Are We Falling Short? Why NICE 2025 Guidelines May Not Be Enough to Prevent Falls

Falls remain one of the most reported safety incidents across NHS Trusts — and one of the most preventable. With the new 2025 NICE guidelines now in force, the focus on inpatient falls has sharpened. But while the policy has progressed, real-world data suggests that implementation challenges persist — and in some areas, risks may be increasing.

Falls Prevention -What NICE 2025 Says – and What It Doesn’t

The updated NICE guidance on preventing falls in older people sets out several key standards:

• All inpatients aged 65+, or at higher risk, should receive a multifactorial falls risk assessment

• Post-fall assessments must be conducted promptly, regardless of injury visibility

• Care teams should consider environmental, footwear, and medication factors

• Equipment for lifting and repositioning must be available and appropriate

• Staff training must be up-to-date and reflect current legislation and guidance

  
  

These expectations are clear. But the on-the-ground picture tells a more complex story — especially around resourcing, training, and how risk is actually tracked and acted upon.

What the Data Suggests

Across large acute Trusts, there is growing concern about the scale of inpatient falls. In several cases:

• Injury rates are trending upwards, with some sites reporting over 30% of falls resulting in harm

• Manual handling equipment, such as air-assisted lifting devices, is in limited supply — often pushed beyond the usage limits set by warranty

• Post-fall response still varies between settings, with some staff unsure whether to hoist, call for help, or attempt manual recovery
  

While policies are in place, the capacity to deliver them consistently remains a challenge. And in many cases, the question isn't whether a risk assessment has been completed — but whether the tools exist to act safely once a risk is known.

Flat Lifting: The Silent Gap in NICE

One of the most notable omissions in the 2025 guidance is the lack of reference to flat lifting. This is particularly relevant in cases where the patient may have sustained an injury, such as a suspected spinal or hip fracture.

Current guidance often defaults to hoisting for recovery, but this may not always be the safest option. The HOP7 training framework, widely used across NHS trusts, highlights the importance of:

• Supine lifting techniques for patients where injury cannot be ruled out

• Avoiding rotational strain during recovery

• Reducing the number of carers required through safer, friction-reducing equipment

Flat lift kits — designed to keep the patient in a lying position and supported during movement — offer a safe, low-friction method of recovery that protects both the patient and the staff. Yet they remain underused, and in some areas, completely absent.

Are We Measuring What Matters?

A growing area of discussion in falls prevention is how we understand and monitor mobility over time.

Traditional assessments are often carried out at the point of admission or after an incident, relying heavily on staff observation and manual documentation. But this approach can miss gradual changes in movement patterns that precede a fall — especially in busy wards where teams are stretched.

There is increasing awareness that objective tracking of mobility and functional movement could:

• Provide earlier warning signs of decline

• Support more accurate care planning

• Reduce reliance on subjective assessments alone

• Help differentiate between temporary unsteadiness and progressive mobility loss

Embedding movement and recovery data into routine practice could enhance both prevention and post-fall review — offering a more rounded view of risk and response.

Training and Environment Still Matter

Beyond equipment and assessment tools, the environment itself plays a major role in fall prevention. Many inpatient settings feature confined spaces — small bathrooms, tight corridors, and multi-bed bays — where recovery becomes even more complex.

In these environments, staff need access to training that reflects:

• Realistic fall scenarios

• The legal framework surrounding post-fall care

• When to lift, when to wait, and how to recover safely

• Confidence in making decisions based on environment, ability, and injury risk

It’s not just about ticking training boxes. It’s about empowering staff to act with clarity in the moment that matters.

Bridging the Gap Between Policy and Practice

The 2025 NICE guidelines set a clear expectation for reducing falls and responding effectively when they occur. But the challenges on the ground point to several key areas where current guidance stops short:

• Flat lifting options are not formally addressed

• Access to suitable lifting equipment remains inconsistent

• Movement and mobility tracking is largely absent

• Staff training often lacks real-world simulation

Without bridging these gaps, the risk is that falls will continue to occur — and more importantly, that injuries will continue to rise despite best efforts.

A System Ready for Smarter Solutions

There is no doubt the system is striving to improve. But improving falls outcomes isn’t just about policy — it’s about resourcing, training, and redefining how we track and understand risk.

Preventing falls starts long before someone hits the floor. The ability to detect subtle changes in mobility, to respond with the right equipment, and to recover with confidence — these are the pieces that turn good guidance into great care.