Commissioning hip fracture care – the NICE way

Dr Karthik Kayan is onsultant orthogeriatrician at Stockport NHS Foundation NHS Trust.

Prof Opinder Sahota is consultant in elderly medicine at Nottingham University Hospitals NHS Trust and Joint Chairman of the Falls and Bones SIG at the BGS.

It is well known in geriatric medicine circles that hip fractures are the most common osteoporotic fracture affecting predominantly older people.

Currently, the incidence of hip fracture emergency admission is around 70,000 in the UK and will continue to increase as the population ages. The projected incidence for hip fracture in the UK is 101,000 by 2020. The crippling effects of hip fracture are significant for the patient as independence is affected and a number of them die within a year of sustaining a fracture. The cost of managing osteoporotic fractures is £1.7 billion and over 90 per cent of this is due to health and social care costs associated with the fracture.

National Hip Fracture Database Reports on Developments in Acute and Post-Acute Care

Dr Helen Wilson, is co chair of the National Hip Fracture Database (NHFD), a joint endeavour of the BGS and the British Orthopaedic Association to improve the care of patients with fragility fractures.

Hip fracture, which usually results from the combination of a fall and pre existing osteoporosis, is the most common serious injury of older people, with around 76,000 cases occurring per year across the UK. Many patients are already frail. Mortality is high, residual disability common, and care costly. Although there is good evidence on best practice in surgical, medical and rehabilitation care following hip fracture, such care and its outcomes – in terms of return home and also of mortality – continue to vary.

The NHFD has published a supplement to its 2012 National Report which demonstrates continuing improvements in acute care but  highlights variations in post-acute care and overall length of NHS stay.