The 2025 National Hip Fracture Database report on 2024: ‘Room for improvement: hip fracture care in 2024’
With over 70,000 people in England, Wales and Northern Ireland experiencing 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 to prevent this injury.
This report examines how care in 2024 aligned to the key patient goals of:
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Admission - How soon will I be made comfortable and admitted to the right ward?
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Operation - How is my operation explained and supervised, so I can get up afterwards?
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Rehabilitation - How will I be supported to get back on my feet after surgery?
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Care quality - Will I receive the same quality of care as other people?
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Care consistency - Does every fracture lead to the same quality of care?
The key findings of the 2024 report include:
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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.
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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.
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The NHFD 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.
The key recommendations include that 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.
Mark Bowditch, BOA President said, ‘Whilst the surgical care of older people with a broken hip continues to improve this Report makes clear that there is still more to be achieved that will yield better outcomes for them. Of particular note is the decision to pilot the use of the results of the pelvic ring fracture audit to challenge the inequity in the management of fragility fractures in different anatomical sites.’
Further details at: www.nhfd.co.uk/2025report.