Falls are a major health crisis for older adults. They cost the NHS £2.3 billion annually and undermine patient independence.
While proactive falls prevention reduces injuries and NHS costs, identifying who is at risk has been problematic. Previous prediction models lacked integration into routine clinical systems, forcing healthcare services to rely on inefficient, manual screening that wasted valuable time instead of delivering targeted care.
How eFalls has addressed this
To solve this, NIHR Applied Research Collaboration (ARC): Yorkshire & Humber and other NIHR partners supported the implementation and evaluation of the eFalls clinical prediction model, developed by the NIHR Health Technology Assessment programme.
Using existing electronic primary care health records, eFalls calculates a patient’s 12-month risk of experiencing a fall that requires emergency care or hospital admission.
Developed using a population dataset from Wales and externally validated in Bradford and Airedale (spanning 750,000 records for adults aged 65 and older), eFalls achieved an impressive 82% accuracy rate in identifying high-risk individuals (a 0.82 discrimination score).
Additional testing, funded by NIHR ARC: Wessex, across 32,000 working-age adults (18–65) receiving mental health or learning disability services demonstrated a 0.78 discrimination score.
Real-world results
By shifting NHS care pathways from reactive injury management to proactive prevention, eFalls is already driving real-world results.
Greater Manchester
In collaboration with the Greater Manchester Combined Authority and NIHR ARC: Greater Manchester, the South Wigan Ashton North Primary Care Network launched the first pilot outside research settings in February 2025, serving 37,000 residents. eFalls identified more than 1,000 high-risk patients, 740 of which were eligible to be contacted.
Of them, 198 agreed to a face-to-face consultation and 160 attended the appointment. Strong engagement was found once personal contact had been established, with 78% of people who attended a face-to-face meeting accepting a referral to join the Falls Management Exercise (FaME) programme to improve strength, balance and confidence.
Keighley
A 6-month pilot has shown how health, care and community organisations can work together to identify people at risk of falling and offer support before a crisis happens.
Testimonials from patients demonstrated the success of the combination of eFalls with management tools post-identification. One patient said that the combination of exercise, practical information and peer support helped her feel stronger and steadier. Another testimonial illustrated hope that identifying fall risks can provide an opportunity to address several health needs simultaneously.
A healthcare assistant’s assessment identified multiple risk factors for a patient, including unsteadiness, memory concerns and a drop in blood pressure when standing. By connecting the patient to local support, mobility aids and a medication adjustment, his blood pressure normalised and he received an early referral for cognitive evaluation.
Wider adoption
NIHR ARC: Yorkshire & Humber has supported eFalls implementation in West Yorkshire, where it is being used to identify people at moderate or high risk of falling for proactive falls prevention.
NIHR ARC: East Midlands is supporting eFalls implementation to identify people at risk of falls for targeted prevention in Derby.
The tool has been adopted by Norfolk and Waveney Integrated Care Board following localisation to ensure it suits the local population.
A large Primary Care Network in the Bradford district has piloted implementation, and 6 Primary Care Networks in Leeds are planning implementation.
Potential NHS savings
The overall impact is both clinical and economic. By automating risk identification, eFalls frees up clinicians to deliver timely prevention.
Health economic modelling shows that preventing just 25% of serious falls in England would save the NHS more than £140 million annually while preserving older adults’ quality of life.
Backed by coverage on BBC News, eFalls continues its regional rollout as it undergoes consideration for national NHS policy guidance.