Fractured neck of femur places considerable strain on orthopaedic and geriatric services. This situation may become worse as the population ages. This study estimates the future economic impact of fractured neck of femur in terms of bed days and direct secondary care costs. Methods Population projections by the Office of Population Censuses and Surveys were combined with age-sex-specific incidence rates in England and local data on age-sex-specific resource use. Resource use data were collected on 1253 consecutively admitted patients with fractured neck of femur. We estimate the direct hospital cost and beds used for treating fractured neck of femur in the years 1991–1992, 2011 and 2031. Population projections by the Office of Population Censuses and Surveys were combined with age-sexspecific incidence rates in England and local data on agesex-specific resource use. Resource use data were collected on 1253 consecutively admitted patients with fractured neck of femur. We estimate the direct hospital cost and beds used for treating fractured neck of femur in the years 1991–1992, 2011 and 2031. In 1991–1992, 56 613 people fracturing their hips cost the hospital sector in England approximately £288 million in direct costs alone. Unless treatment patterns alter or age-specific incidence falls this figure will have risen to £360 million (1991–1992 prices) by 2011, with some 69000 cases requiring some 539000 extra hospital bed days per year. In 2031, 96000 cases would cost £507 million (1991–1992 prices) to treat, and would call for over 1 6 million extra bed days per year. The reported steep rise in age-specific incidence of fractured neck of femur may now have abated; however, overall incidence will rise further as England's population continues to age. This rise in volume combined with increasing age and frailty of those fracturing their hips will have major resource implications. Unless beds can be provided, major initiatives will be required to prevent fracture, improve treatment and provide for community care.