The latest National Audit of Inpatient Falls (NAIF) report includes inpatient fall-related injuries beyond hip fractures, examining both preventative care before a fall and the quality of care provided afterwards. It found that patients who fall in hospital and suffer injuries such as pelvic fractures, spinal injuries or head trauma are receiving inconsistent post-fall care, with improvement needed in relation to delirium screening and pain relief.
The NAIF is delivered as part of the Falls and Fragility Fracture Audit Programme (FFFAP) by the Royal College of Physicians (RCP), and commissioned by the Healthcare Quality Improvement Partnership (HQIP), and this 2026 report contains clinical data and facilities audit findings covering 2025.
This is the first NAIF report to move beyond hip fractures, following a switch to direct data entry that allowed the audit to capture the fuller range of injuries patients sustain from inpatient falls, including head injuries, pelvic ring fractures, spinal injuries and rib fractures. In 2025, 4,191 eligible cases were reported by 169 trusts and 7 health boards across England and Wales. Hip fractures remained the most commonly reported single injury (35%), followed closely by head injuries (22%).
The new NAIF report sets out several key findings:
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Strong engagement with the expanded audit: The transition to direct data entry and wider case ascertainment has been well supported by services across England and Wales. In the first year of capturing a broader range of injuries beyond hip fracture, 169 trusts and 7 health boards submitted 4,191 cases, demonstrating reassuring levels of participation and a positive response to the audit’s expansion.
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Post-fall injury checks and medical examinations are sometimes ineffective: Although every case in the audit involved a confirmed injury, no injury was suspected in 47% of post-fall injury checks and 15% of medical examinations, pointing to significant gaps in how effectively these assessments are being carried out.
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Pain relief after a fall is too slow: A new indicator introduced in this report found only 39% of patients received analgesia within 30 minutes of their fall, with those who were prescribed pain relief waiting a median of 50 minutes.
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Care might be worse for some injury types: The first year of data suggests patients with pelvic ring, vertebral and rib fractures may receive poorer post-fall care than those with other injuries. This is a pattern that mirrors findings from the National Hip Fracture Database and the Fracture Liaison Service Database.
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Delirium screening continues to decline: Despite being a key part of pre-fall assessment, delirium screening rates have fallen for four consecutive years, and only a third of cases (33%) had a high-quality multifactorial assessment to optimise safe activity before the injurious fall.
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Outdated screening tools are still in use: A facilities audit, the first since 2022, found 14% of organisations still use risk-prediction tools to assess fall risk, despite these no longer being recommended under NICE guideline NG249.
The NAIF report makes three key recommendations for integrated care boards (ICBs) and Welsh health boards:
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Strengthen oversight of participation and case ascertainment across trusts and health boards.
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Standardise post-fall processes and ensure the workforce is adequately trained in post-fall management.
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Ensure effective falls governance, including reviewing local policies against NAIF-recommended practices and phasing out the use of falls risk-prediction tools.
Dr Sunil Nedungayil, senior clinical lead for the Falls Fragility Fracture Audit Programme, said:
‘This year's report marks an important step forward for NAIF, as we move beyond hip fracture to capture the full picture of harm caused by inpatient falls. The findings are a reminder that an injury is only the starting point, what happens in the minutes and hours afterwards matters just as much for a patient's recovery.
‘Too often, we are still seeing injuries missed on assessment and patients waiting too long for pain relief. This is particularly stark for people with pelvic, vertebral and rib fractures, who consistently receive poorer care than patients with other injuries. Trusts and health boards now have a clearer picture than ever of where care is falling short. We know what good post-fall management looks like, and we owe it to patients to make sure every one of them receives it, regardless of the injury they've sustained or where they are being cared for. We are encouraged by this year’s expanded response from services across England and Wales which has provided greater insight into inpatient falls, helping us to better understand where care is working well and where improvements are needed.’
Dr Julie Whitney, NAIF clinical lead for the Falls and Fragility Fracture Audit Programme, said:
‘One of the most encouraging aspects of this year's report has been the positive response from organisations as NAIF expanded to include different injury types for the first time. Teams have taken on the challenge to successfully adapt their local processes to collect and submit high-quality data, helping to build a richer picture of how to prevent and manage inpatient falls.’
The National Audit of Inpatient Falls (NAIF) is delivered in partnership with the British Geriatrics Society, the British Orthopaedic Association, Getting It Right First Time and the Royal Osteoporosis Society. It collects data from hospitals across England and Wales to support improvements in the prevention and management of inpatient falls. It is one of several HQIP-commissioned national clinical audits within the FFFAP programme, alongside the National Hip Fracture Database (NHFD) and the Fracture Liaison Service Database (FLS-DB). The data and findings are a publicly available resource that support healthcare providers to target improvement activity where it will have the greatest impact on patient care and outcomes.