This is an NHS East of England event, organised via the Eastern Development Centre.

Speakers (confirmed to date)

• Dr Rick Dell. Kaiser Permanente, USA
• Paul Mitchell, Synthesis Medical Limited
• Dr Alun Cooper, GP, Crawley, West Sussex PCT (Fracture, Liaison Services in Primary Care)
• Rob Wakeman, Consultant Orthopaedic Surgeon, BTUH
• Dr Jane Youde Clinical Lead for the Falls and Bone Health Workstream, NHS East Midlands
• Anne Thurston, National Osteoporosis Society (NHS South West)
• Dr Helen Adcock, Consultant Public Health, NHS Norfolk
• David Jarrold, Service Line Leader, Late Life Community Services representing the dementia agenda

Target Audience

• PCT Commissioners
• General Practitioners
• Acute and Community Providers
• Ambulance Services
• Social Care
• Independent/ Third Sector

Why Should You Attend This Event?

• Coronary heart disease care has been transformed since the NSF in 2004
• Stroke strategy 2007 is transforming acute treatment and long term rehabilitation and support
• For both, progress has been underpinned by national concerted efforts underpinned by audit
• Dementia care is now the focus of a major 5 year strategy
• Cancer networks have reduced death rates almost across the board

"Now we can and must address the epidemic of unfinished business of falls and fragility fractures"

(Professor David Oliver, Acting Clinical Advisor, DH; Chair of BGS Falls and Bone Health)

Falls, fractures (hip and non hip) and bone fragility is common and is:

• Often a marker of underlying illness, frailty or a "red flag" to other risks
• A problem for individuals
• Additional costs to systems
• Pressures on health and social care

With a growing ageing population and increase in people with dementia the problem will not go away:

• Despite guidelines, standards and an evidence-base...
• Our care for people with these conditions is still patchy and inconsistent
• Lags behind that for other common conditions
• There is an evidence base for effectiveness/cost-effectiveness. This is QIPP!!
• We need to move beyond isolated pockets of good service
• Especially if we want population gains
• Better, joined-up local commissioning is the solution

How Bad Is It?

Royal College of Physicians Clinical Effectiveness and Evaluation Unit - National Clinical Audit of Falls and Bone Health for Older people:

2007 - of Hip fracture patients

• 35% received clinical osteoporosis assessment
• 18% of 65-74 year old patients were referred for a DXA scan
• 42% received osteoprosis treatment according to NICE TA87

2009

• 29% of NHS Acute Trusts declared that they have a Fracture Liaison nurse in place
• Opportunities to prevent recurrent falls and fractures are being missed
• Commissioning is patchy, rarely providing a co-ordinated falls and fracture strategy
• Many clinical services were not adhering to NICE Technology Appraisal on osteoporosis treatments or Clinical Guidance on falls management

 

What Are The Standards We Should Be Meeting?

• NSF for Older people 2001 - standard six -

- To reduce the number of falls which result in serious injury and ensure effective treatment and rehabilitation for those who have fallen
- By local integrated multi-agency services by 2005

• NICE guidance on secondary prevention of ostoeporosis and fragility fractures 2004 and 2008
• DH Prevention Package for Older People, July 2009 - 4 objectives relating to falls and fractures
• Joint BOA/BGS "Blue Book" on hip fracture management
• National Hip Fracture Database and Audit
• National Patient Safety Agency guidance on falls
• NHS Institute for Innovation and Improvement Focus on fractured neck of femur

- Demonstrate the pathway can be co-ordinated and designed to reduce variation in length of stay (spell and super spell), reduce mortality and re-admissions and achieve better outcomes

Commissioning Levers For Change

• Payment by Results tariff

- Tariff unbundling for hip fractures
- New quality payment (2009/10)

• Directed Enhanced Service (2008/09)

- Aim: encourage practices to confirm the diagnosis and prescribe appropriate pharmacological secondary prevention in patients with osteoporosis. Practices will be expected to complete an audit of:
- Criterion 1: % of women aged 65-74 years with a history of fragility fracture in the previous 12 months with diagnosis of osteoporosis confirmed by a DEXA scan
- Criterion 2: % of women aged 65-74 years with a positive diagnosis of osteoporosis confirmed by a DEXA scan receiving treatment with a bone-sparing agent
- Criterion 3: % of women aged 75 and over with a history of fragility fracture in the previous 12 months who are receiving treatment with a bone-sparing agent
- Income: nationally, £5m p.a. for 2008/09 and 2009/10 which equates to £555.21 for an average practice or £25-£30 per patient