Proactive prevention in action: preventing falls in Norfolk: Norfolk County Council

In Norfolk, a third of people over 65 fall every year, deeply impacting a person’s confidence, mobility and wellbeing, and costing health and social care over £4,000 per fall.

Norfolk County Council (NCC) and its partners wanted to identify people at risk of a fall and offer them preventative support to increase independence and reduce demand for adult social care and health.

NCC built a unique connected data platform which provided a single view of residents. A supporting AI model predicted with 70 per cent accuracy which residents were most at risk of a fall.

There were three key elements to this approach:

• Safely connecting individual data from multiple systems across organisational silos to form a holistic understanding of Norfolk’s residents.
• Automatically enriching existing data by applying Large Language Models to case notes to extract strength and risk information.
• Applying machine learning models on top of our enriched resident data to target the right people with the right support.

Tailored interventions are now provided to at-risk individuals, building on individuals’ strengths and on the assets within local communities.

• Of the cohort of people that received interventions, the fracture rate dropped from 4.2 per cent to 0.5 per cent.
• There has been an average saving of up to £175 per person per week for those who received an intervention versus those who did not.

• The Council is now mobilising the Proactive Intervention operating model, proactively identifying and engaging with c.12,080 people at 58-99 per cent risk of a fall.
• The platform and tools developed will next be used to identify subsequent cohorts of individuals to target for proactive interventions, enabling the Norfolk system to shift from a reactive to a proactive model of support.
• The Council is also setting itself up to operate in this more proactive way, including how it connects residents to community opportunities and fosters community-based provision, alongside operating model changes to deliver the targeted interventions.
• The AI-enabled approach used to prevent falls can now be used by Norfolk to prevent escalation of needs in a wide range of use cases. Cohorts being considered next include isolation and loneliness.

Email: [email protected]

Email: [email protected]