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The resources below have been categorised into the three audits within FFFAP: National Hip Fracture Database (NHFD) National Audit of Inpatient Falls (NAIF) Fracture Liaison Service Database (FLS-DB) Hip fracture: a guide for families and carers All about your hip fracture and what to expect on the road to recovery Recovering after a hip fracture: helping people understand physiotherapy in the NHS How should your hospital prevent and respond falls during your stay Inpatient falls Falls prevention in hospital: a guide for parents, their families and carers What should happen if you or someone you know experiences a fragility fracture Six golden rules for stronger bones Strong bones after 50 - after staying on treatment

The key trends in adult social care in England outlined in this report are: Requests: More people, particularly working-age adults, are requesting support. Receipt of care: The number of people receiving long-term care has fallen again. Eligibility: Financial eligibility is tighter and reform has been put back. Spending: Total expenditure has increased due to the Covid-19 pandemic and is now higher than in 2010/11. Costs: Local authorities are paying more for care home places and home care. Capacity: The total number of care home places has declined slightly. Vacancies: The staff vacancy rate is the highest since records began. Pay: Care-worker pay continues to rise but struggles to compete with other sectors. Carers: Fewer unpaid carers now receive paid support and respite care has also fallen. Quality: Quality is largely stable but fewer ratings were published during Covid-19. Personalisation: Fewer people receive direct payments. Satisfaction: Satisfaction of people using services is edging downward.

Key findings Half (49%) of all the people arriving in A&E by ambulance are over 65. A third (36%) of all the people arriving in A&E by ambulance are over 75. Unplanned hospital admissions have been rising and have become more frequent, particularly for the oldest old. The proportion of older people feeling supported to manage their condition has been falling consistently, almost 20% in relative terms since 2016/17. 2.6 million people over 50 have unmet social care needs increasing to 15% of people in their 70s, and 21% of people in their 80s. In 2022, there were 165,000 vacant posts in social care- an increase of 50% and the highest rate on record. Call for action Integrated Care Systems (ICS) to develop comprehensive strategies for meeting the health and social care needs of older people at home, and in care homes, living in their areas. This must include major efforts to embed prevention in their work so older people can avoid the need for crisis care and maintain their independence. Social care reform and a major and sustained increase in funding. The NHS cannot deliver these improvements alone. The lack of adequate social care for basic daily needs simply stores up problems, leaving older people less able to care for themselves and arriving in hospital with serious health problems that could have been avoided. Multidisciplinary working to become the default method of delivering health and care services to older people. Older people are too often left to fall between the cracks of disjointed services and professionals who don’t communicate well with each other. For ICSs, this means making sure that social care services – and by extension the local authorities that are responsible for them - are central to their leadership and decision-making. A better paid health and social care workforce, with the skills and competencies to properly support older people would make a huge difference to the quality and availability of care. A step change in the recognition of and financial and practical support on offer to unpaid carers, who are holding up many parts of the health and care system.

Recommendations Out-of-hours palliative and end of life care is currently inadequate and fragmented, and must be better valued, prioritised and strengthened. Services must be developed and provided equitably, irrespective of diagnosis, socio -demographic characteristics (e.g. age, ethnicity) and geographical area. Service development and planning must be actively informed by the voices of patients and informal carers; collaboration with patients and informal carers should be used to drive improvements in out-of-hours care, shape service development and help identify potential solutions for gaps in care. Integrated Care Systems, Health Boards and NHS Trusts, Integration Joint Boards and NHS Health Boards, and Health and Social Care (HSC) Trusts across the UK need to strategically develop, enable and support greater integration and coordination of out-of-hours services. District nurses and community nursing teams play an extensive role in providing hands-on out-of-hours care, but huge pressures on this workforce limit the care they can provide; improved workforce planning, provision, and support for community providers of out-of-hours palliative and end of life care is essential. A designated telephone line for people with palliative and end of life care needs and their informal carers should be available 24/7, in every part of the UK. Availability and use of shared care records should be audited regularly to overcome the challenges identified in using, sharing and implementing these records across the UK. Such records should be based on timely conversations about needs, wishes and preferences for care at the end of life, and include the availability of anticipatory medicines (if appropriate). The questionnaire provided in this report can be used by those with commissioning responsibilities to understand and address gaps in out-of-hours service provision and identify priorities for improvement. Research into out-of-hours care is essential for future service development and needs continued funding.

