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New guidance launched for hip replacement

NICE guidance aimed at service commissioners

Jo Carlowe

Monday, 26 November 2012

New guidance has been issued today to help provide better services for people who have fractured their hip.

The guidance issued by the National Institute for Health and Clinical Excellence (NICE) provides advice on the commissioning of services for people with fragility fracture of the hip or fracture of the hip due to osteoporosis or osteopenia. It includes services for the ongoing secondary prevention of further hip fracture/fragility fractures.

There are currently around 60,000 emergency hospital admissions for hip fracture in England each year and demographic projections suggest this is set to rise significantly over the next decade. Outcomes for patients with broken hips can be poor, with only around half of patients discharged to their usual place of residence within 30 days and 1 in 3 dying within 12 months.

In addition, around half of all hip fracture patients do not regain their previous level of mobility and people who have had a previous hip fracture are more likely to experience a further hip fracture in the future.

Drawing on the NICE clinical guideline and accompanying quality standard for hip fracture, the guide for commissioners highlights evidenced-based interventions that can help improve outcomes for people who have fractured their hip.

The guide will be of interest to commissioners in primary care trusts, commissioning support services and clinical commissioning groups, as well as to public health and local authority commissioners and will help them towards achieving the outcomes set out in the NHS, Public Health, commissioning and Adult Social Care Outcomes Frameworks, as well as the Commissioning outcomes Framework (COF) and the Quality and outcomes framework (QOF).

The guide for commissioners focuses on a number of key areas of care for people with hip fracture. These include: specifying a Hip Fracture Programme; specifying services for the rapid optimisation of fitness for surgery; specifying services for post-surgery rehabilitation and hospital discharge, and specifying services for the secondary prevention of fragility fractures.

The guide encourages commissioners to work with a range of partners when planning services for people with or recovering from hip fracture, including clinical commissioning groups, health and wellbeing boards, social care, service users and carers. The guide also includes a commissioning and benchmarking tool to help users determine the level of service that might be needed locally and to help calculate the cost of commissioning a hip fracture service.

Commenting on the guidance, Professor Cameron Swift, Emeritus Professor of Health Care of the Elderly, Kings College London, said: “This guide presents an exceptional opportunity for commissioners to deliver a comprehensive world-leading, evidence-driven, cost-effective response to a major, urgent and costly health care challenge. Used in conjunction with a ready-made national measurement tool (the National Hip Fracture Database), forward progress can be readily and easily charted. I commend it to them.”

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