The tide has turned Response on behalf of the British Orthopaedic Association Miss Clare Marx CBE FRCS

The challenge to T&O 70,000 hip fractures amongst 300,000 fragility fractures a year Care and rehabilitation of patients with hip fracture is the central challenge for trauma services; those that can provide good care for these patients will cope well with the range of other fragility fractures encountered.

BOA Blue book 2007 Four big messages Multidisciplinary approach to the management of fragility fracture patients Reliable secondary prevention osteoporosis falls Chronic disease model Quality assurance the NHFD

National Hip fracture data base

A series of firsts Recommendations of the profession accepted by DoH The program led to a change in the payment system (Best Practice Tariff) Use of the NHFD – a non DoH data base for monitoring the compliance The establishment of the fracture fragility steering group at the DoH to take it forward into the wider Health care setting

NHFD data 2010

NHFD data 2010

NHFD data 2010

BPT Compliance in Q1 and Q2

Turning the tide

Drivers for change Standard setting by professional organisations championing multidisciplinary working The recognition that robust data enables change, research and quality improvements Best Practice Tariff which takes clinical standards and rewards performance against those standards monitored by NHFD

Summary As a profession we must collaboratively champion change and be prepared to work for real quality improvements for our patients The Best Practice Tariff has lead the way as a model for changes in commissioning of services

Conclusions We welcome the focus this report brings on Care of the older patient undergoing emergency surgery Although we have further to go in T&O, recent developments have turned the tide This NCEPOD does not go far enough in challenging the commissioners of the future to ensure that standards of care are delivered