NHS Bolton CCG Falls Collaborative

A new approach to public service transformation

With the NHS under increasing pressure, innovative ideas to reduce harm and improve health outcomes are highly sought after. The associated cost-saving benefits of new, innovative approaches make the need for change all the more important. In Bolton, Mace is helping the NHS with this challenge.

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NHS Bolton CCG Falls Collaborative Project summary


NHS Bolton Clinical Commissioning Group

Key partners

Bolton NHS Foundation Trust, Bolton Council, North West Ambulance Service, Bolton at Home, Age UK, Greater Manchester Fire and Rescue Service

Services provided

Project and programme management




UK North

Project timeline

Start date
April 2019

Project story

With falls and fractures in people aged 65 and over accounting for over four million hospital bed days each year in England alone, and the associated medical costs reaching an estimated £2billion a year, Mace is proud to be playing a part in helping to reducing harm and improving health outcomes for older people which also reduces cost to public services.

In 2019 having recognised that action was needed, the NHS Bolton Clinical Commissioning Group appointed Mace to establish and run a whole-system ‘Falls Collaborative’. The six-month Collaborative saw Mace work with local stakeholders to design a new model of care to focus on preventing falls and having an integrated (or joined up) response when people do fall with the aim of reducing harm caused by preventable falls across Bolton. 

Drawing on their extensive experience of working with the NHS and other public sector organisations, the dedicated Mace team led a comprehensive stakeholder and situational analysis to establish a clear understanding of the challenges faced and the relationships that would be most important in helping to solve them.

Through this early assessment and planning work, we were able to bring together a wide range of stakeholders and involve them in the process to establish an action plan. Working with the stakeholders and using existing data, we produced a set of recommendations that informed the design of a system that enabled a new way of doing things across multiple public services.  

The strong and positive relationships we built with the local stakeholders allowed us to gain their trust and this had a significant influence on our ability to develop and implement a fully integrated approach.

In taking this approach, we co-produced a tiered model that clearly described the offer for local people and outlined the universal, targeted and specialist interventions proposed. This meant that services were designed to prevent falls, but if a fall happened the response from public sector partners would be joined up and integrated with existing services.

To make the most of this, we provided clear criteria for how people could access services to ensure that their care remains joined up. This helped to enhance coordination and provide best value for the commissioner and the patients served. The client was left with a clear plan of action for improving the outcomes for local people in Bolton.  

“Mace’s value driven approach, underpinned by a quality improvement methodology and design thinking, helped elevate the aspirations for the Collaborative. Throughout the process, they were flexible and agile in responding to the evolving model in the context of organisational change taking place in Bolton.”

Points of note

Independent Leadership

Our Strategic Advisory team added value through independent facilitation, clinical leadership and bespoke guidance on how to shift thinking to a more preventative and proactive model of care.

Innovative solutions

Bringing together representatives from housing, fire and voluntary services, as well as from different NHS organisations and Bolton Council, ensured that solutions were considered and developed through a much wider lens. Rather than designing a health solution to a health issue – when it is often too late – a wider approach led us to a more innovative solution that looked at all the factors that will prevent future harm from falling. 

Flexible and adaptable

Our ability to flex with evolving client needs and respond to organisational change provided an agile and effective strategy that remained focused on achieving the desired outcomes.

A people-centric approach

At every stage in the design journey, we took a step back and looked at ‘what would work for the person?’, whether that was an older person, friend, relative or member of the public. This meant that the model and pathways were focused on people and not the needs of the organisations or individual professionals.