The National Hip Fracture Database’s 2025 report ‘Room for improvement: hip fracture care in 2024’ highlights key ways in which clinicians, managers, and policymakers can improve care and outcomes for frail and older patients.
Each year over 70,000 people in England, Wales and Northern Ireland have a hip fracture and a quarter of them can expect to have another fragility fracture in the future. Unless something is done to prevent such fractures, it is estimated that the total of number of hip fractures could double by 2060.
The latest report from the National Hip Fracture Database shows a huge improvement in medication provision, in that most patients (58%) now receive bone strengthening medication while they are in hospital. However, in 2024 ten hospitals (6%) still discharged over three-quarters of their patients without effective bone medication.
'Room for improvement: hip fracture care in 2024’examines how hip fracture care in 2024 aligned to key patient goals in admission, rehabilitation and care quality. It revealed that 20 hospitals reported that their patients faced an average delay over 24 hours before they reached the care of the multidisciplinary team in an appropriate orthopaedic ward.
The report lays out ways in which integrated care boards in England, health boards in Wales, and health and social care trusts in Northern Ireland can improve hip fracture care. These include requiring emergency and orthopaedic departments to agree fast-track admission polices and ensuring that every hospital has the capacity to provide all hip fracture patients with physiotherapist-directed rehabilitation at the weekend.
Professor Antony Johansen, National Hip Fracture Database orthogeriatrician clinical lead said:
‘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.’
Mr Will Eardley, National Hip Fracture Database orthopaedic surgery clinical lead, said:
‘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.’
Dr Hilary Williams, clinical vice president of the Royal College of Physicians, said:
‘This report lays bare specific weaknesses in the care offered to many hip fracture patients. Like many areas of the health service, an aging population and the consequent increases in demand are stretching services and impacting patient care.
‘However, ICBs, health boards in Wales and social care trusts in Northern Ireland do have it in their gift to streamline and revise services to ensure patients are treated and rehabilitated more quickly and effectively. The steps outlined in this report, including fast tracking admissions and ensuring appropriate physiotherapy capacity, will improve patient outcomes and ultimately reduce future demand.’
Key findings of the 'Room for improvement: hip fracture care in 2024' report include:
- In 2024, it took an average of 15 hours before patients were made comfortable on a ward appropriate to their needs. Twenty (12%) hospitals recorded an average delay of over 24 hours.
- Two hospitals still recorded that over 10% of their patients did not receive surgery.
- 5% of all operations were recorded as having been performed by unsupervised trainees and nine hospitals (5%) recorded that over 10% of their patients were not allowed to fully weight bear after surgery.
- Most patients (58%) now receive bone strengthening medication, but in 2024, 10 hospitals (6%) discharged over three-quarters of their patients without effective bone protection.
- In 2022 the NHFD found that over a quarter of hospitals were only providing their patients with physiotherapy from Monday to Friday. NHFD data used in developing the Royal Osteoporosis Society’s ‘REDUCE toolkit’, shows how weekend therapy at could see patients spending 2.3 fewer days in hospital; a cost saving of £676 each.
Key recommendations
- 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.
A webinar to discuss the report’s findings is scheduled for 6 November 2025 5.30pm to 7pm – reserve your place: Register now