Fracture Liaison Services

Question for Short Debate

Asked by

To ask His Majesty’s Government what progress they have made towards establishing fracture liaison services across England, and what plans they have to meet their commitment to provide universal coverage by 2030.

My Lords, at the start of September the Prime Minister made it clear that his Government are now entering the delivery phase. I take him at this word and would like our debate today to focus on helping him to do just that, by setting out how they can deliver on three goals: reducing waiting lists and saving lives; boosting economic growth; and protecting the most vulnerable in our society, particularly the elderly. There is one simple way to deliver speedily on all three: publish the long-awaited bone plan before Christmas.

During the election, the Health and Social Care Secretary said, to his great credit, that developing the rollout plan for fracture liaison services would be one of his first acts in Government. Unfortunately, we are still waiting. In recent years we have had numerous debates on osteoporosis, resulting in clear commitments to move forward, but the truth is that, while their expansion has happened at pace in Wales, we have seen no progress at all in England.

The case for doing so is as strong as ever. Half of women aged over 50 and one-fifth of men will suffer disabling and potentially fatal fractures because of osteoporosis. There are effective medications that prevent fractures and preserve people’s independence, but, shockingly, two-thirds of osteoporosis patients are missing out on that treatment because this Government—and indeed the last one, I readily admit—have so far failed to match words with deeds. The end result of untreated osteoporosis is a broken hip, which results in a three-week hospital stay and kills one-quarter of people within a year. The majority of those who survive face a life infinitely smaller and consumed with pain. I know because I saw it with my own mum, whose latter years were dominated by agony and disability because her osteoporosis was not treated properly.

Campaigns run by two newspapers, the Sunday Express and the Mail on Sunday, have brought this injustice out of the shadows and achieved a consensus on the way forward. This is not a partisan issue; I suspect that we all agree on both the ends and the means. We just need to get on with it.

To turn back to delivery, during the election the Health Secretary made two commitments to people living with osteoporosis. The first was to increase the number of DEXA scans. I thank him and the Government for the £2 million for new scanners released to fulfil that first promise. That is a good start, but fracture prevention relies on more than just a scan. If heart disease patients got only ECGs but then no treatment, there would be outrage. If you want to prevent secondary heart attacks, you do not stop at a cholesterol test.

That is why the second commitment made by the Health Secretary is much more consequential. He promised to expand fracture liaison service clinics to all areas by 2030 so that we can prevent 74,000 fractures by that date, including 31,000 life-threatening hip fractures. Ministers have repeatedly given that commitment to Parliament and, thankfully, the policy is enshrined in the 10-year plan. Again, that is a good start but, despite those commitments, we have heard nothing about how or when it is to be implemented, hence this debate today. The time between now and Christmas is critical if we are to meet the Government’s promise. This afternoon, I ask the Minister to consider three reasons why publishing the bone plan is now extremely urgent.

My Lords, the timer seems to have stopped. We will take a short break while it is being fixed.

Sitting suspended.

My Lords, the Grand Committee has been suspended as a result of technical issues. We will now resume and finish at 5.16 pm. Will noble Lords please bear that in mind and maybe knock a minute or two off their speeches?

My Lords, I thank the noble Lord, Lord Black of Brentwood, for his contribution, which was so stunning that it put the lights out. I will cut my speech short to allow others to get in, in the time available.

As people who know about the subject know, the fracture liaison service was pioneered in Glasgow in 1999. Other countries have picked up this model very successfully to the extent that we, in England at least, are in danger of falling well behind. More than a decade ago in New Zealand, for example, the Government set out to make fracture liaison services available to everyone, backed by targeted central investment. Today, 99% of New Zealanders have access to a fracture liaison service. It is a striking example of how clarity from central government, supported by a plan, can deliver universal coverage in a short time.

Japan offers another lesson. Faced with the oldest population in the world and a growing number of hip fractures, the Japanese Government introduced a simple FLS incentive scheme in 2022. In just three years, the number of services has more than doubled, and every region now has at least one FLS. It is a reminder that, when Governments set clear expectations, progress follows.

In the meantime, progress in England has stalled. Just over half of NHS trusts have an FLS, meaning that thousands of people are treated for a fracture each year but never investigated for underlying causes. The Government’s commitment is welcome and, more importantly, achievable, but commitments alone will not deliver the service. As the noble Lord, Lord Black, said, a delivery plan is now urgently needed to show how that goal will be achieved. That should be this year, preferably by Christmas; otherwise, we will be halfway through this Parliament.

My Lords, I declare my interest as an ambassador for the Royal Osteoporosis Society, and I congratulate the noble Lord, Lord Black of Brentwood, on securing this important debate. Since the campaign for universal access to fracture liaison services was launched, I have seen osteoporosis evolve from an issue oft overlooked in public policy to one that now enjoys cross-party support, with the noble Lord a doughty and persistent champion. Every party endorses the importance of universal fracture liaison services: they are in Labour’s 10-year plan for health, the Conservative manifesto, the Liberal Democrat manifesto and even in the policies of the Reform Party.

However, despite this almost unique level of consensus meaning this should have been an open goal, yet somehow the ball has been lost in kerfuffle and confusion. The confusion is not about intent or even value. Everyone agrees that universal fracture liaison services will save lives and money, but communication between different parts of the system has broken down. The Royal Osteoporosis Society, Ministers, NHS England and local commissioners and indeed the extensive list of networks and organisations that we heard about earlier are all working towards the same goal, yet they seem to be doing so on different pitches. The proposal, for instance, to include fracture liaison services in neighbourhood health centres could one day prove valuable but, as an idea, it was poorly communicated and has just led to greater uncertainty. Commissioners are now unsure whether they should act locally or wait for a national steer and, as a result, progress has stalled.

