New guidance urges higher priority on hip fractures

NICE is recommending that all hip surgery should take place at most a day after hospital admission, amid accusations that hip fracture patients are being given ‘low priority’ by NHS hospitals.

There have been frequent reports in recent weeks of elderly people suffering discrimination in the care they receive, and some have suggested that hip fracture patients are being ignored because they have less of a voice in hospitals. Half of them have to wait 36 hours in hospitals before undergoing surgery, often undertaken by junior doctors.

NICE not only wants the surgery carried out more quickly, but urges surgeons, physicians, anaesthetists, nurses and physiotherapists to work together in co-ordinated ‘hip fracture programmes’ to care for patients.

The recommendations are set out in NICE’s first clinical guidance document on hip fractures. It estimates the measures would cost £1.4m a year for English hospitals – a tiny fraction of the £2bn annual cost of treating hip fractures and caring for those left with limited mobility afterwards.

The ageing population means that the number of hip fractures is likely to rise from around 75,000 a year now to about 100,000 a year by 2020.

Cameron Swift, emeritus professor of healthcare of the elderly at King's College London and chairman of the guideline development group, told a press conference: “We have got, with hip fracture, a healthcare challenge over the coming decades of potentially epidemic proportions.

“So often when we talk about our growing numbers of older people we encounter a sense of gloom and despair almost that we've got an insoluble problem. We've found there are solutions which can be not only effective but cost-effective in addressing this particular challenge.”

Tim Chesser, consultant orthopaedic and trauma surgeon with North Bristol NHS trust’s Frenchay and Southmead hospitals and a member of the guideline development group, told the Daily Telegraph newspaper: “They present as emergencies but they've often been given a very low priority in the hospital setting, especially in the emergency setting, and the patients had to wait several days before their surgery, before they are allowed to start recovering from their impact fall and their fracture.

“This surgery was often undertaken on the evening list by junior staff.

“These patients are old, they don't have a voice in a hospital setting where you have young trauma patients who do complain. Everyone should have an equal voice.”