The effective management of older patients with fragility fractures of the femur remains central to modern trauma care. Processes of assessment and communication alongside means of identifying poor performance are vital to improving care in this population. The National Hip Fracture Database (NHFD) now contains around 1 million cases and has evolved over time to reflect contemporary practices in the care of older injured patients. The NHFD is in a unique position to inform hip fracture care and the wider global management of injured older patients. This report provides an update and details the processes within the NHFD, the scope, lessons learned and highlights future direction.