The National Hip Fracture Database (NHFD) national report 2014 shows that improvements in care mean that more patients are surviving after hip fracture. The report is launched today (12 September 2014) at the British Orthopaedic Association (BOA) congress in Brighton.

In 2013 the average 30 day mortality was 8.05%; this is an improvement on the previous figure of 8.1% from the NHFD report for 2011-2012. This may appear a small percentage change but so many people suffer with hip fracture each year that it amounts to a real advance. The improvements in care that this latest report describes mean that over 300 fewer people died within 30 days of hip fracture than was the case in 2011-2012.

The NHFD audit is commissioned by the Healthcare Quality Improvement Partnership (HQIP) as part of the National Clinical Audit and Patient Outcomes Programme (NCAPOP)*. The NHFD audit is carried out by the Royal College of Physicians.

Care is improving in many areas including the time it take for patients to get to theatre and their access to a specialist consultant (orthogeriatrician). More patients (71.7%) are getting to theatre 'on the day of admission or the day after' for surgery. This is a small increase from 70.6% reported last year. More patients (81.6%) have access to an orthogeriatrician today compared with only a quarter of patients in 2009. Improving such aspects of care explains the improvements in performance we have seen over recent years.

The NHFD has successfully supported the Best Practice Tariff (BPT) initiative. The BPT, only available in England, is an incentive for hospitals to meet the specified standards for hip fracture care. The NHFD audits care against the clinical aspects of these standards. Since BPT was introduced for hip fracture in 2010, there has been a rise in the provision of orthogeriatric care and greater access to specialist medical expertise for patients admitted to hospital for hip fracture.

Commenting on the results, Dr Antony Johansen, NHFD clinical lead, orthogeriatric medicine said,

"This report marks another positive set of annual results, which show how, overall, hip fracture care has continued to improve year on year since the audit started in 2007. These improvements are against backdrop of an increase in the number of patients being treated and an increase in the average age of the hip fracture patient. Almost 50% (47.4%)** of patients are being admitted to an orthopaedic ward within four hours of arriving at hospital. But there has been a slight dip in this result compared with last year's national report (48.9%)."

Professor Tim Briggs, British Orthopaedic Association (BOA) President said, Orthopaedic trauma surgeons continue to lead the improvement of care for the elderly suffering fractures of their hip. With more patients getting earlier operations and mortality continuing to drop, the care across England is now recognised as world class. The BOA, in supporting the NHFD, undertakes multidisciplinary reviews of hospitals with poorer results. All hospitals reviewed have shown improvements in care and we strongly encourage others to follow their example in responding to the report. It is essential that clinicians continue to drive further continuous quality improvement in hip fracture services to the benefit of patients nationally, and we are particularly pleased to see the report published as part of the BOA Annual Congress 2014 on 'Managing Change'."

Professor Paul Knight, British Geriatrics Society (BGS) President said, "We welcome this report that shows once again that planned multidisciplinary care for older people has the capacity to improve outcomes and we would commend the methodology of the audit to others engaged in health service provision."

The NHFD national report 2014 reports data from the calendar year 2013. A copy of the audit report is available from NHFD's website.

Also published today is 11th Annual Report from the National Joint Registry (NJR). This report shows that while more joint replacements than ever are taking place (200,000***), the numbers of people dying following surgery have halved and that for most patients, the risk of having the original implant changed within ten years was less than 5%.