Hertfordshire falls unit helps avoid unnecessary A&E call outs

Social worker involvement with emergency services can avoid trips to A&E, a Hertfordshire pilot has found. Julie Griffiths reports

A social worker and emergency care practitioner are responding to 999 calls in an ambulance response car in what is thought to be the first initiative of its kind.

The six-month pilot, run by Hertfordshire Council and the East of England Ambulance Service NHS Trust, helps older people avoid unnecessary trips to A&E, promotes joint working and looks set to make savings for the ambulance service of about £30,000.

Social worker Jackie Reid, who responds to calls with emergency care practitioner Graham Clements, says: “It’s such a good idea that I constantly ask, ‘why did no one think of this years ago?’.”

When a 999 call comes in to ambulance dispatch between 8am and 4pm and meets specific criteria then, instead of an ambulance, the “falls car” is sent. Criteria include that the patient is more than 65 years old and lives in Dacorum, Watford, Three Rivers, St Albans or Hertsmere. The fall has to have taken place in the home or a care home – so no slips on ice or snow – and high falls are not included.

Once at the patient’s home, if the clinical assessment by Clements is that the patient can be treated at home, Reid is on hand to provide help to prevent future falls.

This might be the provision of equipment, a change to the care package, or simply advice. Reid, a level-three hospital social worker on secondment, says she can instantly see the difference that the visit has made to service users, making it a fulfilling job.

“I’m going in and making it safe. And, because a lot of the equipment is in the van, I can often set things up. If they need more help, I send the case on to the review team who then take it forward,” she says.

About 50% of calls are from older people unknown to adult social services and they often lack understanding about the help they are entitled to so Reid can explain how the system works.

The idea for the pilot came from Pauline Pickering, area manager of older people and physical disability in Hertfordshire Council, and Dave Fountain, general manager for Bedfordshire and West Hertfordshire at the East of England ambulance service.

Emergency Calls

In 2008, the region’s ambulance service responded to more than 20,000 emergency calls in Hertfordshire that were categorised as falls, accounting for a fifth of the workload. The aim was to reduce this while also benefiting the patient.

Pickering says: “It’s a better outcome for them if they don’t need to go to A&E. But if they do need to go, then they go. It’s always a clinical decision.”

She emphasises that the scheme is about reducing the number of trips to A&E rather than avoiding admission to hospital. But the savings are still significant. It costs £275 to send an ambulance out each time. Then there are the costs for triage, patient transport services and, if a patient is admitted to hospital, the overnight care costs.

Pickering says the initiative has gone “extremely well” but no decision will be taken on a roll-out until the pilot ends. It is also unclear whether any savings would be re-allocated if the project were to be made permanent.

The project is jointly funded and has meant close working between the two organisations to sell the idea to other partners, such as the county’s equipment service for disabled people, commissioners, and home care agencies.

Reid believes the pilot has also done wonders for promoting better understanding and respect among those on the front line.

“The ambulance stations are now more aware of what social workers do. And it’s been a real eye-opener for me – I didn’t realise an emergency care practitioner existed before this. We’re building relationships and knowledge so the pilot has been a benefit to us as well as the service user,” she says.

Case study

CARLO and MARY DELLA-VALLE

‘It’s like having a mini A&E department in your home’

When 90-year-old Carlo Della-Valle fell in his home, his wife Mary, who is in her eighties, called 999. When Carlo has fallen in the past, an ambulance took the couple to A&E where long waits at hospital have ensued.

“I have sat in the hospital for hours. There are so many people to be seen,” says Mary.

But this time, social worker Jackie Reid and emergency care practitioner Graham Clements arrived to help.

Clements attended to Carlo’s medical needs, which included getting him off the floor, a cut hand, and blood pressure checks. And Reid asked about the help the couple received and ascertained whether more support was needed. They felt they had enough outside support but, at Reid’s suggestion, accepted a perch chair for Carlo to use when shaving to help prevent future falls.

Mary describes the service as “marvellous”.

“It was like having a mini-A&E department here in our home. It’s such a good idea,” she says.

Key facts about the service

In its first 28 days, the project responded to 65 calls. From these:

● Six people were admitted to hospital for fractures.

● Two calls were not appropriate for the pilot.

● Fifty-seven were treated at home instead whereas previously they would have been conveyed to hospital.

● Social care and medical support was provided in people’s homes where appropriate.