Key findings Workforce and sector size An estimated 17,900 organisations were involved in providing or organising adult social care in England as at 2021/22. Those services were delivered in an estimated 39,000 establishments. There were also 65,000 individuals employing their own staff. The total number of adult social care posts in 2021/22 was 1.79m. 1.62m of these posts were filled by a person (filled posts) and 165,000 were posts that employers were actively seeking to recruit somebody to (vacancies). The adult social care sector was estimated to contribute £51.5 billion gross value added (GVA) per annum to the economy in England (up 2% from 2020/21). Recent trends – workforce supply and demand The total number of posts in adult social care in England as at 2021/22 was 1.79 million (up 0.3% from 2020/21). Of these posts, 1.62m were currently filled by a person (filled posts) and 165,000 were posts that employers were actively seeking to recruit somebody to (vacancies). Skills for Care workforce estimates show a decrease in the number of filled posts in 2021/22. Overall, the decrease was around 3% (50,000 posts). The vacancy rate has risen over the same period to the highest rate since records began in 2012/13. The number of vacancies increased by 52% in 2021/22 by 55,000 to 165,000 vacant posts. The vacancy rate in 2021/22 was 10.7%. This shows that the decrease in filled posts is due to recruitment and retention difficulties in the sector rather than a decrease in demand. Employers have not been able to recruit and keep all the staff they need. As a result, an increasing number of posts remain vacant. The starter rate has fallen from 37.3% in 2018/19 to 30.8% in 2021/22. The turnover rate these periods remained at a similar level (29% in 2021/22). Therefore, around the same proportion of people are leaving their roles, but there are fewer people replacing them. The UK vacancy rate has increased rapidly in the past year. This increase has created competition for staff and contributed to the increase in the adult social care vacancy rate over the same period. During 2022, following the relaxation of rules regarding testing and isolation, sickness rates have begun to decrease towards pre-pandemic levels (6.2 days as at August 2022 compared to 4.6 days in 2019/20). Workforce characteristics The adult social care workforce continued to be made up of around 82% female workers, the average age was 45 (with 28% aged 55 and over), 23% of the workforce had black, Asian and minority ethnicity and 16% had a non-British nationality. Data collected in the ASC-WDS since care workers were added to the shortage occupation list showed more people were arriving in the UK to take up adult social care jobs. In 2022, between February and August, 11% of workers new to their role within the year had also arrived in the UK within the year. This was greater than the equivalent period in 2021 (4%) and 2020 (2%). Almost a quarter of the adult social care workforce (24%, or 358,000 filled posts) were employed on zero-hours contracts. In April 2021, the NLW rose from £8.72 to £8.91 (2.2% in nominal terms). This increase contributed to a 5.4% increase in the median nominal care worker hourly rate from March 2021 to March 2022. This was the second highest increase over the recorded period. The median hourly rate for care workers decreased, in real terms, by 1.5% between March 2021 and March 2022. This compares to an average increase of 1.8% per year since September 2012. This decrease was driven by the high cost of living in 2021/22 with inflation rising to 7.0%. Analysis of workforce data from the ASC-WDS shows that there were differences in diversity between job roles. Notably, there were proportionally more males and more white people in senior roles than front line roles. The root cause of this difference can’t be ascertained from ASC-WDS data alone. Our forecasts show that if the number of adult social care posts grows proportionally to the projected number of people aged 65 and over in the population between 2021 and 2035, an increase of 27% (480,000 extra posts) would be required by 2035. Employers with favourable workforce metrics (such as high levels of learning and development), on average, had better outcomes (lower staff turnover and/or high CQC ratings).

Key issues Some of the key issues covered in the report include: understanding the significance of staging dementia, the challenges and decisions occurring at each stage, and the specificities of different types of dementias. delving into the impact of diagnosis on people living with dementia, their carers, relatives, and communities. addressing the symptoms and changes commonly associated with dementia, and the pharmacological and non-pharmacological interventions that can help people living with dementia and their carers. showcasing international and national perspectives on models of care. laying the groundwork for forward-thinking, principled approaches to dementia, necessary in order to move the needle forward. Recommendations The report makes the following recommendations: National dementia plans need to become a policy priority Person-centred care must become the norm Care should be culturally appropriate and gender inclusive Support for carers must be prioritised Care needs to be coordinated and accessible We must continue to challenge stigma and raise awareness – it remains a severe barrier Education must be improved and expanded Further trials of cost-effective and evidenced-based psychosocial interventions are needed Risk reduction must be bolstered