Falls Prevention Teams, Explained in Plain English

By Len Burgess, Senior Care Advisor · Published 4 September 2026

The latest post in our Jargon Buster series covers one of the most important specialist services in elderly care and one that most families have never heard of: the local NHS falls prevention team. Who they are, what they do, why NICE completely refreshed the national guidance in 2025, and how to get your relative referred in 2026.

If your relative has fallen once, is worried about falling, has lost confidence on their feet, has been to A&E after a fall, or is starting to shuffle, hesitate, or hold onto furniture at home, the professional service most likely to change the picture for them is your local NHS falls prevention team.

Falls are the single most consequential health event in older age. One in three adults over 65 and one in two over 80 will fall at least once each year. Falls are the leading cause of injury-related death in older people in the UK, the most common reason for emergency hospital admission in the over 75s, and one of the biggest triggers for permanent care home admission.

Yet falls are not an inevitable part of ageing. They are largely preventable, and a specific NHS service is designed to prevent them.

This post explains what a falls prevention team actually is, how the newly refreshed 2025 NICE guidance shapes what they do, who qualifies for their support, and how families can access the service in 2026. It builds on our wider guides to physiotherapists, occupational therapists, podiatrists, community pharmacists, and the multidisciplinary team.

What is a falls prevention team?

A falls prevention team is a specialist NHS multidisciplinary team dedicated to assessing why an older person is at risk of falling and putting a coordinated plan in place to reduce that risk. In some areas, they are called a falls clinic; in others, a falls service or falls and syncope clinic. They typically operate from community outpatient clinics or as visiting community services, and they focus specifically on older people who have fallen or are at high risk of falling.

The team is genuinely multidisciplinary. Depending on the area, it can include:

Specialist falls physiotherapists, who lead strength and balance assessment and programmes
Occupational therapists, who assess home safety, equipment needs, and daily activity risks
Consultant geriatricians or specialist doctors, particularly for complex cases and unexplained falls
Advanced nurse practitioners or community matrons, coordinating care and prescribing medications
Specialist falls nurses, some of whom lead falls clinics in community settings
Pharmacists, reviewing medications that increase falls risk
Podiatrists, addressing foot pain and gait problems
Optometrists in some services, particularly for vision-related falls
Support workers and rehabilitation assistants, delivering exercise programmes and follow-up

A few essentials to lock in:

Falls prevention services are free through the NHS and typically accessed by GP referral, self-referral in some areas, or referral from hospital A&E after a fall
The current national guideline is NICE NG249, "Falls: assessment and prevention in older people and in people 50 and over at higher risk", published in April 2025, which replaced the earlier CG161 guideline from 2013
The two most widely used exercise programmes recommended by the NHS are the Otago Exercise Programme (home-based, individually tailored) and the FaME (Falls Management Exercise) programme (group-based, community delivered)
Access, waiting times, and exactly which professionals are involved vary significantly by ICB, but the underlying model is now standardised through NG249
Falls are not an inevitable consequence of ageing. Around 30 per cent of falls in older people are considered preventable with proper multifactorial intervention

What does a falls prevention team actually do?

The core of any modern falls service is the multifactorial falls assessment, which is exactly what it sounds like: an assessment of all the factors that contribute to falls risk, so that a personalised prevention plan can be put in place. This is the approach NICE NG249 endorses, and it works because falls are rarely caused by a single problem. They typically arise from three or four issues acting together.

A comprehensive multifactorial falls assessment covers:

