Can Payment by Results Improve Hip Fracture Surgery Delays

Mortality following hip fracture surgery is high, with 7% mortality at 30 days and 18% at 120 days. This reflects the pre-existing poor health of some of those who present with such an injury. Large studies have demonstrated that delayed surgery is an independent risk factor for mortality. The British Orthopaedic Association (BOA) recommends that hip fracture surgery be undertaken within 48 hours in all those medically fit. Payment by Results (PbR) was introduced in July 2000 in the NHS Plan, linking the allocation of funds to hospitals to the activity undertaken. This was designed to 'provide a transparent, rules-based system […] which would reward efficiency, support patient choice and diversity and encourage activity for sustainable waiting time reductions'.