By working collaboratively with local clinicians and stakeholders, an action research (plan-do-study-act) approach will be used to generate knowledge to understand how to best implement the intervention (PERFECTED Enhanced Recovery Pathway), which was developed from learning and research undertaken as part of Work Package 1. During the current study the PERFECTED Enhanced Recovery Pathway (ERP) will be used to optimise care on three ortho-geriatric wards for 12 months. These wards are located in Norfolk, Nottinghamshire and Yorkshire. The sole participants are NHS personnel delivering care on selected wards.