Quarter 4 - March 2019 
Hip fractures can result in pain, loss of independence, distress and an increased risk of mortality. They are largely caused by falls and a major cause for requiring social care. Age and sex are major risk factors for hip fractures – they are more common amongst people aged 80+ and post-menopausal women.
The age standardised rate for Emergency Hospital Admission for hip fractures in West Sussex in 2017/18 is 569 per 100,000 65+ population which is similar to the rate for England. This is down from 595 per 100,000 65+ population for 2016/17, a numerical but not statistically significant reduction. It is worth noting that the emergency admission rate for those aged 80+ was significantly worse than the rate for England in 2016/17 and is now similar to the England rate, a reduction from 1,658 to 1,568 per 100,000 80+ population. While these reductions are to be welcomed, it needs to be highlighted that any activity impacting on them will be historical relating to the period of data collection.
Falls and fall related injuries are a current priority area at both STP and county levels. Falls are one of the three Surry and East Sussex STP strategic priorities along with CVD and MSK and the initial workshop to scope areas for focussed activity will be held on Tues 23rd April. Reducing falls and fall-related injuries is one of the four priority outcomes for the Ageing Well component of the refreshed West Sussex Health and Wellbeing Strategy.
 The Director of Public Health and the Public Health Consultant lead have recently led on the development and delivery of a major winter pressures strategic falls prevention programme aimed at reducing Winter Pressures on the NHS. The programme involved:
  • Sussex Community Foundation Trust recruiting 31fte staff to increase capacity around triage and the provision of multifactorial risk and home hazard assessments
  • District and boroughs being resourced to increase capacity around the provision of strength and balance exercise
  • A Public Health campaign on the Super 6 exercises including a Make Every Contact County training video for professionals working with at-risk older people.
  • Slipper swap events held across the county
November 2018
Hip fractures can result in pain, loss of independence, distress and an increased risk of mortality. They are largely caused by falls and a major cause of requiring social care. Age and sex are major risk factors for hip fractures – they are more common amongst people aged 80+ and post-menopausal women.
 The interim Head of Service - Stages of Life, has taken over as chair of West Sussex Falls Prevention Steering Group and is also now the public health lead for the STP falls workstream, one of the three strategic priorities along with CVD and MSK. The interim Head of Service is also working with the Director of Public Health on the delivery of a major winter pressures strategic falls prevention programme aimed at improving outcomes and reducing waiting times and emergency admissions. Key system partners have been engaged including Sussex Community Foundation Trust, South East Coast Ambulance Trust and WSCC Independent Living Services and Fire and Rescue Service. Priority areas for action agreed and expressions of interest are currently being sought. As part of the programme Public Health are promoting population level approaches to falls prevention including producing an falls prevention z-card with information on the super 6 strength and balance improving exercises (and info on what to do following a fall) and an accompanying training video to ensure effective use through a make every contact count (MECC) approach.             
Quarter 2 - September 2018
Hip fractures can result in pain, loss of independence, distress and an increased risk of mortality. They are largely caused by falls and are a major reason for requiring social care. Age and sex are significant risk factors for hip fractures – the rate is higher amongst very elderly people (80+) and post-menopausal women.    
Other risk factors include osteoporosis, having a previous fracture or history of falls, smoking, high alcohol consumption, low BMI and visual impairment.
 Work on falls prevention and recovery cuts across organisations and sectors. The West Sussex Falls and Fracture Prevention Steering Group, led by Public Health, includes representation from Districts and Boroughs, the NHS, Fire and Rescue Service, social care and the voluntary and community sector. The group identify how to improve local provision. 
There are a wide range of falls and fracture prevention services in West Sussex.
West Sussex Falls and Fracture Prevention Service is the specialist community NHS service for older people at risk of falls and fall-related injuries. It offers a number of services including multifactorial risk assessment in the home, strength and balance exercise programmes, home hazard assessment and modification, education and training for other professionals. There are teams in Chichester, Haywards Heath, Horsham and Worthing.  
Fracture liaison services (FLS) identify people with a first fragility fracture and then treat and monitor them to reduce the risk of a second more serious fracture including hip fractures. Crawley FLS is an innovative GP-based service which offers care closer to home and frees up consultant time.
West Sussex Wellbeing Hubs provide evidence based strength and balance exercise programmes for people who are scared of falling, feel unsteady or have a history of falls. To increase the availability of falls prevention focused exercises for older population West Sussex County Council Public Health team funded 15 spaces on an OTAGO Exercise Programme training course, with graduates of the course running programmes at Wellbeing Hubs and Age UK
WSCC Independent Living Service works with adults who have a physical impairment or illness including people who have experienced falls-related injuries or who have a history of falling. Occupational therapists assess the home environment to identify hazards and barriers to independence and then provide advice and assistance around home adaptations to address these.
Chichester Careline is an independent living service that provides telehealth for falls detection and response including wearable pendants and units that can be used to raise an alarm call in the event of a fall and fitting falls detection sensors in the home.
Latest results
In 2015/16, there were approx. 578.4 per 100,000 population. This does not differ significantly from the England average. 

Background

Key risk factors for hip fracture are age and gender. The rate of fracture is higher in very elderly groups (80+ years) and also higher in post-menopausal women. West Sussex has an increasing number of people in“very elderly” age groups, and given differences in life expectancy more of these people are women. In recent years the trend in emergency admissions for hip fracture has been fairly stable but projected increases in the very elderly age group is expected.

Work on falls prevention and recovery cuts across organisations and sectors. The West Sussex Falls & Fracture Prevention Steering Group, led by Public Health, includes representation from Districts and Boroughs, health, Fire and Rescue Service, social care and the voluntary sector. The group identify how to improve local provision.