Falls history and circumstances. The team gathers detailed information about any recent falls: when they happened, what your relative was doing, whether they lost consciousness, whether there were warning symptoms, how they got up, and whether they were injured. Patterns matter more than individual events.
Strength, balance, and gait assessment. Specialist physiotherapists carry out standard tests including the Timed Up and Go, the Berg Balance Scale, and the 180-degree turn test. These identify specific weaknesses that can be targeted with exercise. As a rough benchmark, a healthy person in their 70s should be able to balance on one leg for around 10 seconds; significantly less can indicate elevated falls risk.
Medication review. Some medications significantly increase falls risk, particularly sedatives, sleeping tablets, some antidepressants, blood pressure tablets that cause dizziness, and combinations of drugs. A pharmacist reviews the whole medication list and often recommends changes.
Blood pressure and postural hypotension check. Postural hypotension is a drop in blood pressure when standing up, which causes dizziness and is a very common falls trigger in older people. The team measures blood pressure lying, sitting, and standing to identify this.
Vision and hearing assessment. Both are directly linked to falls risk, and both are often underassessed. The team either checks these directly or refers on to specialist services.
Home hazards assessment. An occupational therapist visits the home to identify falls hazards: loose rugs, poor lighting, unsafe stairs, cluttered walkways, bathroom risks, and missing handrails. They recommend adaptations and equipment where needed.
Foot health and footwear. Foot pain, thickened nails, deformities, and poor footwear are significant falls contributors. The team may involve a podiatrist and always reviews footwear.
Bone health assessment. Not because it prevents falls, but because knowing bone density (through a DEXA scan) helps identify whether a fall would likely cause a fracture, and whether osteoporosis treatment is needed.
Continence assessment. Getting to the toilet urgently, particularly at night, is one of the most common circumstances in which older people fall. Improving continence often reduces falls.
Cognitive assessment. Dementia, mild cognitive impairment, and delirium all significantly increase falls risk, and identifying them changes the prevention approach.
Fear of falling. After a first fall, many older people become fearful, restrict activity, and paradoxically become weaker and more likely to fall. The team assesses this and often addresses it through specific confidence and rehabilitation programmes.

Once the assessment is complete, the team designs a personalised falls prevention plan and coordinates its delivery. This typically includes an exercise programme (Otago, FaME, or tailored equivalent), medication changes, home modifications, equipment, and any onward referrals needed.

How does this apply to me?

These are the five questions families ask most often about falls prevention teams.

1. What does a falls prevention team do, and who should be referred?

The team carries out the comprehensive multifactorial falls assessment described above and then coordinates the delivery of a personalised prevention plan. NICE NG249 recommends referral for older people who:

Have fallen once or more in the last year, particularly if they needed medical attention
Are worried about falling or have started restricting activity because of fear
Have a specific health condition that increases falls risk (Parkinson's, stroke, dementia, complex frailty, severe arthritis, visual impairment)
Have found their balance or gait deteriorating
Have been referred from A&E after a fall, whether or not they were injured
Are aged 65 or over with multiple long-term conditions that create combined risk
Are aged 50 to 64 and at higher risk due to specific conditions

If your relative fits any of these, ask the GP directly for a falls prevention referral. In many areas, self-referral is also available through the NHS website.

2. What are the best exercises to prevent falls in older people?

This is one of the most useful practical questions in the whole area. The NHS and NICE recommend two evidence-based exercise programmes for older people, and both work by improving strength and balance together.

The Otago Exercise Programme is home-based and individually tailored. A physiotherapist visits four or five times over several months, prescribes an individualised programme of strength and balance exercises, and progresses them over time. The exercises take around 30 minutes, three times a week, alongside two 30-minute walks per week. Otago has strong evidence for reducing falls, particularly in people over 80.

The FaME (Falls Management Exercise) programme is a group-based community programme lasting typically 24 weeks. Participants attend weekly classes led by a trained instructor and do additional home practice. FaME improves strength, balance, and confidence, and has strong evidence for reducing falls in community-dwelling older adults.

For older people who prefer general exercise, tai chi has good evidence for improving balance, as do specific NHS strength and balance videos available on the NHS website. The single most important principle is that any effective falls prevention exercise must work on balance and strength together. General walking alone does not reduce falls; it needs specific balance and strength work.

If your relative has been referred to a falls prevention team, ask which programme they will be enrolled in and what home practice will be recommended. If they have not been referred but you want to start something, ask the GP or search the NHS website for Otago exercises for older people.

3. How does a falls prevention team work with care homes?

Care home residents fall at approximately three times the rate of older people living at home, and falls in care homes are a major cause of injury, hospital admission, and death. Falls prevention teams work with care homes in several specific ways.

In many areas, care homes have access to specialist falls prevention support through the Enhanced Health in Care Homes framework, either through direct visits from falls teams or through the Integrated Neighbourhood Team model.

A recent NHS-supported research programme developed the Guide to Action for Care Homes (GtACH), a multifactorial falls prevention programme specifically designed for care home settings, which is being adopted by more homes each year. GtACH involves staff training, individualised resident assessment, and structured intervention plans.

