The incidence of hip fractures is an index of the overall burden of osteoporosis in a society. Hip fractures are a major cause of morbidity, mortality and hospital admissions amongst older people. A study published recently in the Journal of Public Health Medicine by Tai-Yin Wu and colleagues examined trends in hip fracture admissions and mortality in England. They found that between 1998 and 2009, there was little change in age-standardized hip fracture rates (102.0 to 101.8 fractures per 100,000 person-years), but age-standardized in-hospital mortality decreased by 17%, from 127 to 106 deaths per 1,000 hip fracture admissions. Most hip fractures and deaths occurred in women and older people. A socioeconomic gradient was present for mortality, with a 26% difference in mortality in 2008 (94 to 118 deaths per 1,000) between the most affluent and most deprived areas in England. As the number of older people in the population rises, hips fractures will continue to be an important public health issue, emphasising the need for the effective prevention of osteoporosis, and rapid, high-quality treatment of patients once they are admitted to hospital.
NHS budgets are under considerable pressure. It is therefore unsurprising that many NHS Integrated Care Boards (ICBs) In England will aim to prioritise price in contract awards, But this approach is a significant threat to community-centred healthcare. While competitive tendering is a legally required, an excessive focus on costs in awarding NHS contracts risks overshadowing key factors such as established community trust, local expertise, and the long-term impact on continuity of care. This shift towards cheaper, often external, commercial providers threatens to cut the links between communities and their local health services. The argument that competitive tendering is solely about legal compliance, and not cost, is undermined by the very nature of such tendering, which by design encourages the lowest bid. This approach risks eroding the social fabric of local healthcare provision, where established relationships and understanding of specific community needs are essential. Establishe...
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