Falls can have a devastating impact on an older person’s life, causing physical injury and a loss of confidence and independence. This project aims to improve prevention and management of falls to reduce the impact on older residents and the health and social care system.
Falls are a preventable health issue which affect about a third of over-65s annually. Southwark Council, with support from colleagues at Guy’s and St Thomas’ NHS Foundation Trust and Lambeth Council, has been exploring how a digital app could provide a joined-up and cost-effective approach to falls management and prevention.
The rate of falls-related injuries in Southwark are amongst the highest in London. With the over 65 population predicted to rise by 40 per cent over the next ten years, this preventable health issue will cause pressure within the health and social care system, as well as distress and poor health outcomes for residents.
Southwark Council focussed on the problem statement:
How can we improve prevention and management of falls in Southwark to reduce the impact on local residents and the wider health and social care system?
Key aims and achievements
- Improved awareness of falls prevention access services
- 25 - 30 per cent reduction in falls based on results from care home version of the app.
- Forecast £398,307 cash savings from acute and ambulance costs for Southwark and Lambeth over two years.
- £213,150 non-cash savings in intermediate care / social care costs for Southwark over two years.
At the end of the discovery phase, the Health Innovation Network had designed three potential routes for the project to take. The team selected the falls prevention app following a workshop with key stakeholders from the health, social care and voluntary and community sectors, where attendees were asked to rank the options along five key metrics.
The output from the implementation phase broadly aligns with their goals from the discovery phase – the solution has just become more detailed. Some new ideas came about during development and testing of the app such as the ability to create referrals directly.
User research and prototyping
Throughout the implementation phase, the project team undertook many activities, engaging with users and developing a prototype of the product.
I don't see why anyone in my sort of role wouldn't want to use this.
Staff member involved in a testing session
In the early stages of the implementation phase, the team held three design workshops with a range of stakeholders including staff, the VCS and extra care residents, staff and carers. These workshops were used to introduce the app to people and explain its purpose. They also explored what the key issues facing service users would be and what people would want included. The team highlighted that having a wide range of stakeholders involved at this point was important and has ensured the scalability of the app.
Over 20 staff involved. Staff came from a variety of teams including Adult Social Care in both Lambeth and Southwark, district nursing teams, GPs, Community Reablement and Falls Service clinicians, OT specialists, voluntary and community sector, as well as staff from the pilot groups themselves.
Design show and tell sessions
These were attended by 25 staff across two sessions. These were used to get feedback from stakeholder groups on potential uses for the app, that informed its redesign.
One-to-one prototype testing sessions
These were attended by 18 staff between 28 November and 4 December 2020. Staff were able to click through the app and make suggestions. Twenty recommendations came out of these sessions, with roughly half being taken forward immediately. The others have been noted for further iterations.
Q&A introductory sessions
Sessions about the app held in the week of 18 January 2021 were attended by 13 staff. Mop up events are being planned to reach the staff unable to attend due to current pressures.
Throughout the implementation phase, project teams were asked to produce reports forecasting the cash, non-cash, societal and quality benefits. The project team has forecast the following benefits over the first two years from launch:
The project team identified a number of unintended benefits from the implementation phase of the project. These include:
- Improved working across teams. The project team have been able to pull people together for a common focus and raise awareness around falls prevention.
- Safe Steps have offered their care home app license until March 2022. The team believe that if Safe Steps had not been involved in this project, they would have been less likely to do this as they would not have had the same foothold in London.
During the discovery phase, the council developed a logic model to guide the implementation phase and to help in quantifying the inputs, activities, outputs, outcomes and impacts which are likely to result from the delivery of this project.
Key outcomes and impact measures:
- 25 - 30 per cent reduction in the number of falls - based on similar outcomes evidence by the care home version of the app
- consistency across teams when completing falls risk assessments
- improved access to falls prevention services (eg strength and balance)
- decreased ambulance callouts
- decreased conveyances to hospital
- improved service user experience.
The council have engaged with the Health Innovation Network to create an evaluation framework. In the short term this will measure staff and service user experience, but in the long term will measure reduction in falls / rates of falls and reduction in costs.