For families choosing a care home, the questions to ask are: what falls prevention approach does the home use, how are residents assessed for falls risk, how is that risk reviewed after any fall, what exercise or mobility programmes are offered, and how does the home work with local falls prevention services. Vague answers about falls management are a warning sign, because falls are one of the highest risk aspects of care home residency. Confident, structured answers indicate a well-run home.

4. What should we do immediately after a fall, and what happens at A&E?

If your relative has fallen:

Stay calm and check for injury before attempting to move them. If they cannot get up, are in significant pain, cannot move a limb, hit their head, are on blood-thinning medication, or seem confused or drowsy, call 999.
If they can get up safely and are not injured, help them up carefully using the recommended technique of rolling onto their side, coming onto their hands and knees, and using a sturdy chair to push up from.
After any fall, even a minor one, contact the GP to request assessment. Every fall is a signal that something needs attention.
After a fall requiring A&E, ask specifically about falls prevention referral as part of discharge planning. NICE NG249 requires this to be offered, but in practice it is often overlooked.

At A&E after a fall, the team should assess for injury (particularly hip fracture, wrist fracture, and head injury), check for medical causes of the fall (heart rhythm problems, low blood pressure, infection, dehydration, delirium), and consider whether the fall was actually a syncopal event (fainting due to a heart or blood pressure cause). If your relative is discharged from A&E, request a falls prevention referral and the discharge letter explicitly noting the fall.

5. Can we access falls prevention support privately if NHS waits are long?

Yes, and this is often worth considering. NHS falls prevention waiting times vary significantly, and in some areas the wait can be several months. Private options include:

Private physiotherapists experienced in older adult rehabilitation, who can deliver Otago or equivalent programmes. Typical costs are around £50 to £80 for an initial assessment and £40 to £65 per follow-up session. Home visits are usually more.
Private occupational therapists for home hazard assessment. Typical costs are around £150 to £250 for a comprehensive home assessment with a written report.
Community exercise classes aimed at older people, including tai chi, chair-based exercise, and specialist balance classes. Age UK runs many of these at low or no cost across the UK.
Falls specialists in private clinics, particularly for complex or unexplained falls that need cardiology or neurology input.

If your relative can afford private input, it can bridge NHS waiting times and start prevention work sooner. Private assessments should be shared with the NHS team when the referral eventually progresses, to avoid duplication.

The takeaway

Falls prevention is one of the most valuable and least widely used specialist services in elderly care. The refreshed 2025 NICE guidance, the widespread rollout of evidence-based exercise programmes, and the growing integration of falls services into community teams mean that the NHS is now better set up than ever to prevent falls, if families know how to access the support.

Three practical takeaways. After any fall, however minor, ask the GP for a falls prevention referral, because NICE guidance requires it and it is one of the most consequential referrals a GP can make. Ensure any exercise your relative does works on balance and strength together, because general walking alone does not reduce falls, and the wrong exercise wastes their effort. And ask any care home you are considering about their falls prevention approach, because falls management in care settings varies significantly, and a well-run home will answer this question confidently.

Our funding calculator can show you how the costs of care work alongside NHS support and funding routes. Our wider Jargon Buster series explains every term you will come across, including detailed guides to physiotherapists, occupational therapists, podiatrists, community pharmacists, and NHS community teams.

This article is for general guidance only and reflects how NHS falls prevention services work in England as of 2026, under NICE guideline NG249. Availability, waiting times, and referral routes vary by ICB. For specific advice, contact your relative's GP, the care home's registered manager, or your local NHS trust falls service.

Sources

Frequently asked questions

What actually happens at a falls clinic appointment?

A first falls clinic appointment typically lasts 60 to 90 minutes and involves several specific things. A detailed history covering any recent falls, near misses, medical conditions, and medications. Physical examination, including heart, blood pressure lying and standing, vision check, cognitive screening, and often blood tests. Specific falls assessments including the Timed Up and Go test (timing how long it takes to stand from a chair, walk 3 metres, turn, walk back and sit down), the Berg Balance Scale, and a 180-degree turn test. Home hazard discussion and often referral for an occupational therapy home visit. Medication review, sometimes with a pharmacist present. A written personalised falls prevention plan with clear next steps. Bring the following to a first appointment: a list of all medications including doses and over-the-counter items, a summary of any recent falls with dates and circumstances, details of any recent hospital admissions, glasses and hearing aids if worn, and the shoes your relative wears most often because footwear will be assessed. The more information you bring, the more useful the appointment will be.

