The NHFD commissioners’ report 2015 is aimed at Clinical Commissioning Groups (CCGs) in England and in particular, commissioners who commission services for hip fracture, trauma and care for older people. The report details variation in practice around the UK, supporting the development of the best way to care for the frail and older patients who experience hip fracture injuries.
We urge commissioners to use this report alongside provider-level data from the National Hip Fracture Database (NHFD) annual report 2015 to fully understand the quality of hip fracture services in their area. In particular:
• CCGs must question whether Hospital Episode Statistics (HES) data are capturing patients’ length of stay (LOS) in rehabilitation beds they commission in community hospitals and care homes.
• Three CCGs will need to question why fewer than 20% of hip fracture patients in their local population receive treatment in a hip fracture programme (HFP), the model of care that is central to National Institute for Health and Care Excellence (NICE) guidance.
• A number of CCGs (51) should challenge local providers where fewer than 70% of patients are recorded as receiving the prompt surgery recommended by NICE clinical guideline 124(CG124).
• Teams at 19 CCGs will wish to consider why fewer than half of their patients were able to be mobilised out of bed on the day following surgery, and to question whether this reflected poor perioperative fluid and pain management, or a failure to provide the early physiotherapy assessment recommended in NICE quality standard 16 (QS16).
• Where poor performance is highlighted in the summary tables, CCGs should examine their local provider hospitals’ performance, as detailed in the NHFD annual report 2015, and in individual hospital dashboards available at the National Hip Fracture Database (NHFD).