London Ambulance Service pilot reduces 999 calls and visits to A&E

A seven month pilot run by London Ambulance Service NHS Trust in partnership with Royal Voluntary Service has helped cut emergency calls and visits to A&E amongst frequent fallers in two London boroughs.

The active ageing pilot ran from November 2017 to May 2018 and was set up to decrease the number of falls in two London boroughs, with a goal of reducing demand on both the ambulance service and hospitals as well as improving outcomes in later life.

The pilot ran in Merton and Hackney, where need is particularly high, and tested a new model of ‘mobility volunteers’. Older people who fall frequently and call 999 were referred to Royal Voluntary Service, who then paired local volunteers with clients. These volunteers visited clients in their homes and worked with them for a period of 6-8 weeks to improve their physical function and wellbeing.

Following 6-8 weeks of volunteer intervention, the active ageing pilot had a number of positive outcomes. These included a 42% reduction in falls amongst clients *, a 45% decrease in calls from clients to 999 as a result of a fall and a 29% reduction in clients being admitted to A&E.

Clients also showed improved physical function and health and wellbeing. 60% improved on a 30-second Sit to Stand test and almost 70% improved on walking or gait speed in the Timed Up and Go (TUG) test. Furthermore, over one in four felt their health had improved, more than one third felt happier and more confident and one in four said they felt less lonely.

The programme was based on Royal Voluntary Service’s ‘mobility volunteers’ doing one-to-one chair-based exercises with clients, as well as providing advice on hydration and nutrition. At the end of the 6-8 weeks of visits, volunteers then supported clients to transition to a community exercise programme or other local activities to help them build and maintain their social connections.

During the pilot period, over 70 referrals were received from London Ambulance Service or falls teams working with the ambulance service. A total of 31 very frail clients, the majority of which were 85+ completed the full 6 to 8 week intervention. The pilot focused on recruiting volunteers from underrepresented groups (e.g. BME backgrounds) and a total of 34 volunteers were recruited from a diverse range of backgrounds during the course of the programme.

"Frailty need not be an inevitable part of getting older. We know that targeted resistance-based exercises can significantly help older adults improve their physical function and reduce their risk of falls. Our volunteers received specialist training to provide 45-60 minute exercise sessions each week to help clients regain their independence. This included leg strengthening exercises to help them get out of a chair or off the toilet and arm exercises to help them get dressed and out of bed. We are very pleased with these results. Given the age and high levels of frailty of these clients and a relatively short period of intervention. , such findings are very encouraging and suggest greater gains might be made with a longer support period."

Dr Allison Smith, Head of Strategy and Development at Royal Voluntary Service

"We partnered with Royal Voluntary Service to test an innovative way to support what is a particularly vulnerable group. Recruiting local volunteers to support frail, often socially isolated people within their community has been extremely rewarding for everyone involved. It has highlighted the importance of working with volunteers and the role London Ambulance Service has, with its unique position of working across London, in identifying areas of need which are often hidden to the wider health and social care system. By working in a partnership like this that works across traditional, organisational boundaries, we are able to better connect communities and improve people’s quality of life.”

Briony Sloper, Deputy Director of Nursing & Quality, London Ambulance Service NHS Trust

"The first person I met was Anna, who was 96 and housebound. She was not what I was expecting! She is bubbly, chatty, full of knowledge and interesting stories from her past and really keen to be on the programme. She finds it difficult to get out and about because of physical ailments but was craving a social life outside of her home. I worked with Anna for six weeks to complete a set routine of gentle exercises. We struck up a friendship and it was a pleasure to be able to spend time helping someone in need become more active. By volunteering I feel I am helping the local emergency services and helping older people to be more mobile and sociable. All of this gives me a sense of pride that I am helping my community.There was no respect for youth when I was young, and now that I am old, there is no respect for age - I missed it coming and going."

Becky Seaton is 41 and lives in Lower Morden. She donated one hour a week to support the pilot in Merton

The Kings Fund estimates falls account for around 40 per cent of all ambulance call outs to the homes of people over 65 and are a leading cause of older people’s use of hospital beds. London Ambulance Service estimates that each ‘call-out and convey to hospital’ costs the service approximately £300.

For further information