1 Building the Case

Building the Case for Investment in FaME

This section contains resources for helping you to build the case locally for investment in FaME delivery. From the research carried out in the FaME Ireland study, it is clear that making the financial case for investment is crucial and often very difficult. It can be the key barrier to implementation.  

To help make a strong case a range of resources have been put together in this section. It contains a summary of the research evidence for senior members of local planning bodies and a briefing for elected members (which can be adapted for other audiences), links to resources including a formal Return on Investment Tool for falls interventions to help make the economic case, and example case studies that can be used to convey the ‘human case’. It is worth noting that the Return on Investment Tool can be adapted to include local costings and variations on delivery to make it more locally relevant. Finally, there is also a sample business case that can be populated with local data and costings.

1.1 A summary of the evidence for service managers 

Clinical trials have shown FaME to be effective at reducing falls, concerns about falling, improving quality of life and increasing habitual activity levels. Unlike many other fall-prevention programmes, FaME also helps people regain the skill of getting up from the floor, further reducing their concerns about falling, avoiding ambulance call outs for non-injurious falls and reducing the need to receive care or move into care. Our research has shown that FaME is feasible to implement, continues to be effective over time and is enjoyed by people who take part. 

1.2 Return on Investment 

While no formal cost analysis has yet been conducted on FaME programmes delivered in Ireland, FaME programmes in the UK have consistently shown return on investment.  

In 2018 Public Health England developed a Return on Investment tool for the assessment of falls prevention programmes for older people living in the community. The original tool was based on theoretical costs to deliver the FaME (and Otago) programmes and can be found here (please note this model is shown in £, not €): 

https://www.gov.uk/government/publications/falls-prevention-cost-effective-commissioning  

In 2025, York Health Economics Consortium updated the Return on Investment tool to include costs from >200 programmes in three areas of the UK. This updated tool is now available in the UK FaME Toolkit (again, this model is shown in £, not €): 

Read a Social Return on Investment Report (2017) by Gateshead Older Peoples Assembly where they calculated for every £1 of public health money invested in Staying Steady (FaME) classes, the return to the public purse is £50.59. The Staying Steady classes are supported by public health funds of £19,146. This provides estimated savings of at least £968,736 compared to the spend on public health without this investment. 

https://laterlifetraining.co.uk/news/psi-sessions-show-significant-social-return-investment 

1.3 Business Case 

An evidence-based business case for the FaME programme can be downloaded from the UK FaME Toolkit website and modified for local use. This document is intended to support the case for funding FaME by service managers.  

1.4 Experiences and Case Studies: Benefit of FaME for older adults 

Margaret, Kerry 

Margaret joined the FaME programme in Kerry in 2024. Prior to joining FaME, Margaret had two knee replacements which impacted her balance and mobility. Following her surgeries, Margaret required a walker to move around but was keen to regain some of the mobility and independence that she had lost.  

Margaret initially attended a community ran exercise class for older adults but found this too difficult for her level of ability. After being referred to FaME, she now feels much more able to exercise due to the level support and individualisation that FaME provides.  

Despite being only half-way through the programme, Margaret describes the “transformative” effect that FaME has had. She has found that her balance and mobility have greatly improved as she now only requires a walking stick to get around.  Margaret also described an instance when she was in the garden hanging up her washing and unconsciously walked on the grass: “I always just stand on the cement but completely unconsciously, I walked on the grass. I haven't ever walked on the grass, ever…I was so excited, you know, because it was major progress to walk on not solid ground.” 

Anne, Dublin 

Anne started attending FaME after it being recommended by her GP. Anne has arthritis affecting her knees and lower back which impact her balance. As a result, she has had several falls prior to attending FaME.  

Part-way through the FaME programme, Anne fell at home while getting out of bed during the middle of the night. Having already learned the backward chaining technique as part of FaME, she was able to get-up from the floor. This avoided a long lie, and an ambulance call out by using the skills Anne had mastered in her FaME group. It is likely also that attending the FaME group saved a significant cost to the HSE and spared her the distress a fall would have caused had she not been able to rise. 

Anne said “it was great knowing how to get up” and that FaME had given her the confidence to manage similar situations in the future.  

