Lord Black of Brentwood
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.
Lord Black of Brentwood (Con)
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.
First, the stakeholder community that will make implementation possible is ready and raring to go. It simply needs the starting gun to be fired. The Royal Osteoporosis Society has been in the vanguard, and I pay immense tribute to its tireless campaigning, but it is much more than one organisation. There is now a community of interest around fracture prevention, composed of 60 organisations with various stakes in women’s health, healthy aging, easing burdens on the NHS and keeping older employees in the workforce. On the medical side, that includes seven royal medical colleges along with the representative bodies for physiotherapists, radiographers, social workers and paramedics.
Leading business voices and the trade unions have called for nationwide FLS because economic growth is being stunted by older workers stopping or reducing work due to fractures. Last year, a dozen eminent societies formed a shadow implementation group to help Ministers deliver the FLS policy. An exemplar rollout plan and high-level recommended approach was submitted, but there has been no response from the Government. The current information vacuum is undermining confidence among these organisations. Unless the bone plan emerges by the end of the year, it will be impossible to maintain belief across the sector that FLS will ever become a reality.
Secondly, every year that we delay we see a cascade of preventable fractures, and that costs money, which we all know is in short supply. If we had rolled out FLS in summer 2024, by now we would have saved £60 million, two-thirds of the money needed to pump-prime every FLS across England up to break-even point. I sympathise with the Health Secretary’s comments, reported in the press last week, about “invest to save” initiatives such as FLS needing investment before savings accrue, but achieving the shift that he rightly wants to make from treatment to prevention must start somewhere. You will not find many other treatment models that break even within just 24 months and deliver £1.88 for every £1 invested. This is about replacing badly-spent money with sensible investment in prevention.
It is not just about the money that is being wasted. Every year that we delay the FLS rollout, another 2,500 people die following broken hips, which FLS clinics could have prevented. That’s 2,500 mums and dads, grandmas and grandpas.
Thirdly, the vacuum of information around FLS is in fact causing perverse outcomes which undermine the prevention of fractures. For the last 16 months, government spokespeople have consistently told newspapers that a national rollout of FLS is imminent. Ministers have given the same commitments repeatedly to both Houses of Parliament. That is great but it should therefore not surprise the Government that commissioners who would have acted on FLS independently have, as a result, paused their plans awaiting a national rollout plan and that, since the election, no new FLSs have opened. That is why I make this appeal to the noble Baroness and her colleagues: please publish the bone plan. You may otherwise be unintentionally harming the important cause of fracture prevention rather than advancing it.
A huge amount of energy and impetus have built up around this issue over recent years. Numerous organisations want to help Ministers, in good faith, to turn it into an example of NHS reform under this Government—serving all three of the strategic shifts that the Health Secretary wants to drive. But uncertainty is eroding that energy and good will, when it could so easily be harnessed for the public good.
I am sure that in her response, to which I much look forward, the noble Baroness will repeat the reassurances given repeatedly to Parliament that FLSs will be implemented by 2030. But I beg her to ask her colleagues, please, to fire the starting gun now by publishing the implementation plan by year-end. Everyone here today—I thank noble Lords so much for taking part, which shows how important this debate is—wants simply to get on with it. Let us make it happen by Christmas. For thousands of families and vulnerable individuals, it would be the best possible present they could ever receive.
The Deputy Chairman of Committees (Lord Haskel) (Lab)
My Lords, the timer seems to have stopped. We will take a short break while it is being fixed.
The Deputy Chairman of Committees (Lord Haskel) (Lab)
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?
Baroness Donaghy (Lab)
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.
Baroness Bull (CB)
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.
There is no shortage of evidence to support the case for universal FLS and no shortage of the will and expertise necessary to make it happen. The obstacle is obfuscation. A clear statement from government, followed up by collective action to get everyone on the same page would translate the current confusion into clarity. As we have heard, if the Minister can make that happen before Christmas, we could turn the broad agreement into real delivery.
Baroness Chisholm of Owlpen (Non-Afl)
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.
Lord Lexden (Con)
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.
No one, I think, disputes that the most effective way this state of affairs can be remedied is through the provision of fracture liaison services which identify and treat people after their first fracture, helping to prevent a second. Yet, as we have heard, only around half of NHS trusts provide such a service. Like everyone —I think—taking part in this debate, I hope the Government, who have shown that they understand the need for urgent action, will publish before Christmas their plan to extend fracture liaison services throughout the country.
Baroness Hayter of Kentish Town (Lab)
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.
