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Public Health: Strength and Balance Programme

Volume 788: debated on Thursday 18 January 2018


Asked by

To ask Her Majesty’s Government whether they intend to provide local authorities with sufficient resources to enable them to provide universal access to the Strength and Balance Programme for adults over 65.

My Lords, we are providing £16 billion to local authorities to spend on public health during the course of this Parliament. It is for local authorities to determine their spending priorities, reflecting the needs of their populations. The Chief Medical Officer recommends that adults undertake strength and balance activities on at least two days a week. Most local authorities provide opportunities for these activities within their falls prevention programmes.

I thank the Minister for his reply and declare an interest as deputy president of ROSPA. Will the Minister acknowledge that it is the failure to tackle adequately the chronic causes that means a quarter of a million elderly people attend accident and emergency each year with fall-related injuries, which makes an NHS crisis inevitable when seasonal illness strikes the same social group? To ease the unacceptable burden on A&E departments, will he urge the Government to give more tangible support to local authorities and to age-related and safety organisations whose work with elderly people, through what they call strength and balance exercise-based programmes, can and does significantly reduce the risk of injuries to those taking part?

The noble Lord is quite right to point out the importance of preventing falls. Around 95% of hip fractures come about through falls, at particular cost and pain to the individual, of course, but also to the wider economy as a whole. I should point out that Public Health England supports a number of activities, one of which is a partnership with Sport England that has trained 5,000 health professionals in delivering physical activities, including strength and balance work. I agree that more needs to be done at local authority level, particularly as we have an ageing population, but there is good work going on at the local level.

My Lords, in parts of Cornwall there has been real success with the strength and balance programme, with a huge reduction in falls. We all know that prevention is always better and cheaper than the cure. Can the Minister tell the House what work has been done to determine how much could be saved for the NHS as a result of a total rollout of this programme and why reductions to local authority public health budgets are jeopardising such programmes?

I have not seen an extrapolation of the benefits the noble Baroness talks about but they would clearly be significant. There are a number of schemes going on at a local level, which it is important to point out. One of them, which we have discussed before, is the “Dance to Health” programme that started with six pilots two years ago. That is now a nationwide scheme across England and Wales. Local authorities should look at precisely that kind of activity. Public Health England is committed to making sure that local authorities understand the Chief Medical Officer’s targets, so that we see more of these programmes taking place.

My Lords, I declare my interest as president of the Chartered Society of Physiotherapy. There is evidence that every £1 spent on physiotherapy can save £1.50 on the cost of a fall along the whole trajectory. There is also evidence that targeted, multifactorial risk assessment of people at particular risk can decrease falls by 60%. Therefore, will the Minister make sure that falls prevention is viewed across the whole of the NHS and not only delegated to local authorities and programmes outside, because that would miss some of the people who are at the highest risk of falls?

I am grateful to the noble Baroness for pointing out the benefits of physiotherapy. She might be aware of a scheme in Middlesbrough that is providing for people who have fallen a precise pathway from physio into community activities involving strength and balance work. As ever, one of the challenges is to make sure that all local authorities know about such programmes and put them in place. They are not necessarily expensive, but they take a bit of time. I will make sure that Public Health England is taking that attitude of spreading good practice across the country.

My Lords, NICE’s most recent and excellent quality statements in January 2017 offer guidance on falls and the importance of multifactorial risk assessments and interventions. These interventions require resources, particularly from social care specialists and public health workers, who we know are at the sharp end because of the financial pressure the Government have put on local authority funding and the successive reductions of public health budgets. Now that the Secretary of State has responsibility for social care, will he therefore ensure that strength and balance programmes are properly resourced? When will NICE next update its statistics on the uptake of guidance on this matter?

I will write to the noble Baroness with specifics on the NICE guidelines, which are incredibly important because they establish best practice. Of course, it is then incumbent on professionals to follow that best practice. We know that public health budgets have been under pressure, but local authorities are still getting £16 billion over five years. That is a lot of money and they can use some of it to focus on such activities. Moreover, in the spring Budget last year, there were big increases in the social care budget, which I know we all welcomed. That money is particularly focused on older people and preventing falls, which is what we want to see as part of that programme too.

My Lords, the noble Lord, Lord Jordan, has raised a matter that is of close interest to a large number of noble Lords. I wonder whether it would be worth considering having access to the programme to which he refers in the Palace of Westminster.

My noble friend makes an extremely good suggestion and I look forward to talking to him about that. Perhaps he could lead such a class.

My Lords, in addition to the suggestions that have been made, perhaps I could pass on a tip: playing tennis is quite good for this sort of thing.

Indeed it is, as are other things such as yoga, tai chi and—believe it or not—carrying shopping bags.

I declare my interest as chairman of University College London Partners. What assessment have the Government made of the provision of accountable care organisations to drive the integration across primary care, secondary care and social care to achieve the kinds of objectives that are the subject of this question?

The noble Lord makes an incredibly important point. We know that we want an integrated health service, particularly as we have older people with comorbidities using a range of services. The five-year forward view—NHS England’s own strategy for the future—talks about how that integration will take place through what the noble Lord calls accountable care organisations or systems. We are moving ahead with these: indeed, the most recent Budget is providing significant capital to support that integration. This is the future of the NHS, and we all need to get behind it.