Mary, Dublin 

Mary wanted to take part in an exercise class in order to avoid having surgery on her knee. After discussing her situation with a physiotherapist, Mary opted to join her local FaME programme.  

Since starting the programme, Mary has attended every session and is managing to perform her home exercises at least twice a week. She notes that this is helping her to feel more confident and steadier when moving around.  

However, for Mary, the social aspect of FaME is the best part about the programme – particularly the ‘tea and chat’ after sessions. Mary had recently lost her husband and so the FaME programme has provided social support that was previously missing in her life: “I needed it.  My husband died in October.  I needed recovery.... I needed to get out of the house.  It’s a motivator.”   

Following FaME, Mary is hoping to continue exercising in a similar group setting and will maintain the social connections she has made through FaME.  

1.5 Case Study: Wider benefits of FaME - Impact on HSE primary care physiotherapy 

Within the FaME Ireland study, all three original early adopter sites (Dublin, Kerry, Sligo/Leitrim) and a fourth site (Cork) integrated FaME programmes within HSE primary care physiotherapy services. This meant that the majority of FaME referrals were made by physiotherapists and, at some sites, physiotherapists assisted with FaME delivery during the early weeks of the programme.  

Physiotherapy managers across the sites reported the growing number of primary care physiotherapy referrals for older adults, with the majority presenting with frailty and at risk of falls. It was estimated at two sites that 70% of all clients referred to primary care physiotherapy services were at intermediate or high risk of falls. Therefore, FaME provided a suitable and evidence-based falls management intervention for these clients. As one service manager highlighted:

“This was a high need area with a lot of risk associated by not addressing it. So we kind of weighed up the how do we best use our resources and decided to prioritise into this area.”  

The additional evidence-based complementary service for falls prevention also positively impacted waiting lists by reducing the number of appointments required by older adults  

“It's certainly an advantage to us. A typical patient that we might get referred for falls once we once we assess them, we would then probably need to see them maybe 3-4 times over a two-month period to try to progress a rehab program…But if we can refer them on to FaME then that's a huge benefit.”  

To sustain FaME, physiotherapy service managers need clear evidence that FaME effectively prevents falls and improves existing physiotherapy services efficiencies. Higher-level HSE management support was viewed as being essential to the sustainability of FaME 

“We've been lucky in that regard in that the network manager has decided to stick to this goal of delivering FaME. And it hasn't resulted in longer waiting lists so far, so good.”  

Guidance on capturing this impact is provided within this toolkit (Section 4: Monitoring and Evaluation). 

Case Study: Advocating and coordinating falls services between sectors: Coordinator Role 

Securing funding was consistently highlighted within the FaME Ireland study as a key barrier to delivering FaME. The programmes included within FaME Ireland were not permanently funded; instead, service managers had to apply annually for funding through ad hoc HSE and local authority budgets. Funders having an awareness and interest in falls management helped secure funding for FaME. Therefore, advocacy and awareness raising was critical to the successful adoption. 

At one FaME Ireland study site (Sligo/Leitrim), the local Falls Coordinator helped to champion the adoption of FaME. As coordinating evidence-based falls prevention services across all health sectors is an integral part of their role, their expertise and understanding were key to raising awareness among service managers and supporting the application for funding: 

“[The Falls Coordinator] makes a huge difference. Even though it’s fragmented, they pull it all together. It wouldn’t happen without them.” 

In particular, the Falls Coordinator helped develop the business case for FaME by integrating research evidence and local/national falls guidelines to highlight the need for FaME. Additionally, through having an awareness of local falls services and the needs of the older adult population, they were able to demonstrate the potential impact of FaME – which is a key area that funders are interested in: 

“When we present that to [the service funders], they say that this is a no brainer because they can see the finance piece and that it would make a difference.”  

Once funded, the falls coordinator also helped with implementing FaME. This included identifying efficiencies within the system through service planning and streamlining referral and assessment documentation, identifying PSI-trained exercise professionals, supporting PSIs with programme delivery, supporting quality assurance checks, and establishing a community of practice to support service fidelity.  

Within your service or local area, consider whether a similar Falls Coordinator role exists or who the key ‘falls champions’ are that can enable the adoption of FaME.