The Audit Commission has criticised hospitals for failing to make enough progress in treating patients with hip fractures.
In 1995, the commission found that patients faced long waits for assessment in accident and emergency departments and for operations, one in 10 of which were carried out by a junior doctor.
In an update published last week, it says three-quarters of hospitals have fast-track procedures in A&E, the number of patients waiting more than 48 hours for an operation has been reduced from 22 per cent to 18 per cent, and the number of operations carried out by un-supervised junior surgeons has fallen from one in 10 to one in 100.
But only 7 per cent of patients - 18 per cent in Wales - are admitted from A&E within an hour, as recommended.
Audit Commission controller Andrew Foster said: 'In too many cases, performance has either not improved or got worse.' These hospitals needed to 'fundamentally rethink their processes', he said.
NHS Confederation chief executive Stephen Thornton said it was important not to 'underestimate the managerial and clinical resources needed' for this.
United they Stand: co-ordinating care for elderly patients with hip fracture. Audit Commission publications, 0800 502 030.£5.