Room for improvement: hip fracture care in 2024
The National Hip Fracture Database’s 2025 report Room for improvement: hip fracture care in 2024 points out key challenges in care to help clinicians, managers, and policymakers in delivering better outcomes for frail and older patients across England, Wales and Northern Ireland.
Each year over 70,000 people in England, Wales and Northern Ireland have a hip fracture – and with an ageing population this figure could double by 2060. It is therefore important to both improve hip fracture patient care and do all we can to prevent this injury.
This report examines how care in 2024 aligned to key patient goals:
- Admission - how soon will I be made comfortable and admitted to the right ward?
- Operation - how is my operation explained and supervised, so I can get up afterwards?
- Rehabilitation - how will I be supported to get back on my feet after surgery?
- Care quality - will I receive the same quality of care as other people?
- Care consistency - does every fracture lead to the same quality of care?
'Patients’ experience of care after a hip fracture has improved enormously since the NHFD was created nearly 20 years ago. Most hospitals can be proud of their achievements, but this report shows how a number of hospitals have fallen behind in the care they are offering, and discusses how the NHFD is helping them to catch up with the care being offered elsewhere.'
Antony Johansen, NHFD orthogeriatrician clinical lead
'From a surgical perspective, the care of older people with a broken hip continues to improve year on year. Patients across England and Wales following admission to hospital with a broken hip are often included in trials which are helping us to make the best choices with our patients around the time of the operation.
Despite these advances, there remain areas where closer working between surgeons and the wider members of the clinical team could yield further patient benefits. In particular, the seniority of the surgical team and communication around allowing patients to weightbear following their operation are areas highlighted in this report where improvements can continue to be made.'
Will Eardley, NHFD orthopaedic surgery clinical lead
- Emergency departments know that each day at least one person will need urgent admission for hip fracture surgery. But in 2024, patients still spent an average of 15 hours waiting before being made comfortable in a bed, on a ward appropriate to their needs.
- It is a concern that two hospitals still recorded that over 10% of their patients did not receive surgery, that 5% of all operations were recorded as having been performed by unsupervised trainees, and that nine hospitals (5%) recorded over 10% of patients as not being allowed to fully weight bear after surgery.
- Our 2022 facilities survey found over a quarter of hospitals were only providing a Monday to Friday physiotherapy service to all of their patients. NHFD data have been used in developing the REDUCE toolkit, which shows how therapy on Saturday and/or Sunday could see patients spending 2.3 fewer days in hospital, with a cost saving of £676 per patient.
- A quarter of people who break their hip will have another fragility fracture in the future. The majority of patients (58%) now receive bone strengthening medication, but in 2024, 10 hospitals (6%) discharged over three-quarters of their patients without effective bone protection.
- The NHFD is looking at, but has not found, inequalities in hip fracture care and outcome for people of different ages, sexes or ethnicities. However, inequality is definitely seen for people who suffer fractures other than at the hip. Pelvic fractures are a very common reason for admission but these patients do not tend to receive the quality of care that is usual after a hip fracture.
By April 2026, all Integrated Care Boards (ICBs), Health Boards in Wales and Health and Social Care Trusts in Northern Ireland should:
- Require emergency and orthopaedic departments to agree fast-track admission policies, so that at least one in five patients reach a specialist orthopaedic ward within 4 hours of admission with a hip fracture.
- Review each hospital’s NHFD data to ensure that at least 95% of patients are able to access surgery, that this is documented as having been supervised by a senior surgeon and that it allows them to get up fully weightbearing.
- Require each hospital to commission appropriate physiotherapy capacity so that all inpatients recovering from hip fracture can receive at least one session of physiotherapist-directed rehabilitation each weekend.
- Require all hospital teams to review their use of injectable bone protection, so that at least half of all patients are recorded to be on bone strengthening medication 4 months after a hip fracture.
NHS England and Welsh government should:
- Use the results of the audit of pelvic ring fracture we will be piloting from January 2026 to challenge the main form of inequity in the management of fragility fracture which, as both the NHFD and GIRFT have shown, relates to the care of people with fractures at different sites.