We know that Ministers face multiple pressures and competing priorities, but a clear commitment was made, and those who fought for it need to see that it still stands. What we need now is to convert confusion into clarity so that we can harness the current consensus to drive change. Commissioners, clinicians and patient groups all need to understand what is expected of them and when. A straightforward statement from the Government that sets out responsibilities, timelines and how the FLS rollout fits within the 10-year plan and neighbourhood health centre programme would resolve much of the current uncertainty.

My Lords, I thank my noble friend Lord Black for securing this debate. We all share the same goal: all noble Lords speaking today and health leaders across the country want to see more fracture liaison services available to more people. Those who suffer from osteoporosis, with its distressing, painful and debilitating consequences, were given hope before the last election by the Government, who made a clear and welcome commitment to ensure that every part of England will have access to fracture liaison services by 2030, and it now forms part of the 10-year health plan for England.

However, I am fearful that we are not moving forward. No new fracture liaison services have opened, and 2030 is only just over four years away, as the noble Baroness, Lady Donaghy, mentioned in her speech. Of course, resources are tight, the NHS faces extraordinary pressures and new funding is difficult to find. If resources are holding things up, I ask the Minister to work with the Royal Osteoporosis Society, which has done so much to support and champion fracture liaison services over many years and again stands ready to help, working closely with the department, to develop a practical, phased rollout plan.

I welcome the media coverage a fortnight ago when the Health Secretary said that he wanted to develop a plan for delivery with the Royal Osteoporosis Society. Such a plan need not be perfect. I have been involved with the Royal Osteoporosis Society for many years, and I know that it is pragmatic and aware of the constraints and challenges faced by the Government. We are all hoping that a practical landing zone will be found for a policy that we are all championing.

I share the concerns expressed by my noble friend Lord Black that a plan needs to emerge by Christmas. Given that a commitment was given to the media that this would be an early priority of the Government and that there is a need to maintain trust and confidence across the network and among partner organisations that this change will happen, let us get on with it and make it happen.

My Lords, my noble friend Lord Black is, thankfully, a persistent person. The subject we are discussing today is one that he has brought before your Lordships with some frequency, through debates and Oral Questions. Those who suffer the pain and distress that osteoporosis brings have no more determined parliamentary champion than him. Evidence continues to accumulate in support of the action for which he has long called and which he has reiterated so powerfully today: the urgent need to establish fracture liaison services throughout our country.

For some years the Royal College of Physicians has charted a steady rise in the number of hip fractures. Its latest annual report, published last month, records yet another increase. It also shows, once again, how unevenly the services that could reverse this trend are spread across our country. Indeed, there could be no clearer example of that much-reviled phenomenon: the postcode lottery.

Curiously, there seems to be no figure for the total number of hip fractures in the United Kingdom. Scotland appears disinclined to share information. In the other three parts of the country the total now stands at some 70,000. Without the action for which my noble friend Lord Black is calling, the number will go on mounting remorselessly. Experts believe that it will double by 2060, bringing the total to 140,000. The bill will be crippling. Today each hip fracture costs the health and care services around £28,000. Total expenditure, which now stands at some £2 billion, is likely to reach £3.8 billion by 2060—virtually doubling the huge burden borne by our overstretched NHS.

The burden can and must be reduced. The key to this is to ensure that those who incur smaller, less severe fractures are correctly diagnosed as suffering from osteoporosis and are treated accordingly. That would cut the number of hip fractures dramatically, but it will not happen without the major change for which my noble friend Lord Black and others have long been pressing. At the moment, around half of those who break a hip have experienced an earlier, less severe fracture without being correctly diagnosed and treated. That means that tens of thousands of people are being discharged from hospital at severe risk of hip fracture and, in due course, some of them will suffer one. More than one in four of those who have a hip fracture will die within a year.

My Lords, it is a great pleasure to follow the noble Lord, Lord Lexden, and to speak again in a debate initiated by the noble Lord, Lord Black. When the Government confirmed last year that they would deliver FLS across England by 2030, it was a real mark of genuine progress and warmly welcomed by all of us—not least, of course, by the noble Lord, Lord Black, himself, who has been asking for this for so long. But despite this, I share the concern of many about the slow rate of progress.

The Government have said that fracture liaison services

“are commissioned by integrated care boards, which are well-placed to make decisions according to local need”.

Now that should be the case, but it unfortunately always tends to be the neglected health conditions, such as osteoporosis, that are overlooked without national co-ordination and insistence—and, surprise, surprise, it is usually women’s issues that are overlooked most.

I was delighted to hear this week a lot on the radio about prostate cancer. However, where is the similar attention to those living with osteoporosis, two-thirds of whom will miss out on treatment? That silence is inexcusable. Luckily, we are in general living longer, but hospitals will not be able to cope with the spiralling numbers of hip and spinal fractures if we do not have that FLS to prevent these breaks. Over just the past two weeks, two of my friends have fallen and broken their hips. I do not know whether they had a particular predisposition but the pain that they are suffering, and the cost to the health service of patching them up, would probably pay for half of a local FLS in their area.

The Health Secretary recognised all of this when he committed to a national rollout of FLS by 2030. Indeed, before the election, Labour’s election platform singled out a small number of health conditions for targeted action and osteoporosis was one of them. We all cheered. I know and understand that a national plan tends to jar with the move towards greater localisation but, given that commitment to implement FLSs by 2030 —only five years off now—surely we can make an exception for that national initiative here. Rather like the pledge to end new HIV transmissions by 2030, which the 10-year plan says will be set out in a delivery plan, we need this for FLS. Let us have the same in this area.