The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Merron) (Lab)
My Lords, I congratulate the noble Lord, Lord Black, on securing this important debate and pay tribute to his very effective campaigning over many years. I am always touched when he refers to his mother; personally, I always feel that his campaigning shows great respect to his mother, and I am sure that the whole House appreciates that. I also enjoyed, as I am sure the noble Lord, Lord Kamall, did, his reminder to me and the now Opposition Front Bench of what we said when we were on the other side, and we are suitably—not chastened exactly—brought to book by his comments.
I thank other noble Lords for their many insightful and accurate contributions. As I am sure noble Lords will be aware, I have much sympathy with many of the points that have been made. I know this is an issue close to many, either because of their own experience or that of those to whom they are close.
As we have heard, including from the right reverend Prelate the Bishop of London, inequalities in access to and the quality of fracture liaison services have a significant impact on so many people across the country. Over half a million people in England alone suffer a fragility fracture every year. More than 40% of those will suffer another fracture within a decade. As the noble Lord, Lord Black, so powerfully illustrated, fracture liaison services can play a vital role in reducing the risk of refracture, improving quality of life and, importantly, increasing the number of years that can be lived in good health.
Many noble Lords referred to the postcode lottery, including my noble friend Lady Quin and the noble Lord, Lord Rennard. Noble Lords spoke of the difference in access coming at a substantial cost. I agree; it is not only a cost for the NHS and social care, but there are also many personal costs of life-changing injury and increased mortality and morbidity. This cannot continue.
Today’s debate refers to the progress towards universal provision by 2030. The noble Lord, Lord Black, and other noble Lords powerfully advanced the case for moving swiftly and the potential consequences of not doing so. It was suggested that there was funding from the previous Government for the expansion of fracture liaison services. All investigations show that no funding was ever confirmed or announced, including as part of the Major Conditions Strategy. I remind your Lordships’ House that the 2030 ambition for the rollout of fracture liaison services was first announced by the previous Government on the day after the election was called. On that point, I am very grateful for the understanding of a number of noble Lords, including the noble Lord, Lord Kamall, and my noble friend Lady Quin, that these are early days for the Government, but I will attempt to be helpful.
This mission-led Government will expand access to fracture liaison services, alongside, importantly, delivering 40,000 more appointments each week and increasing diagnostic capacity to meet the demand for diagnostic services. Why? It is because fracture liaison services play a vital role in the mission to build an NHS for the future, where waiting times are reduced and more care is moved to the community, closer to where people need it. We have to be honest about the scale of the action needed, as noble Lords will know that this Government have been. I will make some points about the background and the challenges ahead. As the Chamber will understand, it will not be solvable overnight.
My right honourable friend the Secretary of State commissioned an independent investigation into the NHS as one of his first actions in government. The findings by the noble Lord, Lord Darzi, laid bare the fact that the NHS currently has the longest waiting lists, the lowest patient satisfaction and a deterioration in the nation’s underlying health, with widespread problems for people accessing services. This includes fracture liaison services.
In response, the Government announced the 10-year plan, which will be published next spring. The plan will be shaped by input from the public, patients and health and care staff through an engagement exercise—on which noble Lords heard me answer a Question from the right reverend Prelate earlier this week, who was good enough to raise it again today. The exercise was launched as:
“The biggest national conversation about the future of the NHS”.
It will include consideration of the three fundamental long-term shifts for health reform, as emphasised by my noble friend Lady Quin and the right reverend Prelate: hospital to community, analogue to digital and changing from sickness to prevention. I agree with noble Lords that fracture liaison services encapsulate all three. This is a long-term challenge and will take time to deliver, so the plan will consider what immediate actions are needed to get the NHS back on its feet and get waiting lists down, as well as long-term changes.
We are continuing our close working relationship with NHS England to tackle issues related to provision of fracture liaison services, which are a crucial prevention service. The noble Lord, Lord Black, my noble friend Lady Donaghy and the noble Baroness, Lady Bull, along with other noble Lords, suggested a number of potential solutions. We are considering a wide range of options as we seek to identify the most effective ways of improving the quality of and access to the fracture liaison service model and the interventions it provides. I look forward to continuing work with noble Lords and being able to bring more information to this House.
My noble friend Lady Ritchie referred to the role of ICBs, and this point was raised several times helpfully in the debate. As noble Lords are well aware, fracture liaison services are commissioned by ICBs and are making decisions according to local need. National expectations of ICBs and trusts for the next financial year will be set out in the 2025-26 NHS planning guidance. I know that the matter of finance has been raised a number of times, including by the right reverend Prelate.
Along with many noble Lords here, we have benefitted from continuing engagement with the Royal Osteoporosis Society and a number of partners. The noble Lord, Lord Brownlow, rightly paid tribute to the role of Her Majesty the Queen. I felt that was an extremely important recognition with which I want to associate myself. In our engagement with our stakeholders, we are looking at the best ways to support the systems that work.
The noble Lord, Lord Shinkwin, raised matters relating to those of working age. It is the case that osteoporosis and the risk of repeated fragility fractures remain significant contributors to economic inactivity. I was pleased to hear the noble Lords, Lord Black and Lord Shinkwin, recognise the significance of musculo- skeletal conditions as drivers of long-term sickness absence. It is absolutely the case that those conditions are the second leading cause of sickness absence and the leading cause of a reduction of years lived in good health and employment.
There is much joint working going on between DWP, DHSC and NHS England under the Getting It Right First Time teams to deliver a programme, working with ICBs to reduce waiting times and improve data and referral pathways. The recent Get Britain Working White Paper included an announcement of £3.5 million in funding for this year to provide a model for musculo- skeletal community services to kick-start economic growth.
The noble Baroness, Lady Bull, and the right reverend Prelate raised women’s health. The noble Lord, Lord Black, was kind enough to draw attention to my previous interest in the issue of fracture liaison services. That now chimes in very well with one of my responsibilities, as I am the Minister for women’s health. I am dismayed at how often women’s health needs are not considered when designing services, and even worse are the additional stark inequalities referred to by the right reverend Prelate. I assure your Lordships’ House that it is a priority for us to ensure that all women receive the high-quality care that they deserve.
I close by restating our commitment to expanding access to these vital fracture liaison services. The work continues, and I look forward to updating noble Lords a number of times as we make progress together.