Recurring concern

Insufficient orthogeriatric provision for elderly orthopaedic trauma patients

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First reported 4 Aug 2022•Latest report 18 Apr 2023

Definition

What this concern includes

Includes failures in the dedicated orthogeriatric care system for elderly patients with orthopaedic trauma, including insufficient specialist provision, unavailable orthogeriatric beds or capacity, failure to provide orthogeriatric input on admission, and resulting delays in appropriate care or surgery.

Not included

  • Excludes general hospital, emergency-department or critical-care capacity shortages where orthogeriatric care is not the specifically identified deficiency.
  • Excludes generic staffing or bed shortages unless they directly prevent or delay orthogeriatric care for elderly orthopaedic trauma patients.
  • Excludes isolated orthopaedic treatment, referral or clinical-decision failures where inadequate orthogeriatric provision is not identified.
  • Excludes care for younger trauma patients or patients without a material orthopaedic-trauma and age-related-comorbidity context.
Reports
2

Distinct published reports

Individual concerns
2

A report can raise multiple concerns

Date range
2022–2023

First to latest report issue date

Stated actions
1

Described in published responses

Reports over time

Reports over time

Reports about this concern issued each year.

* 2026 is projected from reports observed to 7 Sep 2026.

Most frequent recipients

Most frequent recipients

Reports about this concern sent to each recipient.

Barking, Havering and Redbridge University Hospitals NHS Trust1
Department of Health and Social Care1
Greater Manchester Health and Social Care Partnership1
Tameside and Glossop Integrated Care NHS Foundation Trust1

Concerns and responses across reports

Only concerns grouped under this recurring concern are included. Select any concern, action or position to view the source wording.

  1. East London

    AI-generated summary

    John Edward Stiff · Prevention of Future Deaths report

    This summary was generated using AI from the published report. Please read the original report for the complete account.

    Report summary

    John Edward Stiff was admitted to Queen's Hospital after a believed unwitnessed fall and was diagnosed with an undisplaced pelvic fracture. His condition declined, including reduced appetite and a chest infection, and he died at the hospital on 16 November 2022. The report raised concerns that patients with hip and pelvic fractures and age-related co-morbidities would be better cared for by orthogeriatricians, and that limited access to such care could contribute to untimely deaths.

    Read the report on judiciary.uk

    Source evidence

    How this individual concern was interpreted

    PFD Monitor created a concise, searchable interpretation from the report wording shown below.

    PFD Monitor interpretation

    Insufficient orthogeriatric provision for elderly orthopaedic trauma patients with comorbidities

    Wider context from the report

    “The Inquest heard evidence from an orthopaedic surgeon that patients such as Mr Stiff, who suffer hip and pelvic fractures and who have a number of additional age-related co-morbidities, would be best cared for by ortho-geriatricians. The inquest heard that this matter has been raised by the orthopaedic team on multiple occasions, but the orthogeriatric provision has not been increased. The Inquest also heard that the lack of orthogeriatric provision is a national issue of concern within the NHS. Orthopaedic trauma in elderly patients often exacerbates underlying medical conditions. Orthogeriatric trained staff would be better trained to recognise and treat medical co-morbidities. It is therefore considered that improved access to orthogeriatric care for this patient cohort could prevent future untimely deaths. ”

    Source location

    John Edward Stiff · Prevention of Future Deaths report
    Page 2 · concerns

    Open source report

    Source evidence

    How this respondent position was interpreted

    PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

    PFD Monitor interpretation

    Individual NHS Trusts are responsible for creating orthogeriatric care pathways based on local patients and workforce skills.

    Verbatim wording from the response

    “Orthogeriatric care is a medical-surgical model which brings together multidisciplinary health professionals from trauma, orthopaedics and geriatric medicine to treat the fracture and frailty issues affecting people with hip fractures. I understand that Orthogeriatric provision varies across the NHS. Each individual Trust will create their own care pathways, having regard to both their patients and the skills of their workforce.”

    Source location

    Response from Department of Health and Social Care
    Page 1 · response
    Published 20 April 2023

    Open published response

  2. Manchester South

    AI-generated summary

    James Robert Curry · Prevention of Future Deaths report

    This summary was generated using AI from the published report. Please read the original report for the complete account.

    Report summary

    James Robert Curry died at Tameside General Hospital on 18 November 2021 from bronchopneumonia after an accidental fall caused a fractured neck of femur. The report identified prolonged waiting in the emergency department, shortages of beds and theatre capacity, lack of orthogeriatric care, and surgery taking place outside the recommended timescale as substantive concerns.

    Read the report on judiciary.uk

    Source evidence

    How this individual concern was interpreted

    PFD Monitor created a concise, searchable interpretation from the report wording shown below.

    PFD Monitor interpretation

    Failure to provide NICE-compliant orthogeriatric care on admission

    Wider context from the report

    “1. The Inquest heard that a lengthy wait for an elderly patient with a hip fracture on a trolley in the Emergency Department will impact their physiological reserves and add to their pain. In Mr Curry’s case, the Inquest heard that the prolonged wait was due to a shortage of beds within the Trust. That situation is still the case; 2. Mr Curry needed an orthopaedic bed to enable him to have the operation. The evidence was that a shortage of beds meant that he could not be placed in one and had to go to AMU. As a consequence on admission he did not receive the orthogeriatric care envisaged by NICE in their guidance; 3. The Inquest heard that the operation should have taken place earlier than it did under the NICE guidance. The Inquest was told that the NICE guidance is based on ensuring the best outcomes for elderly patients with fracture neck of femur and reducing mortality. It did not due to a shortage of capacity in the Trust. The Inquest heard that the Trust was regularly not able to operate in timescales compliant with the NICE guidance. ”

    Source location

    James Robert Curry · Prevention of Future Deaths report
    Page 2 · concerns

    Open source report

    Source evidence

    How this respondent action was interpreted

    PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

    PFD Monitor interpretation

    Monitor compliance with NICE hip-fracture guidance and submit daily data to the National Hip Fracture Database and related audit programme.

    Verbatim wording from the response

    “For assurance of performance with the National Institute for Health and Care Excellence (NICE) Clinical guidance the Surgery, Women’s and Children’s Division are monitoring compliance on an ongoing basis. The Trust submits data to the National Hip Fracture Database, which specifically looks at care for patients over the age of 60, who undergo surgery following a hip fracture. This includes data to improve care through quality improvement in line with NICE guidelines and the National Falls and Fragility Fracture Audit Programme (FFFAP). Data is submitted by the trauma co-ordinators daily. The Trust have implemented a Divisional fractured neck of femur improvement programme which is reported and monitored daily via the Divisional senior leadership team.”

    Source location

    Response from Tameside and Glossop Integrated Care
    Page 2 · response
    Published 29 September 2022

    Open published response
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Data last updated 7 September 2026