How can we help my relative overcome fear of falling?

Fear of falling is one of the most consequential secondary effects of a first fall, and it deserves specific attention. It creates a paradox where the fear itself makes falls more likely: an older person who becomes afraid to walk restricts activity, loses strength, becomes less confident, and then falls more easily. Practical steps that help include: acknowledging the fear rather than dismissing it, because dismissive responses tend to entrench the anxiety; starting exercise gradually with supervision, ideally through a physiotherapist led programme like Otago or a group like FaME; using appropriate walking aids without shame where a stick or frame genuinely helps, because refusing aids often means less walking overall; removing home hazards to reduce actual risk; wearing appropriate footwear and getting eyesight checked; treating any pain that limits confidence; and considering falls prevention counselling where fear has become significantly disabling. Some falls prevention services now include cognitive behavioural therapy for fear of falling, which has good evidence. The most important message is that avoiding activity makes things worse, not better.

What home adaptations most reduce falls risk?

An occupational therapist assessment is the single best way to identify what your relative specifically needs, but common adaptations that consistently reduce falls include: grab rails in the bathroom, particularly by the toilet and in the shower or bath; a raised toilet seat where standing up is difficult; a walk in shower or bath board to reduce the risk of climbing over a bath edge; a stair rail on both sides of every staircase; removing loose rugs or securing them with anti slip backing; improving lighting, particularly on stairs and in hallways; installing a nightlight on the route to the bathroom; rearranging the kitchen so frequently used items are between waist and shoulder height; removing trip hazards such as trailing cables, cluttered floors, and pets' bowls in walkways; a perching stool for the kitchen if standing is difficult; and, for higher risk situations, a personal alarm worn as a pendant or wristband so help can be summoned quickly if a fall does happen. Many of these adaptations are available free or subsidised through the local council under the Care Act 2014 if your relative has been assessed as having an eligible need. Larger adaptations can be funded through the Disabled Facilities Grant, which we cover in more detail elsewhere in this series.

How does falls prevention interact with NHS Continuing Healthcare and Funded Nursing Care?

Falls themselves rarely qualify someone for CHC or FNC on their own, but they often contribute significantly as part of a wider picture of complex clinical need. NHS Continuing Healthcare assessments use the Decision Support Tool, which scores across 12 domains. Mobility is one of those domains, and people with frequent falls, severe balance problems, or reduced mobility often score highly. Skin (including tissue viability) can also score highly where falls have caused pressure injury or where risk of injury from falls is significant. Documented falls, hospital admissions after falls, and specialist falls assessments all count as valuable evidence at a CHC assessment. If your relative has significant falls related needs and is being assessed for CHC, request that all falls prevention team records are made available and, if possible, ask whether the falls specialist can provide a written statement. For FNC, falls are relevant where they indicate a nursing home level of care need. We cover CHC, the Decision Support Tool, CHC assessors, and FNC in detail elsewhere in this series.

Are hip protectors and personal alarms worth using?

Both have their place, but neither is a substitute for proper fall prevention. Hip protectors are padded undergarments designed to absorb impact and reduce hip fracture risk if a fall occurs. Evidence for their effectiveness is mixed. They may help in specific high-risk settings such as some care homes with residents who fall frequently, but they do not prevent falls themselves and many older people find them uncomfortable or refuse to wear them. If they are being considered, the falls prevention team or specialist geriatrician is best placed to advise on individual suitability. Personal alarms (worn as pendants or wristbands) do not prevent falls but they significantly reduce the harm done when a fall does happen, because help can be summoned quickly. This is particularly important for older people who live alone, because prolonged time on the floor after a fall causes pressure injuries, dehydration, hypothermia, and psychological trauma. Personal alarms are widely available through local councils, Age UK, and private providers, with typical costs of around £10 to £20 per month for a basic service. Newer options include fall detection smartwatches and smart home sensors that alert family members automatically. Neither hip protectors nor personal alarms should be seen as an alternative to a proper falls assessment; they are additions to it, not replacements.