The Frailty Network’s clinical lead has helped to promote a safety campaign to reduce the number of people injured by falls this winter.

Professor Martin Vernon (pictured left) advised people at increased risk of falls, along with their families and carers to take some simple actions to keep them safe in an NHS press release sent out this month.

In 2020, almost a thousand people across the North West died as a result of a fall at home. The greatest proportion of those were over the age of 75, where 730 people died as a result of a fall.

Falls are also the number one reason for an older person to be taken to A&E with around 1 in 20 sustaining a broken bone and needing hospital admission.  

North West Ambulance Service teams attended more than 96,000 falls across the North West between April 2021 and March 2022.  

Prof Vernon, who is a senior consultant geriatrician, said: “There are many factors which can increase the risk of a person falling over including long term health conditions, such as heart disease, disorders of the nervous system including dementia or other disabling conditions and side effects of medication.  

“While some of these factors may not be reversible, there are also many important causes of falls which can be addressed more easily such as reduced physical activity, loss of balance - particularly among older people - poor vision, particularly among those living in a care home, and unsafe environments.”

As people get older, they are increasingly likely to sustain a fall, but in many cases, this can be prevented through a few simple actions, including mopping up spillages, removing clutter, wearing well-fitted shoes in a good condition, and doing regular strength and balance exercises.

Prof Vernon added: “I recommend everyone takes some simple precautions to help them take care of themselves, make their homes safer and increase activity to improve strength and balance. For people who are online there are some good apps they can look at such as KOKUhealth.com.”

On November 1, we welcomed Dr Shivakumar Krishnamoorthy (pictured right) as our new joint clinical director from secondary care. 

Krish is a stroke consultant at Stepping Hill Hospital and has held senior leadership roles in the Trust for many years.

He said: “It is an absolute privilege to join the excellent network team and I look forward to providing leadership and in driving the stroke improvements in Greater Manchester.”

Krish will be meeting the stroke inpatient teams and getting up to speed with the wide-ranging programme of work in the coming weeks.

In further news, the region’s thrombectomy service is on target to treat 250 cases a year after moving to a 24/7 service in March this year.

Thrombectomy is a life-saving procedure where blood clots in the brain are mechanically extracted by a highly specialist team at the Manchester Centre for Clinical Neurosciences based at Salford Royal Hospital.

Greater Manchester is one of only six regions in the country to offer thrombectomy throughout the day and night, with all residents able to access the service through our centralised hyper acute care pathway, involving Fairfield General, Stepping Hill and Salford Royal Hospital stroke services.

You can follow the Network on Twitter @GMNISDN and find out more about them on their website.

In the latest of his occasional blog series, our clinical director, Dr Peter Elton (pictured left), writes about clinicians’ and policy makers’ relationship with making decisions based on the evidence of existing trends.

Mathematician and philosopher Bertrand Russell warned of the dangers of extrapolation: "The chicken noticed that the farmer came every day to feed it. It predicted that the farmer would continue to bring food every day. Inductivists think that the chicken had "extrapolated" its observations into a theory, and that each feeding time added justification to that theory. Then one day the farmer came and wrung the chicken's neck. This inductively justifies the conclusion that induction cannot justify any conclusion."

This perspective has made us overcautious towards extrapolation. There are numerous examples.

The Chief Medical Officer would only recommend inhaled budesonide for COViD to reduce hospitalisation for people with COViD in those over 50 because evidence of effectiveness in the PRINCIPLE trial only included this age group (in order to maximise the statistical power of the trial rather than for clinical reasons) and the STOIC trial, which included younger patients, was considered too small.

The Cochrane Review of self-management of warfarin, compared to warfarin managed at a clinic, leads to thromboembolic events being reduced by about a half whereas DOACs (direct-acting oral anticoagulants) lead to a reduction of only a quarter. The absence of a direct comparison has led to a reluctance to translate the evidence into practice.

The correct answer

Vitamin D has been shown improve the outcome of pregnancy, without adverse events, at doses between 400iu daily and a single dose of 200,000iu. A local proposal, based on what is readily available, of a loading dose of 20,000iu followed by a daily dose of 400iu daily has caused concern because no trial has used that exact regime.

Extrapolation is more often required when treatments are cheap and there is no incentive for pharmaceutical firms to fund research which may support those particular remedies. It does not stop them using extrapolation when it suits them. 

Bevacizumab was given at a dose of 350mg, for a person of average weight, every two weeks for people with cancer. It was effective whilst causing, amongst other things, adverse gastrointestinal, renal and hypertensive events. Novartis extrapolated that these adverse events would be a danger when giving intravitreal injections of bevacizumab, for wet age-related macular degeneration at a dose of 1.25 mg every month. In response, they developed an alternative, similar drug, ranibizumab with a hundredfold cost.

We should not disregard extrapolation. It is an important element of policy making. Careful extrapolation will almost always give you the correct answer - except when it doesn't.

Greater Manchester’s Maternity Equity and Equality plan has been recognised nationally by NHS England as a beacon of good practice.

The plan was commended at a recent maternity transformation update meeting for its strong involvement of service users and going the extra mile by referencing other protected characteristics, such as sexual orientation and disability, as well as the presentation of the document being clearly written and designed. 

This is an important piece of work in our commitment to providing high quality healthcare to all our communities in the region and a credit to the Greater Manchester and Eastern Cheshire Local Maternity and Neonatal System (LMNS), who put the plan together.

Data shows that the period of time from becoming pregnant and up to a year after giving birth, mortality outcomes are worse for those from Black, Asian and mixed ethnic groups and those living in poorer areas, so last year the NHS pledged to improve this.

Each region was asked to work with women and their families to set out how they plan to address the issue. The plans detail how each area will work to ensure all mothers and babies achieve equal health outcomes as well as improve the experience for staff from minority ethnic groups.

Eileen Stringer, the Maternity Network’s clinical lead midwife, (pictured above right) said: “It has been a privilege to work with so many of our partners and service users in developing this plan. The plan provides us with a great opportunity over the next 5 years to address many aspects of care and introduce measures that will empower women, people and families so that their childbirth experience and outcomes are the best that they can be.

“Working together with partners and service users to co-produce a maternity equity plan means that together we will improve the experiences and outcomes for pregnancy, childbirth and beyond, setting the scene for our maternity service users to have a long and healthy family life together.”

The Network is establishing an implementation group to start to bring the plan to life and work with partners and service users to implement these important actions. They will be reporting back to the LMNS board and the Integrated Care Board (ICB) on the progress on a regular basis.