The forgotten piece of a complex jigsaw: Vestibular assessment is a blind spot for England's NHS falls services

BackgroundFalls remain a major healthcare burden from an individual to societal level. Vestibular disorders are recognised as a significant risk factor for falls in older adults, but identification and assessment of such conditions has only recently been included in national and international guidance. The extent to which National Health Service (NHS) falls services in England are including vestibular assessment is not well known.MethodA freedom-of-information request was sent to 117 Falls Services run by NHS Trusts in England to identify if they included vestibular assessment/management, if so which professions were providing this and whether Trusts planned to develop this aspect.Results115 out of the 117 identified Trusts replied. 39/115 (33.9%) of Trusts reported that their falls prevention services included staff trained to assess and treat vestibular dysfunction. Physiotherapists were the most common profession delivering this. Despite the lack of provision, just 23/115 (20%) of Trusts reported this was an area of their service they were planning to develop.DiscussionThese results show a significant lack of vestibular management in falls services. Accordingly, in their current offering, a majority of NHS Trust falls services will not be able to fully implement recently updated NICE guidance (NG249) or World Falls Guidelines for falls prevention. Given the extensive burden of falls in older adults, steps to close this gap would appear important.