Up and about or falling short: mapping falls and fracture prevention services in Scotland
In Scotland, the Scottish Government assesses the services which people with or at risk of fragility fractures have access to.
The Scottish NHS is organised through a series of regional boards and local Community Health and Care Partnerships (CH(C)Ps). The latter work to integrate health and social care in primary and community settings.
As part of the National Falls Programme in Scotland, between May and October 2011 all CH(C)P falls leads completed self-assessments of local arrangements for managing and preventing falls and fractures in older people. The key findings were as follows:
- Two thirds (66%) of CH(C)Ps provide a Fracture Liaison Service (FLS) for people over the age of 50; FLS provision remains higher in Scotland than the rest of the UK.
- There has been some improvement since the last Scottish FLS audit in 2009 - this found that 77.6% of the Scottish population had access to routine post fracture assessment; six NHS boards had board-wide access to post fracture assessment; three NHS boards had limited access; and five NHS boards had no formal arrangements.
- However, the absence of an FLS or equivalent continues to be an issue in some areas, particularly in the islands and more rural Scottish NHS boards, where poor access to DXA scanning is also a drawback.
- A minority of falls prevention services in CHCPs have formal links with FLSs (where they exist). These links include agreed referral protocols and pathways between services. This does not suggest an integrated approach to falls and bone health. It is also a less favourable finding than that of a 2009 audit which suggested that seven out of nine NHS boards with an FLS had established pathways with falls services. The report states that “this is an area of care where simple changes in practice could benefit older people at risk of falls and fractures considerably.
The full audit report can be accessed here.