Achieving these two targets on HIV and FLS would be a major boost in preventing ill health. We can help provide a better service for older people, particularly the half of women who are vulnerable. If they could all get a bone plan under their Christmas tree, I think we would all be very happy.
Lord Shinkwin (Con)
My Lords, I, too, thank my noble friend Lord Black of Brentwood for his indefatigable championing of this crucial issue. I will not repeat the strong arguments that he and others have already made, but I pay tribute to his dogged determination to persuade the Government, as others have said, to turn the “What?” into the eagerly anticipated “How?” and “When?” Like him, I also pay tribute to the Royal Osteoporosis Society for its tireless campaigning on this issue. The rollout of fracture liaison services would strengthen the NHS. I also take this opportunity to thank the Secretary of State for Health for the action he has already taken on an issue that is currently waiting for the NHS.
Whenever we discuss the care of people with a bone condition such as mine, I am inevitably reminded of my childhood orthopaedic surgeon, to whom I owe so much. He came to this country as a teenage refugee from racism—abhorrent, toxic, genocidal racism—the sort of racism spouted by Dr Rahmeh Aladwan. How sad that in the 60th anniversary year of Labour’s Race Relations Act, we are seeing the repugnant resurgence of a racism that claimed the lives of all my surgeon’s relatives who came to wave him off as he left Nazi-occupied Prague, so I would be grateful to the Minister if she could convey my thanks to the Secretary of State for his commitment to reform the system governing the regulation of the UK medical register, and, to quote a departmental source, “to make it easier to kick racists out of the NHS”.
No one has an interest in allowing our NHS to be weakened by racism, and I am sure that my Jewish surgeon would have applauded the Secretary of State’s principled stand, but I am also confident that he would have urged him to detail the how and when of the rollout of fracture liaison services. He was dedicated to me, his patients and the NHS. The rollout of fracture liaison services would build on my surgeon’s life-enhancing legacy. It would change so many people’s lives for the better, as we have already heard, and it would strengthen our NHS. I look forward to the Minister’s reply.
Baroness Royall of Blaisdon (Lab)
My Lords, my thanks also go to the noble Lord, Lord Black, for this important debate, but most importantly for his persistence, which I believe has been instrumental in securing the Government’s commitment to deliver universal fracture liaison services by 2030—and I love his insistence on delivery.
It is essential that the FLS plan is delivered this year. I gently suggest to my noble friend the Minister that the forthcoming update to the women’s health strategy might offer the ideal opportunity to make progress. I understand, of course, that osteoporosis affects men as well, but it is one of the most common long-term conditions affecting women. Half of women aged over 50 will experience a fracture caused by osteoporosis. I, like many others, speak from a personal perspective. My mother had chronic osteoporosis, so I joined the Royal Osteoporosis Society, which has helped me enormously. I too pay tribute to it for its campaigning, for the information and support it provides for sufferers and for the support it provides for researchers. I am glad that the Government wish to work with it.
As we know, more than 2.5 million women in England are living with the condition, and most do not know until they break a bone. The last women’s health strategy focused on reproductive and gynaecological health, but the update offers an opportunity to address conditions that threaten women’s independence in later life. Including a rollout plan for fracture liaison services within that update would show that the Government mean what they say about taking action over words. I hope the Minister will relay that message to her department as it prepares the updated women’s health strategy.
We know these services work, yet the postcode lottery remains stark. A part of the country I know well, Gloucestershire, still has no fracture liaison service at all. A woman who slips and breaks her wrist in my area, the Forest of Dean, or in Cheltenham will be patched up in A&E and sent home, her osteoporosis undiagnosed and untreated. Yet just 40 miles away in Oxfordshire, where the noble Earl lives, the local FLS identified and treated more than 2,500 people last year. The contrast between these neighbouring areas shows why a national rollout plan cannot wait. Commissioning takes time. From approval to maturity, an FLS can take five years to establish, so the decisions made this year will determine whether the 2030 target can be met.
Like the noble Lord, Lord Black, I welcome the Government’s commitment in their plan on reforming elective care for patients to boosting the number of bone density—DEXA—scanners by investing in up to 13 DEXA scanners, six of which will replace existing machines. This would be brilliant as it would enable an extra 29,000 bone scans a year. However, it also requires radiographers to enable the scans to take place, so I ask my noble friend the Minister for her assurance that there will be an adequate number of them.
