One in five elderly people with broken hips do not get surgery quickly enough, a survey shows.
Patients are meant to be operated on within 48 hours, but the annual audit in England, Wales and Northern Ireland showed many waited longer.
The survey of 36,000 patients also raised concerns about access to specialist care, the right drugs and support to prevent future falls.
However, compared to previous years it showed standards were improving.
Hip fractures from falls are one of the most common reasons for elderly people to end up in hospital.
There are about 76,000 cases every year, costing the NHS about £1.4bn to treat - a figure which is doubled when the associated social care costs are taken into account.
The audit was compiled from the National Hip Fracture Database, a voluntary reporting system which 90% of hospitals feed into.
It found that 80% of patients were given surgery within 48 hours - the recommended time-frame for treatment
Administrative problems and a lack of staff were identified as reasons for slow treatment.
What was more, a third did not have falls assessment, which is considered key to preventing future problems through home modifications and exercise regimes.
Meanwhile, a quarter were not assessed to see if they needed drug treatment to strengthen bones, while significant numbers were also not seen by specialist doctors who play a key role in carrying out medical checks and evaluating other health needs.
One in 20 patients also developed pressure sores - a sign of problems with the quality of nursing care.
The audit also showed that hospitals have a long way to go before they achieve the very best results.
Only a third of units achieved a high enough standard to get the bonus payment under the NHS funding system for excellent performance.
And, for the first time, the audit named individual hospitals with the results showing large variations in the standards of care.
For example, just over half of patients at London's Charing Cross hospital were seen within 48 hours, compared to 95% at Wansbeck Hospital in Northumberland.
Colin Currie, a consultant geriatrician who helped compile the data, said there was "no excuse" for the poor care being seen in some hospitals.
"The human cost of hip fracture is enormous and poor quality care can result in patients enduring avoidable disability and even the loss of home and independence."
Michelle Mitchell, of Age UK, said the finding were "very worrying".
"Reducing falls and improving the care and support we give people following a fall must be a priority for our health service."
Professor Keith Willett, the government's trauma tsar in England, said it was clear "further work" was need to drive up standards.
He added the incentives built into the payment system should help drive up improvements in the future.