Half of those with hip fractures currently have to wait 36 hours in hospital, in pain and in fear, before undergoing surgery and in many cases junior doctors carry out their operations rather than more experienced staff, it is claimed.

The National Institute for Health and Clinical Excellence (Nice) is now recommending that all hip surgery should take place at most a day after hospital admission and that surgeons, physicians, anaesthetists, nurses and physiotherapists should all work together in co-ordinated Hip Fracture Programmes to care for patients.

It says this approach would lead to fewer costly days in hospital and allow patients to regain their mobility and independence quicker, as well as reducing the chance of them suffering complications in surgery or dying soon afterwards.

Nice believes the improved system, set out in its first clinical guidance document on hip fractures, would only cost hospitals in England a total of £1.4million a year extra and warns of a hip fracture "epidemic" in the coming decades as the population grows older.

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."

Up to 75,000 people suffer hip fractures every year in Britain, and the figure is expected to reach 100,000 by the end of the decade as the population ages. Experts say broken hips affect more women than breast cancer.

The problem is estimated to cost £2billion a year in medical treatment and social care for victims who are left house-bound or struggling on crutches for weeks even after having their hips replaced.

Fewer than 50 per cent of those who are taken to A&E with a broken hip are operated on within 36 hours, although the delay is now shorter than it was several years ago.

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, said: "They present as emergencies but they've often been given a very low priority in the hospital setting, especially in the emergency setting, and in 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."

Asked why hip fracture patients were such a low priority, he replied: "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."

Nice says that outcomes are often "poor" for hip fracture patients with one in three dying within 12 months of surgery, and although in many cases this is down to the patients having other health problems that are only identified when they suffer a fall, other elderly people are unable to return to their former homes and have to move into residential care or suffer further accidents if they do not receive the support they need.

The watchdog's new guidance recommends that surgery should take place on the day of hospital admission or the day after, and should be carried out on a planned trauma list with consultants supervising junior staff in order to reduce the risk of complications and shorten the patient's stay.

It also sets out a multi-disciplinary approach involving the different professionals found in a hospital along with social services, rather than just seeing hip fractures as a surgical problem. This will ensure that the patients' other health problems and care needs are assessed so they can be discharged quicker and regain the life they enjoyed before their fall.

Nice estimates that it currently costs £6,770 to treat an individual hip fracture and that implementing the new co-ordinated regime would only add an extra £2,696 per 100,000 population.

Article from The Telegraph