- Team working: the project team have worked together really well during the implementation phase, despite the unpredictable circumstances and necessity of remote working. The team meet virtually twice a week and were able to link in effectively with people outside of the team. They believe that meeting virtually made it easier to make those connections.
- Increased confidence in digital: the project has opened people’s minds to the use of digital tools. Before the project (and the Covid-19 pandemic), many had concerns around digitising and bringing in new technology.
- Addressing prevention: the project has helped the council in their aim to shift their focus to prevention as opposed to reaction.
- Stakeholder buy-in: the team have had good buy-in from senior stakeholders, who are enthusiastic about the product.
Challenges and lessons learned
- Delays due to the Covid-19 pandemic: the project’s delivery partner, Safe Steps, had to adjust their timelines to work on the Covid-19 app. The project was also required to pause for a few days at the outset of the pandemic under direction from the Director of Adult Social Care at Southwark council.
- Limited capacity due to the Covid-19 pandemic: stakeholder capacity to be involved in the project was heavily impacted by the Covid-19 pandemic. The project team noted that they were never able to work with all the stakeholders at the same time.
- Communication between teams: the project team noted that communication between the different teams could have been improved, though they recognised that some of the difficulties were a product of capacity restraints caused by Covid-19. The team also acknowledged that there was a particular challenge with communication between Southwark and Lambeth councils due to Lambeth being added to the project scope after the discovery phase, as well as Covid-19 and resourcing issues.
- Information governance: the information governance requirements to make patient records accessible differ from borough to borough. This has required lots of time and resource.
- The importance of involving a wide range of people in user research: this has helped ensure the product is easily scalable.
- The importance of a discovery phase: it enabled the project team to get genuine views from residents and carers on falls and falls prevention. They noted it would have been easy to assume they already knew enough.
- The great potential of digital tools: the team now have a much better understanding of the role of digital in health and social care and the potential for this to expand.
Impact of Covid-19
- Reduced capacity: this affected many of the teams involved, most notably Safe Steps as their team needed to prioritise work on the development of a Covid-19 app, leading to a significant delay in the planned timescales.
- Virtual testing: the project team had to undertake most of the user testing via Microsoft Teams. To ensure that the team were conducting these tests appropriately, they sought best practice advice from the Digital Service Design Manager at Southwark Council. This testing was originally planned to take place in groups, but speaking to users one-to-one enabled the team to get into more granular detail. Remote testing also meant they were able to offer evening sessions for response officers working evening shifts.
- Elements of the project progressed more quickly than anticipated: there was a greater acceptance of digital solutions, more people moved to a virtual way of working and there were relaxations in the data sharing requirements.
Within Southwark: the team believe the app could easily be scaled up to be used in more teams and they have already identified many teams that could use it. The project team have intentionally designed the app so that it is scalable, instead of being unique to the project. Within the app itself, there is the ability to add a service. The team will continue to look at opportunities to scale the app in the coming months. The team highlighted that the app has potential to be scaled up beyond their own organisations and could be used by the voluntary sector (e.g. Age UK or social prescribers). This broader coverage would also allow for earlier prevention.
The project team noted one thing that could prevent the app being scaled up is the level of capacity within teams that would be receiving it. The project team are hopeful that their evaluation will have proven that implementation of the app is a manageable task, and this will encourage teams to pilot the app.
Elsewhere: Safe Steps are hoping to roll out the app to other boroughs, particularly those where their care home app is already in use. The team noted that replicating the app elsewhere should be easy as they have pulled together a spreadsheet with all the potential actions and services which they will be able to share with other councils. They have already had interest from at least one other area.
The team identified the biggest potential barrier as data sharing. They noted that, although requirements have been eased due to the Covid-19 pandemic, there have still been issues when they have wanted to make patient records accessible. The team suggested that it would be useful to have a model data sharing agreement sponsored by the Department of Health and Social Care that enables sharing of information and access to shared patient databases. At the moment, boroughs are having to do it on an individual basis which is consuming a lot of time and resource.
The team noted that areas that already have a relationship with Safe Steps may find it easier to implement, though this would not be a significant barrier to others. They also noted that areas that have already implemented the care home app might have increased buy-in from stakeholders.
Find out more
Jamie Penston-Raja: Jamie.Penston-Raja@southwark.gov.uk