NHFD report finds hip fracture care shaped by where you live

21 Sep 2026

A patient’s chances of surviving a hip fracture can depend more on the hospital where they are treated than their age, sex, ethnicity or socioeconomic background, according to the latest National Hip Fracture Database (NHFD) report, published in September 2026 by HQIP. Focused on inequalities, the report also highlights a need for more universal provision of care to be provided by fracture liaison services, calling on hospitals and other parts of the healthcare system to work more closely together to prevent secondary hip fractures.

“We know what good care looks like. Every patient who breaks a hip should receive high-quality care regardless of where they live or which hospital they attend. Reducing unwarranted variation must remain a priority if we are to improve outcomes and prevent avoidable harm.” Dr Sunil Nedungayil, senior clinical lead for the Falls Fragility Fracture Audit Programme

Each year, more than 72,000 people are treated in hospital for a hip fracture in England, Wales, Jersey and Northern Ireland. These patients occupy around one in 30 hospital beds, costing the NHS an estimated £1.1 billion annually, and social care a further £1.25 billion in the first 120 days after injury.

The NHFD report sets out several key findings:

A patient’s chances of surviving a hip fracture depend more on the hospital they attend than their socioeconomic background: Variation in 30-day mortality between hospitals was five times greater than the difference seen between the most and least deprived communities.
Delirium remains a major and preventable threat to recovery after hip fracture: Patients experiencing delirium are three times more likely to die in hospital and three times more likely to move into a care home after their injury – with hospital screening rates varying.
Thousands of hip fractures could potentially be prevented: Around a quarter of patients admitted with a hip fracture each year have previously suffered a fragility fracture, yet many were not receiving treatment to strengthen their bones and reduce the risk of further fractures. Nearly half of NHS trusts in England do not have a Fracture Liaison Service.
Patients with other fragility fractures are missing out on specialist care: Nearly all hospitals provide specialist geriatric assessment for hip fracture patients, but people with pelvic and other fragility fractures are significantly less likely to receive equivalent care.
People living in more deprived areas face a higher risk of hip fracture: Men in the least deprived communities are around half as likely to experience a hip fracture as those in the most deprived communities. The report states that more than 8,500 hip fractures among men could be avoided each year if this inequality in risk were reduced.
Waiting times for surgery have worsened since COVID-19: Average time to theatre increased from 33.6 hours in 2020 to 39.3 hours in 2025, reflecting ongoing pressures on NHS services.

Previous work using NHFD data showed that ethnicity was not associated with significant differences in adjusted outcomes, although patients from ethnic minority backgrounds were less likely to be mobilised on the day after surgery, highlighting the importance of accessible patient information and family involvement in rehabilitation.

This report makes four key recommendations for national commissioning bodies and other organisations planning healthcare:

Mandatory monitoring of routine delirium screening using the 4AT (a brief bedside assessment tool used for the rapid initial detection of delirium and cognitive impairment in clinical settings), for all hip fracture patients.
Address variation in care for people with pelvic and other fragility fractures.
Monthly clinical governance meetings in every hip fracture service to review outcomes, safety events and patient feedback.
Universal provision of effective fracture liaison services to improve secondary fracture prevention.

The NHFD collects data from hospitals across England, Wales, Jersey and Northern Ireland, to support improvements in the quality and outcomes of care for people who sustain hip fractures. It is delivered by the Royal College of Physicians (RCP) as part of the Falls and Fragility Fracture Audit Programme (FFFAP), and commissioned by HQIP on behalf of NHS England, the Welsh government and others. This report highlights the value of these programmes in improving healthcare and, ultimately, improving and saving lives. The data and outputs from this work are an invaluable, publicly available resource that shine a light on where improvements will have the maximum impact; supporting healthcare providers to implement changes that will improve care and outcomes for everyone.

Read the report in full: Challenging inequities in hip fracture care – HQIP