Preventing Injury from Falls: the National Strategy 2005-2015, draft consultation document. Submission to the Falls Prevention Strategy. February 2005.

The Foundation supports this strategy. Its representatives at the Auckland consultation workshop on 4 February 2005 acknowledge the value of the consultation process in testing the focus and content of the draft Strategy.

Build strong leadership and co-ordination

The Foundation supports the ambitious approach to the vision statement, "A New Zealand free of injury from falls."

Two goals are stated:

• To reduce the incidence and severity of injury from falls.
• To reduce the impact of fall-related injury on the health and wellbeing of New Zealanders.

As an agency committed to supporting the independence of blind, deafblind and vision-impaired people, the Foundation believes that it is appropriate to clarify that goal 2 is a goal and to develop goal measures and objectives specific to that goal.

The Foundation believes that it is necessary to define "the falls sector", and that this is required for the notion of "inter-sector co-ordination" to have meaning. Leadership must be national but also have regional and local application so that, for example, it accords with the demographic variations across the country.

Improve the gathering and dissemination of knowledge that focuses on the prevention of injury from falls

More consistent recording of falls related health events and further research into falls are key. Hospitalisation counts do not fully represent the fall-related injuries and impacts experienced by individuals. "Consolidating and co-ordinating existing and emerging information about priority populations, settings and circumstances contributing to injury from falls" needs to be widened to emphasise extending the amount of knowledge about falls.

Accessible information

With respect to raising awareness, it is essential that public information on falls and their prevention be accessible to blind, deafblind, and vision-impaired citizens. Communication strategies must therefore include provision for accessible formats: audio, braille, electronic text, and large print. Accessible web pages must offer any downloadable documents in Word or text form as well as PDF. The Telephone Information Service operated by the Foundation is an excellent way to communicate essential information in audio form to blind people throughout New Zealand.

Develop and implement best practice falls prevention programmes and interventions

The Foundation supports the development of best practice programmes.

There is a reference to "population groups" among the actions. However, the Foundation strongly believes that the Strategy must make explicit reference to people with disabilities. Our experience is that if disabled people are not mentioned in a document such as this, programmes are developed that fail to make adequate provision for including disabled people. To ensure inclusiveness, strategic thinking and planning must from the outset recognise the needs of people who live with disability.

The falls strategy could usefully make reference to the New Zealand Disability Strategy and its vision of a society which does not disable people who live with an impairment.

Safety in the environment

Among the many challenges facing blind and vision-impaired people is that of ensuring personal safety in an environment they cannot see clearly. Sighted people may encounter obstacles; for a blind or vision-impaired person the obstacle can become a hazard. An everyday environment that sighted people navigate easily often presents as unpredictable and disorienting for people who cannot see clearly or at all. This increases the likelihood of personal injury and/or trauma for blind and vision-impaired people. Deafblind people have particular needs, as they not easily able to rely on what can be heard in the environment.

Emerging technologies

The action statement which refers to "changes in technology" could be linked with those parts of the draft New Zealand Digital Strategy which envisage using information technology to deliver health services to New Zealanders. The Foundation believes that the Digital Strategy has the capacity to encourage blue sky thinking. With the right technological infrastructure in place, it becomes possible to develop services that support a range of people in a variety of situations, e.g. seniors who choose to remain in their own homes.

Already many New Zealanders use a personal alarm system consisting of a wireless transmitter worn around the neck or wrist which can relay a signal to a remote location via the unit plugged into the telephone line. It is not difficult to see the value of being able to extend such monitoring technology to assist people who need some level of support to cope and avoid injury in their own homes.

Orientation and Mobility services

Orientation and mobility is the rehabilitation and habilitation discipline that equips blind and vision-impaired people with the skills to travel and enter any familiar or unfamiliar environment and navigate it safely, effectively, and independently.

Overseas experience suggests that elements within the orientation and mobility training provided by the Foundation to its members can assist other people with reduced mobility to move about with a lower incidence of falls. The Strategy offers opportunity to research and test "multiple strategies". The Foundation welcomes this and would certainly be keen to participate in research activity. The Strategy must acknowledge that extending the existing evidence base will require additional resources.

In some countries "travel training" is a specialist service which provides individuals who have a health condition or disability other than vision impairment with the skills needed to travel and move safely and independently.

Whether such training might be an intervention that could reduce the risk of falls for priority groups in New Zealand is a potential area for research.

Adaptive Daily Living services

The Foundation's Adaptive Daily Living instructors offer services such as simple colour and texture contrast to distinguish surfaces. Such interventions make a demonstrable difference in the day to day quality of life experienced by Foundation members.

Create safer environments

Safer environments are those accessible to and safe for people with disability. Invariably such places prove to be safer for others in the community. The Strategy should make reference to NZS 4121:2001 Design for Access and Mobility - Buildings and Associated Facilities, as well as to relevant sections in the Building Act 1991 and the New Zealand Building Code.

Inclusive design

The Foundation emphasises that the ideal is not special adaptations that will make public and other places safe for people who are blind or vision impaired. The ideal is that the needs of blind, vision-impaired, and other disabled people are core to the planning and development of public spaces, buildings, and facilities. Inclusiveness rather than adaptation is the aim of the New Zealand Disability Strategy.

Ensure appropriate funding and resources

The Strategy should reflect that falls prevention work is currently undertaken by a range of agencies, including not for profit organisations which are not funded for the level of falls prevention activity they undertake or could undertake if they were better resourced. Better research and the exposing of unmet need are likely to require new rather than realigned funding.

A national Strategy that is a whole government initiative aimed at everyone ("A New Zealand free of injury from falls") must be resourced to reach everyone. That requires the Strategy to incorporate and ensure adequate funding for that component of the Foundation's services that can reduce the likelihood of blind and vision-impaired people suffering a fall.

Priorities

In New Zealand the Ministry of Health's Older People Strategy (page 42) notes that although a fall may appear to result from a single cause, falls are generally the result of more than one factor (physical, lifestyle, social, or environmental). Addressing impaired vision is listed as one of the interventions which can reduce the risk factors an individual experiences. It is already clear from research that vision loss is a significant factor in some falls; among its members, the Foundation's services aim to lessen the likelihood and impact of falls.

The Foundation recommends including among the priority groups both people living with disability and people living with long-term illness.