Shared learning database

Type and Title of Submission


(Update of) Care Home Support Team (CHST) - Reducing Falls


The development of the Care Home Support Team (CHST) has provided a multi-disciplinary/multi-agency support and therapy service to Care Homes in Derbyshire. Access to patients in Care Homes is variable, in that the service relies on the knowledge of the care home staff to refer for appropriate services. Therefore early interventions and preventative measures are not common practice for this group of people. The CHST aims to address these discrepancies. This service offers an opportunity to improve the quality of care to residents in Care Homes and thereby reduce their risk of falls.


2011-12 Shared Learning Awards

Does the submission relate to the general implementation of all NICE guidance?


Does the submission relate to the implementation of a specific piece of NICE guidance?


Full title of NICE guidance:

CG21 - The assessment and prevention of falls in older people

Category(s) that most closely reflects the nature of the submission:

Is the submission industry-sponsored in any way?


Description of submission


Residents in care homes have the right to access community health services they are reliant on being referred by visiting nurses or GPs. Where intermediate care staff have been involved with care homes, they have highlighted concerns about basic skills, lack of appropriate equipment and the inability of care home staff to identify residents at risk of a variety of problems, the biggest of which is the risk of falls. The team felt they could provide an all round comprehensive package comprising; Advice, training, support, rehabilitation, early intervention and prevention of hospital admission.


Achieved by: - Promoting personalised and holistic care and support of residents - Early Intervention from multi-disciplinary team (MDT) for new residents promoting well being and independence at time of transition - Working with Social Care with regard to emergency admissions into care homes to ensure return home is facilitated where possible - Working with staff and Social Care to ensure residents admitted for respite go home at the same level of independence or, if possible, better than on admission - Early rehabilitation support from MDT for residents on discharge from hospital - Quick response from MDT to urgent referrals e.g. frequent falls or decline in mobility, preventing admission - Best practice manual for each home to provide gold standard guidelines/protocols - One stop advice telephone line for all Homes with access to MDT - Bespoke training programmes for staff dealing with individual residents - Specific training for individual Homes - including moving and handling, risk assessments, environmental assessments - Streamlining/simplifying referral system into the service including face to face from care home staff - Advising and supporting care home managers with recommendations with regards to appropriate equipment provision - Identifying and addressing safeguarding issues within the homes


An initial scoping survey was carried out in 4 local care homes to assess views of care home managers with respect to current services and changes they would like to see. Feedback from local GPs, DNs, Social Services, PCT Commissioning Team and other members of the Intermediate Care Team supported the need for developing a specific team. A bid was made and won for funding through Transforming Community Services Innovation Award an MDT of physio, OT, nurse and pharmacist began working with one local home, with work being monitored via PPI surveys of residents, relatives and staff at the care homes. The CHST has currently expanded its work to all local care homes and accepts referrals for other homes on a case by case basis for more complex cases. Written and verbal feedback from residents, relatives, staff and other professionals involved with care homes in the area continues to shape how the team evolves. Two development days were held with input from Continuing Care, Social Care, local Equipment Provider, Specialist Rehabilitation Team and Commissioning Working with SALT, Dietetics and Mental Health Services has enhanced service provision within the care homes. The team has also met with the local acute hospital discharge teams to begin facilitating hospital discharge and attended Social Care team meetings to promote joint working. Our daily contact with the residents continually shapes our ideas and practice.


The project was initially funded after a successful bid for Innovation Fund money. This allowed a pilot in one home and then we expanded to 12 homes locally enabling us to evidence greater numbers. We now go into all care homes in the Amber Valley area and this has been achieved by some service redesign within Intermediate Care Services. Currently the team is cost neutral but given time and sufficient funding the hope is that we begin to make savings from hospital admissions due to the reduced number of falls within our local care homes.

Results and evaluation

Monitoring and evaluating is ongoing and initially was through questionnaires, focus groups and evaluation forms. We have had two major stakeholder events that were attended by managers and senior staff within the care homes. We used these meetings as time to get feedback from the homes but also a time to see what direction they felt the service should be developing in. Some of the most remarkable results have been around falls reduction. For example reducing falls within a residential dementia unit by 60%, improving well being scores in the same home significantly. Looking at individual cases one lady had previously had 15 falls in 8 weeks, 7 of which were in her bedroom, with advice and training to the staff about falls risk assessment, the purchase of a sensor mat, education about the effective use of sedative medication and managing her anxieties the lady had 7 falls, only 2 of which were in her room; again a 50% reduction in falls for this one case. This potentially has saved on paramedic call out, ambulance transfer, potential hospital admissions and a reduction in function post fall. By developing a team that is supporting the care homes it has allowed the community therapy services to develop the team to enable them to provide rapid response to people in the community and this in turn has reduced their waiting list down to 1 week.

Key learning points

Some of the key learning points have been around data collection to enable us to evidence the savings and impact this service has had whilst it has gone through the phases of the project. Ensuring you have support from business development teams and commissioning support is also vital as it is these people who will be able to assist you in taking any project forward. Also making sure that any people who will be stakeholders in the project are included from the first opportunity will enable the project to flow better.

View the supporting material

Contact Details

Name:Sam Pessoll
Job Title:Team Leader (RGN)
Organisation:Derbyshire Community Health Services
Address:Babington Hospital, Derby Road
Postcode:DE56 1WH
Phone:01773 525081


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This page was last updated: 23 August 2011

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Copyright 2014 National Institute for Health and Care Excellence. All rights reserved.