NHS England and the Department of Health and Social Care (DHSC) set a mandate to mitigate the severity of fall-related incidents because of the gaps in the provision of ‘fall response services’. Considering this, the Shropshire, Telford and Wrekin ICB, alongside EMED Group, implemented a 24/7, three-month pilot project to support the area’s Urgent Care Response (UCR) and ambulance frontline teams.
Falls and related injuries are increasingly common. Over two million people fall in their homes each year, and it is the number one reason the elderly are taken to A&E. A severe fall can negatively affect functional independence and quality of life.
A fall that results in a long lie of over one hour can lead to serious injuries, admission to hospital, subsequent moves into long-term care and potentially death. Increased pressure on ambulance services, especially during the winter period makes it difficult to rush to accommodate fall victims effectively.
To combat the severity of fall related incidents, NHS England and the DHSC set a mandate to “improve the quality and capability of care for people through delivery of urgent, crisis response support within two hours” to their “homes or usual place of residence” aiming to prevent “up to 20% of emergency admissions” by putting the right care in place.
The Shropshire, Telford and Wrekin ICB responded to these demands by embedding a ‘quality improvement method’ in light of the NHS’s delivery and continuous improvement review in April of 2023. EMED Group as the incumbent Non-Emergency Patient Transport Service provider in the region (E-Zec under this contract), had the capacity as well as the existing understanding of care logistics and the patients within the area to assist the ICB on a Falls Response Service test from March to May 2023.
The model developed could link in with its Rapid Response UCR teams between 08:00 and 20:00 and directly interface with the emergency ambulance service between 20:00 and 08:00. The project’s objective was 24/7 fulfilment of a two-hour response, improving patient experience and easing the pressure on the ambulance service for falls and Category 4 welfare calls.
EMED’s experience as the incumbent provider and the lower clinical threshold on our staff compared to UCR and frontline ambulance personnel allowed us to mobilise the pilot project within three weeks. Over the 12 weeks of the test, there were 231 ambulance callouts.
After the 12 weeks, EMED confidently reports that it recorded no patient deaths from long lies compared to the 10 deaths recorded three months before the pilot project. EMED enabled the UCR team to respond in an average of 42 minutes, and most calls on scene were within 60 minutes, comfortably meeting the two-hour mandate.
Most calls occurred between 8pm and 8am (155, 67%), significantly reducing pressure on the emergency ambulance service. Additionally, EMED’s results indicate that out of 184 interventions in March and April, it prevented A&E admissions for 87 (47%).
In 2023, the cost of A&E admissions ranged from £86-£418, depending on the department’s location and the complexity of the investigation and treatment. In 2020/21, the estimated average cost of a patient being taken to A&E by ambulance was £367, and ambulance callouts that did not result in a trip to A&E cost roughly £276.
This shows that alongside the additional capacity EMED provided with the 24/7 model, it also enabled the ICB to save an additional £7,917 in ambulance journey costs to A&E and a figure ranging between £7,482 and £36,366 in A&E admission costs, all within a 12-week period.
Over 250 people have been helped during this project and A&E figures have stabilised. For the previous three months, there were 10 reports of people dying due to long lies. There have been none since the provider have taken over, which is very positive. People were dying from waiting to be lifted, and they are not now.
