Occupational Therapy News OTnews October 2019 | Page 39

EARLY INTERVENTION FEATURE
T
o most occupational therapists, the value of falls
ambulances is unambiguous. A typical service sees
a paramedic paired with an occupational therapist,
who together spend a 12-hour shift in a marked car
attending non-injury falls calls to 999 and 111.
They have a proven track record of cutting conveyances to
accident and emergency (A&E), saving huge amounts of cash and
supporting people to stay safe at home.
The East Lancashire Hospitals NHS Trust falls response service,
featured in one of RCOT’s Improving Lives, Saving Money reports,
was able to prove a £197,500 saving over one year after reducing
552 attendances to A&E.
Yet RCOT has heard from members that it is hard to get such
preventative services commissioned, and they are far from universal.
So how did three successful services get off the ground to begin
with?
We have spoken with the people behind the early intervention
vehicles in Norfolk, the falls cars in Bath and North East Somerset, ‘Finding a friendly stat person really helps as they can help explain
how you are making a difference. For example, we can show in the
stats that the number of people with falls and fractures going to A&E
have reduced. The number being admitted has actually increased,
but that means that the right people are going to hospital.’
And numbers are not the only resource to work with. Says
Helen: ‘It can be tricky to find appropriate case studies when you
are starting up a service, but you can really use them to show the
benefits.
‘In terms of getting key people on board, commissioners really like
that – especially if you also link to the NHS Long-Term Plan and keep
sight of the bigger picture.’
and the falls and frailty response service in South Berkshire, to see
what helped them get up and running. approached the occupational therapists to see if there was a way
they could work together.
‘Coincidentally that was during the Improving Lives, Saving
Money campaign; we were reading about it in OTnews and thinking
it sounded interesting,’ says Helen. ‘The timing was just perfect as
the first recommendation of the campaign was working together with
ambulance services to do this kind of service.’
If that sort of conversation isn’t already happening in your area,
then drawing on existing experience to contact the ambulance
service is also an option, says Helen.
‘We know the increase in demand on A&E services and
ambulance services are being tasked with looking at alternative
pathways,’ she says. ‘Take the campaign information to local
ambulance services to show that you could offer something different;
use the RCOT evidence from successful services to demonstrate
their value.’
The service in Bath and North Somerset was initiated by
commissioners, although the ideas had previously been shared with
them by the occupational therapists, suggesting the idea may have
been implanted during their ongoing discussions.
Says Mandy: ‘There’s a case for knowing the examples of new
ideas across the country so you can push it to commissioners. And
learn from other people’s mistakes. I had a long chat with the service
in Lancashire; you just want to talk about problems and how they
got around them.
‘People from nearby areas now want to know how to set it up, so
we just send out our service spec on how we did it. All we can do
is keep informing commissioners, show it works and make their life
easier.’
Working with partners isn’t always straightforward, and costing
up a service can be tricky. But working together to find a common
parlance can help work out sticking points.
‘We work very differently to ambulance crews; they were on
10-hour shifts, which makes it tricky to cost up therapy time,’ says
Mandy. ‘We have had to have quite a lot of discussions on how
Making the most of statistics and case studies
The Central Norfolk Early Intervention Vehicle was piloted by the East
of England Ambulance Service with other community and social care
providers, and is a good example of a successful service.
The emergency medical technician and occupational therapist
may spend twice as long with patients as an ambulance, but the
effect of doing so is clear – only 40 per cent of people attended went
to hospital, compared with 60 per cent by other teams.
As with many services though, proving the cost saving is not
entirely straightforward. The (relatively) easy part is proving an
estimated £284,719 on those immediate admission costs, with the
numbers worked out by comparing themselves with the conveyance
rates of standard ambulance crews.
It is a compelling figure and the sort of statistic that helps
convince commissioners to establish or bolster services. But what
it does not do is take into consideration the longer-term health and
social care costs that are avoided because of their intervention.
Evidencing the cost of care that has not taken place is proving
difficult. ‘It’s hard to prove a negative,’ says Helen Nku, a clinical lead
occupational therapist with Norfolk Community Health and Care
NHS Trust who set up the service.
While those numbers do not readily exist, there are always
an array of statistics to draw on – and finding someone who
understands them can really help.
Mandy Miles is head of ambulatory care for Virgin Care Banes,
which runs a falls car in Bath and North East Somerset with Bath
and North East Somerset CCG, South Western Ambulance Service
NHS Foundation Trust and Bath’s Royal United Hospital.
She says: ‘The thing that’s quite hard with data is how things are
coded in an acute hospital. We were fortunate to have someone at
the clinic commissioning group who loved stats, and they produced
a lot of numbers that I wouldn’t be able to do.
Potential partners
All the services featured here had very different starts, but they
all relied on working well with both ambulance services and
commissioners.
In Norfolk, the East of England Ambulance Service first
OTnews October 2019 39