I would be grateful if the Minister could also tell me what consideration, if any, her department is giving to treating osteoporosis with MBST. This uses magnetic resonance therapy to stimulate bone regeneration and increase bone density. I understand that a neighbourhood health hub at the University of East London is providing MBST therapy—that experience could provide invaluable information.
Recognising osteoporosis as central to women’s health would fire the starting gun on delivery and give millions of women confidence that progress is finally being made.
Lord Rennard (LD)
My Lords, I too welcome the persistent, skilful and incredibly determined approach of the noble Lord, Lord Black of Brentwood, to achieve what is clearly needed—that is, the expansion of the use of fracture liaison services to 100% coverage by 2030. This commitment, contained in the 10-year health plan, is the right goal.
When we consider the issues around osteoporosis, we are discussing a public health crisis. Osteoporosis is a condition that is asymptomatic until fragility fractures strike. These fractures are painful. They can lead to social isolation and a significant loss of mobility and independence, and too often to mental health conditions such as depression. Osteoporosis-related fractures claim as many lives as lung cancer or diabetes. They rank as the second highest cause of bed occupancy within the NHS. We all know how expensive the occupancy of hospital beds is and we are aware of the dangers to many patients of being in hospital. These include the risk of infections, sometimes as serious as sepsis.
We need to try to act further to avoid fractures and the resulting stays in hospital. Fracture liaison services proactively identify patients aged 50 and over with a fracture, assessing their bone health and their falls risk to try to prevent what may be a devastating subsequent fracture. We have heard for many years about the laudable ambition of achieving 100% FLS coverage in England by 2030, but we may fail to achieve that target if we fail to heed the lessons from Wales, where they have achieved that goal.
The Government’s current commitment to action is not as rapid as that which has already been achieved in Wales. In February 2023, the then Welsh Health Minister, the noble Baroness, Lady Morgan of Ely, issued a decisive national mandate. She instructed all health boards to establish fracture liaison services within 18 months, backed by pump-priming investment. By September 2024, the target was met and every acute health board in Wales had a functioning service.
The Welsh Government then committed to achieving international quality standards by 2030. That will mean ensuring that these services are resourced to serve at least 80% of the over-50s. The Welsh Government faced the same hurdles that England faces—the same financial pressures, the same workforce challenges and the same competing priorities—but the difference was urgency and focus. In England, without national co-ordination, commissioners are recognising the value of FLS, but they appear to be waiting for direction before committing scarce resources. The result, as we have heard, is that England now runs the risk of falling behind the rest of the UK in osteoporosis care. We must not let that happen.
The Earl of Effingham (Con)
My Lords, I thank my noble friend Lord Black and other noble Lords for their valuable contributions, which appear unanimous. This is clearly an important issue, which speaks to one of the fundamental objectives of any Government, regardless of political persuasion, when it comes to health—namely that prevention is better than cure. Every £1 spent on prevention saves an estimated £5 in downstream NHS costs. This is money well spent and guarantees multiple returns on investment, which are the kind of words that every Chancellor of the Exchequer wants to hear.
In government, we committed to the goal of 100% FLS coverage and we welcome that the current Administration have taken on the baton to complete that by 2030. We know that there is already 100% coverage across Scotland and Northern Ireland, and it is crucial that we follow in their footsteps. Indeed, without successful intervention, research indicates that one in two patients will potentially have another fracture within two years. This is a serious problem: it creates an unnecessary burden on the taxpayer of at least £650 million over five years but, more importantly, it leads to a loss of independence within a year, which then leads to anxiety, isolation, depression and worse. This has further profound societal and economic consequences, which no one wants to see—as was so well highlighted by the noble Lord, Lord Rennard.
The challenge is to identify, to assess, to intervene and to follow up. That is a tried and tested road map that works and that should be provided by a well-oiled FLS. We might ask whether the Government have made an assessment of integrating fracture risk assessments into routine GP health checks for patients over a certain age. Is there an opportunity to improve sex and region aggregated data, so that we can better understand the scale and nature of the problem and the resulting strategies?
I focus briefly on prevention. Strong muscles lead to strong bones, and strong bones help to minimise the risk of fracture. It has been suggested by many research pieces that strength training can even build bone so, if the Government wish to succeed with their goals, when and how will they ensure that everyone understands the huge benefits of daily exercise and strength training, which would solve so many of the issues that we currently face, not just fractures?
His Majesty’s loyal Opposition welcome action on this, via any specific measures that will address the situation. We ask the Government whether they will take guidance from Scotland and Northern Ireland on how they achieved 100% FLS coverage. A precedent has been set but, as many noble Lords have suggested, actions speak louder than words.
