health commissioning strategies coordinated?
(If yes answer 1.1.9, If no, go to 1.2.1)
Yes No
1.1.9 Has there been a public health analysis contribution to any
aspect of the falls and bone health commissioning strategy? Yes No
1.2 SERVICE LEAD
Is there a lead within the commissioning body who is responsible for services for:
1.2.1 Falls? Yes No
1.2.2 Bone health?
Yes No
1.3 REPORTING
1.3.1 Is there a local population based report on health needs and outcomes relevant to falls and bone health services?
(If yes answer 1.3.2, If no, go to 1.4.1)
Yes No
Does it include:
1.3.2 Bone health (osteoporosis)?
Yes No
1.3.3 Hip fracture rates?
Yes No
1.3.4 Other fragility fracture rates?
If yes answer 1.3.5. If no go to 1.3.6. Yes No
1.3.5 What is the peripheral fracture rate per 100,000 of the PCO population?
Unknow n
1.3.6 Information on the rate of serious injury OR fractures sustained
LOCAL STRATEGIES AND COMMISSIONING
1.3.7 Is there evidence that information from this report fed into the
commissioning strategy? Yes No
1.3.8. Is there a service level agreement or contract which specifies
details of hip fracture patient management? Yes No
1.3.9 Is there a service level agreement or contract which specifies details of case finding for secondary prevention after a fragility fracture?
Yes No
1.4 NICE GUIDANCE
1.4.1 Is there a mechanism at PCO level for assessing whether primary care treatment for people who have a fragility fracture is provided in accordance with TAG 87?
Yes No
1.4.2 Does the PCO have any agreement for added incentives for primary care compliance with NICE guidance such as use of a locally enhanced service, directly enhanced service or local Quality and Outcomes Framework (QoF)?
Yes No
1.5 CARE HOMES
1.5.1 Does the PCO request information from care homes on falls
incidences or falls related injuries? Yes No
1.5.2 Does the PCO keep or have access to a register of older people
that fall in care homes? Yes No
2 CASE FINDING AND REFERRAL
Section 2 is to be completed by HSCTs, Mental Health Trusts (MHTs) and PCOs as providers.
2.1 FIRST LEVEL SCREENING
Yes, fully used
Yes, partially used
2.1.1 Has a first level screening tool been implemented and comprehensively used in the community for older people (this can be part of an overview assessment)?
(If yes fully or partially used answer 2.1.2. If no, go to section 3)
Note: To answer yes the “overview” assessment utilised must include relevant questions relating to falls and bone health and a positive answer should lead to further action. It could be a standardised tool, locally developed which is routinely applied.
No, not at all
Does it include a question to identify those:
2.1.2 At risk of falls?
Yes No
2.1.3 Who have fallen within a defined time period (e.g. previous
12 months)? Yes No
2.1.4 Who have had a fragility fracture or are at risk of
osteoporosis? Yes No
2.1.5 Does the screening tool trigger and direct further
3 STRUCTURE AND STAFFING OF THE FALLS AND BONE HEALTH SERVICE
Section 3 is to be completed by acute trusts, HSCTs and PCOs as providers
3.1 SERVICE
3.1.1 Is there a local coordinated, integrated, multi-professional and multi- agency falls service?
Note: This is taken to mean a coordinated, integrated, multi-professional and multi- agency service which could be held on your premises or can be accessed locally (see audit help notes).
Yes No
Yes all
Parts only
3.1.2 Does your trust provide some or all of the local falls service?
Note: This can be some or all components provided as listed in this section 3, e.g. specific personnel who perform case finding and referral, assessment or direct patient care or clinics where specialised investigations or assessment are undertaken across the whole or part of your locality (see audit help notes).
If you answer yes all or parts only go to 3.2.1. If nothing at all go to section 4.
Nothing at all
3.2 CLINICS WITH TRAINED MEDICAL STAFF
3.2.1 Does your trust provide a clinic (s) or equivalent facility where individual patients attend for assessment and interventions related to falls
prevention with direct clinical involvement of consultant grade or other trained medical staff?
Note: This clinic – can be a facility in outpatients, a day hospital, intermediate care centre etc. which gathers together the staff and equipment to provide a multi-factorial
assessment and plan tailored interventions for fallers (see audit help notes). If yes answer 3.2.2, If no, go to section 3.3
Yes No Consultant Staff grade or associate specialist GP with special interest
3.2.2 If yes, what type of doctor led these clinics?
Note: this could be a consultant geriatrician or other physician with relevant specialist training OR a non-consultant but trained specialist e.g. staff grade or general practitioner with special interest (GPSI) or a registrar supervised by a consultant.
Enter the most experienced doctor if more than one clinic
If you tick other please specify and add this to the comment box on the web tool Other
3.3 CLINICS WITHOUT TRAINED MEDICAL STAFF
3.3.1 Does your trust provide a clinic (s) or equivalent facility where individual patients attend for assessment and interventions related to falls
prevention without trained medical staff (consultant grade or other)?
If yes answer 3.3.2, If no, go to 3.4. If no to both 3.2.1 and 3.3.1 go to 3.5
Note: These are clinics run without trained medical staff and led by nurses,
physiotherapists, occupational therapists, falls coordinators etc, without direct access to a trained specialist doctor.
Yes No
3.3.2 Does the clinic (s) without trained medical staff have referral links to
medical consultants? Yes No
3.4. ALL CLINICS
3.4.1 What was the total number of clinics routinely held during the period from
1st to 30th June 2008?
FF
3.4.2 Taking all the clinics together, how many new patients were seen from 1st
3 STRUCTURE AND STAFFING OF THE FALLS AND BONE HEALTH SERVICE
Section 3 is to be completed by acute trusts, HSCTs and PCOs as providers 3.4.3
As of the 3rd November, how many total weeks ahead is the next clinic session available for a new patient?
Note: If more than one clinic and patients have a choice, enter the shortest wait time. If more than one clinic and patients DO NOT have a choice, enter the longest wait time.
FF
3.5 STAFFING
Yes
No but provides their time
3.5.1 Do you have a Consultant (s) in geriatric
medicine with a commitment to the falls service within their job description / job plan?
If yesor nobut answer 3.5.2, If no, go to 3.5.5
No
3.5.2 If yes or no but, how many hours per week does a designated
consultant (s) in geriatric medicine devote to the falls service?
FFF . F
3.5.3 If yes or no but, how many hours per week are for clinicalduties?
FF*
3.5.4 If yes or no but, how many hours per week are for managerial duties?
*The combination of 3.5.3 and 3.5.4 should agree with the 3.5.2 total
FF*
3.5.5 Do you have a Falls service coordinator (s)?
If yes answer 3.5.6, If no, go to 3.5.9 Yes No
3.5.6 If yes, to falls service co-ordinator (s) how many hours on average per week?
* Cannot exceed 150 hours per week
FFF . F *
3.5.7 Is this a managerial post?
Yes No
3.5.8 Is this a “clinical” post?
Yes No
Yes No
3.5.9 Do you have a Fracture Liaison Nurse (s) or similar designated person(s)?
Note: This could also be a nurse / therapist taking on this role. This will include specific commitment to enhancing the case finding of patients for bone health and falls interventions among those with fractures. It may also include service
development, administration, teaching, training audit etc.
For example it could be a role of a community matron for older people If this is the same post as the falls co-ordinator please state so in the web tool comments box
4 SPECIALIST FALLS MANAGEMENT