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10/09/26

10 September 2026

NHFD annual report 2026

Front Cover For Crown

The National Hip Fracture Database's 2026 annual report, Mind the Gap: Challenging Inequities in Hip Fracture Care, highlights the variation in care experienced by patients with hip fracture across the UK (excluding Scotland) and identifies opportunities to improve equity, consistency and outcomes.

Every year, more than 72,000 people across England, Wales, Jersey and Northern Ireland need hospital care following a hip fracture, occupying around one in every 30 hospital beds and costing the NHS an estimated £1.1 billion annually. Many patients struggle to regain their previous mobility and independence, with social care costs in the first 120 days after hip fracture estimated at a further £1.25 billion. While significant improvements have been made in hip fracture care over the past 17 years, this report shows that where a patient receives treatment remains the greatest determinant of the quality of care and outcomes they experience.

The report explores:

  • Who has the fracture? Examining the impact of ethnicity, age, sex, disability and socioeconomic deprivation on care and outcomes.
  • What type of fracture? Highlighting disparities between hip fracture care and the care of people with other femoral (thigh bone) and pelvic fractures.
  • When did the fracture happen? Looking at how time of day, day of the week and season can influence access to care.
  • Where were patients treated? Demonstrating the continuing postcode lottery in hip fracture care.
  • Why did the fracture happen? Exploring missed opportunities for fracture prevention and the need for effective Fracture Liaison Services.

'This year’s NHFD report highlights several key priorities to improve outcomes for people with hip and fragility fractures. Services should ensure routine delirium screening using the 4AT for all patients admitted with a hip fracture, strengthen local clinical governance through regular multidisciplinary review of outcomes and patient experience, and work to reduce unwarranted variation in care for patients with fragility fractures. In parallel, stakeholders should support the universal provision of effective fracture liaison services (FLS) to ensure equitable access to secondary fracture prevention, osteoporosis management, and falls prevention across all regions.'
Maria Panourgia, NHFD orthogeriatrician clinical lead

'The 2026 NHFD report emphasises the need for equitable and fair health care  to prevent differences in access, treatment and outcomes. Significant differences exist between hospitals in key performance indicators and mortality outcomes, based on Post code residence. This variation in care should be identified and challenged so that every patient, regardless of who they are or where they live, has the best possible opportunity for recovery and prevention of future fractures, through the establishment of effective Fracture liaison Services across the country.'
Anastasios Nikolaidis, NHFD orthopaedic surgery clinical lead

'It is reassuring that this NHFD report shows that care after a hip fracture is unaffected by who someone is; by their age, sex, ethnicity or socioeconomic status. Instead it emphasises how dramatically the quality of care can vary, depending on which hospital they attend after a hip fracture. This postcode variation remains the main challenge that the NHFD seeks to address; so that people attending any hospitals, and people admitted with fractures of any bone, can all receive the high quality care provided by the best hip fracture units.'
Antony Johansen, previous NHFD orthogeriatrician clinical lead 

  • Delirium is a key preventable, treatable cause of poorer hip fracture care and outcome. People with delirium are three times as likely to die as an inpatient and three times as likely to need to move to live in a care home after a hip fracture. Despite this, some hospitals have still not established routine delirium assessment, both when patients are admitted and when they are recovering after surgery.
  • The NHFD’s success in improving hip fracture services means that our reporting now highlights weaknesses in the care of people with other fragility fractures. The same model of continuous audit-driven improvement needs to be extended to the care of people with fragility fractures of other bones.
  • Only two-thirds of respondents to our 2025 Governance Survey reported that their hospital holds a hip fracture clinical governance meeting, and only one-third of these said that patient feedback was discussed in such meetings. Our ‘Cause for concern’ work in 2025 has improved pressure sore surveillance (93% of patients documented as not having a pressure sore compared to 92% in 2024), but three hospitals still report that over one in five of their patients developed a pressure sore after presenting with a hip fracture.
  • Each year a quarter of the people who present with a hip fracture give a history of a previous fragility fracture. In spite of this, at least half of them (around 10,000 people each year) are not receiving the effective bone strengthening medication that might have prevented the hip fracture.

  • NHS England and Welsh Health Boards should mandate and monitor compliance with routine delirium screening using the 4AT for all patients admitted with hip fracture, ensuring that Integrated Care Boards (ICBs) in England and Health Boards in Wales hold hospitals accountable for implementation.
  • Utilising NHFD data on pelvic fragility fractures, Getting It Right First Time (GIRFT), working with the British Orthopaedic Association (BOA) and British Geriatrics Society (BGS), should collaborate to provide the environment for excellent and equitable care of those admitted with fragility fractures, aiming to reduce unwarranted variation in care and outcomes.
  • ICBs and Welsh Health Boards should ensure that every hip fracture service holds clinical governance meetings at least monthly and that these routinely review patient feedback; patient safety events, such as pressure ulcers; and their performance for each KPI.
  • NHS England, ICBs and Welsh Health Boards should ensure universal provision of effective Fracture Liaison Services (FLSs), working with the Royal Osteoporosis Society (ROS) and the Fracture Liaison Service Database (FLS-DB) to eliminate geographical gaps in secondary fracture prevention, in line with the NHS 10 year plan.

NHFD 2026 annual report