National Falls and Bone Health Project AFFINITY

Introduction The purpose of National Falls and Bone Health Project AFFINITY (Activating Falls and Fracture Prevention in Ireland Together) is to implement the ‘National Strategy for the Prevention of Falls and Fractures in Ireland’s Ageing Population’, hereafter known as the National Strategy, and to develop a robust governance framework to monitor progress, ensure accountability and sustainability. The vision of the National Strategy is a “life free from falls and fractures in our ageing population” and the AFFINITY project aims to deliver on this.

Core principles of AFFINITY are: Integration, Implementation and Innovation.

Background Slips/trips/falls in Ireland contributes annually to over one third of National Adverse Event Management System (formerly STARS Web) reported incidents from the publicly funded health and social care system which could have or did lead to unintended and unnecessary harm. In addition, some €520 million is the estimated annual spend in dealing directly with the sequelae of falls and fractures in the absence of implementation of the National Strategy. If Ireland fails to take decisive action now, this latter annual figure is expected to quadruple by 2031, given our ageing demographics. The Health Service Executive (HSE) submitted a Partner Commitment to the European Innovation Partnership on Active and Healthy Ageing (EIP-AHA) Action Group A2 in 2012. A2 is the pilot falls initiative for EIP-AHA which aims to increase the average healthy life years (HLY) in the EU by 2 years by 2020, known as a “Triple Win” for Europe. The EIP-AHA approach fosters partnerships and collaborations and is serving as a key driver for implementation of the National Strategy.

Current Status Implementation of the National Falls and Bone Heath Strategy has been prioritised by the HSE and the State Claims Agency (SCA) for implementation in 2013.  Anne Marie Ryan, HSE Office of the Assistant National Director for Older Persons and Irene O’ Byrne-Maguire, Clinical Risk Adviser with the SCA, have been appointed as joint co-ordinators for the project since mid February. Dr Tara Coughlan has been designated as the Clinical Lead for Falls and Bone Health within the Older Persons Clinical Care Programme. To date a submission to the National Clinical Effectiveness Committee (NCEC) to seek national recognition for the Guiding Framework/Clinical Guidelines to Prevent Falls and Fractures in Ireland’s Ageing Population has been achieved, but will need to be progressed in the coming months.  A submission on the Diagnosis and Management of Osteoporosis in Ireland is already being progressed through the NCEC process. A project plan to implement the National Strategy has been proposed, to include a governance framework, an integrated service delivery model approach to implementation and Key Performance Indicators.

Governance Arrangements The governance framework includes a

  • National Sponsorship Team
  • National Implementation Team
  • Regional Implementation Team aligned to the four HSE Administrative Regions

The National Sponsorship Team (NST) comprises members from the HSE, SCA, Department of Health, Service Delivery Unit and the Clinical Care Programmes. Its remit is to act as a “clearing house” to enable AFFINITY to meet its goals. The Sponsorship Team will report to the HSE Chief Operations Officer, Ms Laverne McGuinness.

The National Implementation Team (NIT) comprises members from various disciplines and with various roles across multiple settings to ensure adequate representation of a “whole system” integrated approach needed.

The Regional Implementation Teams (RIT) will serve to enable the pilot sites/early adopters identified to implement an integrated service delivery model for falls and bone health in line with the Specialist Geriatric Services Model and the Guiding Framework/Clinical Guidelines to Prevent Falls and Fractures in Ireland’s Ageing Population (currently being progressed through the NCEC process).

Integrated Service Delivery Model The proposed implementation approach in 2013 seeks Expressions of Interest (EOI) from potential pilot sites /early adopters (at least one from each of the four HSE Administrative Regions) to implement a Falls and Bone Health integrated care pathway (ICP) for older persons aged 65 years and older in line with the National Strategy and the Specialist Geriatric Services Model and in anticipation of SAT (Single Assessment Tool) for Older Persons.

An Online Audit Tool and an Organisational / Unit Falls Readiness Proposal including Checklist, have been developed to help potential pilots determine their ability to deliver an ICP within and across various settings.  Key members from various

EIP AHA: A2 Action Group Partner




settings and disciplines need to commit to working together (MDT) for a 12 month period to develop and implement an ICP for falls and bone health for a designated population.  This MDT team must be empowered to do so by their respective organisational /unit managers/leads.

The Online Audit Tool is based on a national audit tool developed, implemented and evaluated by the Royal College of Physicians, UK in 2005 to measure the progress of falls and bone health services within the UK against a national Falls Standard and best available evidence, as captured within the Guiding Framework/Clinical Guidelines to Prevent Falls and Fractures in Ireland’s Ageing Population (currently being progressed through the NCEC process). This ICP approach feeds into and draws support from the quality and patient safety agenda and clinical governance arrangements nationally. It also serves to “test” the integrity of the Specialist Geriatric Services Model , a blueprint for the development of comprehensive, integrated and service-user focussed services for older persons nationally.

Change Management Supports To support the National Project AFFINITY a “Falls” collaborative education and training programme focusing on falls prevention in healthcare settings across the Mid Western Region is being launched early in May. This programme can be seen as an enabler for AFFINITY in that it will help commence falls prevention and bone health initiatives or can be used as an enhancer for those teams that already have falls prevention initiatives in place. As part of the training programme the multi-disciplinary teams attending must commit to some initiative to reduce

harm from falls, so that this training can be used as a change management support structure for those teams that wish to become pilot sites/early adopters for falls prevention. The “ Falls” collaborative programme uses the validated quality improvement methodologies of the Institute of Health Care Improvement  (IHI) Break Through Series. Free enrolment has been offered nationally to new or existing MDT members from the other HSE Administrative who are keen to become a pilot site/early adopter. It is hoped that this type of programme will be extended given the short lead in time, and will be delivered in the other HSE Administrative Areas given travel restrictions.

A Web-based Repository is planned to promote clear, consistent and timely communications of relevance across the system to the National Falls and Bone Health Implementation Project AFFINITY It is envisaged that this portal will share news updates regarding key stages/elements of AFFINITY. In addition, it will share information on

  • Governance Arrangements and Actions, including signed off Action Minutes of meetings;
  • The Integrated Service Delivery Model;
  • “Best of Breed” policies, procedures, guidelines and tools;
  • Web links to sentinel websites and other key resources

E Learning supports developed in other jurisdictions, in addition to our own, will be posted to help build competency and capability within the system. Opportunities will be afforded to the system as a whole to share their “best of breed” resources to support the implementation of the National Strategy. Other initiatives of national and international import that are related to falls and bone health will be identified and shared on the web portal.

Key contacts:

Irene O’Byrne-Maguire:

Anne Marie Ryan






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