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

2. 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.

3. 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

6. National Hip fracture data base

7. 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

8. NHFD data 2010

9. NHFD data 2010

10. NHFD data 2010

11. BPT Compliance in Q1 and Q2

12. Turning the tide

13. 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

14. 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

15. 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