Baroness in Waiting/Government Whip (Baroness Blake of Leeds) (Lab)
My Lords, I congratulate the noble Lord, Lord Black, on securing this important debate and thank all noble Lords for their significant contributions. I pay tribute to his personal background; it has brought such depth and strength of feeling to the subject, and I am sure many noble Lords have similar experiences. His persistence in carrying on with this is noted and welcomed. He is right to highlight the importance of reducing waiting lists, driving economic growth and safeguarding the most vulnerable members of our society.
We know that patients, including those with osteoporosis fragility fractures, are waiting too long for care and treatment, which needs to change, as I think all noble Lords have mentioned. This is why, between July 2024 and August 2025, the NHS provided more than 682,000 DEXA scans to patients across the country. As announced earlier this year, we are investing in 13 DEXA scanners to support improvements in early diagnosis and bone health and provide an estimated 29,000 extra scans a year once operational. I completely understand the points in the noble Lord’s speech about the need for follow-up action once the scans have been implemented.
I shall pick up the comments made by my noble friends Lady Royall and Lady Hayter. I think there is an enormous recognition of the need to focus on women’s health; that is an accepted aspect of all the work that we are doing. More generally, we want every person, including those with osteoporosis, to receive the highest quality compassionate care. In the past three years, two new drugs have been recommended by the National Institute for Health and Care Excellence for the treatment of osteoporosis in postmenopausal women, for example. Going back to women’s health, through our 10-year health plan and the women’s health strategy update, we are delivering our manifesto commitment that never again will women’s health be neglected.
The three shifts that I will go on to talk about—hospital to community, analogue to digital and treatment to prevention—are key aspects of the work that we need to do. Following from that, the 10-year workforce plan will ensure that the NHS will have the right people in the right places with the right skills to care for patients when they need it. That is a critical aspect. I will write to my noble friend Lady Royall with the more specific detail, if that is okay.
As the noble Lord, Lord Black, illustrated so powerfully, fracture liaison services can play a vital role in reducing the risk of refracture, improving the quality of life and increasing the years lived in good health. This Government and NHS England support the clinical case for services that help to prevent fragility fractures and support patients who sustain them. As we have heard, we are committed to rolling out fracture liaison services to every part of the country by 2030. As my noble friend Lady Hayter said, this is a genuine commitment. One of the early priorities of the 10-year plan will be a modern service framework for fragility and dementia. This is the first time that this has been introduced.
Going back to the 10-year plan, it is absolutely critical that we provide better care for people with osteoporosis, fragility fractures and other MSK conditions. The noble Lord, Lord Rennard, mentioned the problems with public health that we all know—as a former local government leader I know them only too well. Supporting the shift to prevention, the health system is working to prevent fractures occurring in the first place. Advice from NICE for clinicians includes information and advice on lifestyle changes a person can make to reduce their risk of fragility fracture, which the noble Earl, Lord Effingham, mentioned. These include increasing vitamin D intake, eating a balanced diet, drinking alcohol in moderation, stopping smoking if applicable and participating in a combination of exercise types. These are all absolutely fundamental in working towards the prevention agenda.
We are working to deliver the Getting It Right First Time MSK community delivery programme. The specific teams in this area are working with integrated care board leaders to reduce community waiting times and improve data, metrics and referral pathways to wider support services. Under the 10-year health plan, patients with MSK conditions will soon be able to bypass their GPs and directly access community services, including physiotherapy, pain management and orthopaedics, via the NHS app.
Our vision for a neighbourhood health service is also core to achieving the three shifts. The Department of Health and Social Care and NHS England are working closely together to progress our commitment to shift to a neighbourhood health service. The 10-year plan includes fracture liaison services as a specific example of the services that neighbourhood health centres could host.
As we have heard, fracture liaison services are commissioned by integrated care boards, which we believe are well placed to make decisions according to local need. This Government are committed to giving integrated care boards the freedom and autonomy they need to focus on the job of meeting patients’ needs and improving the communities they serve. I am pleased to say that 41 out of the 42 ICBs have a women’s hub. We need to make sure that they are delivering in this space.
Officials in the Department of Health and Social Care are working closely with NHS England to consider a range of options to ensure the improved quality of and access to these important preventive services. We need to be honest about the scale of the action needed, the challenges faced across the health and care system and the fact that change will not be possible overnight.
I recognise that many are dedicated to campaigning for fracture liaison service expansion. I thank the noble Lord, other contributors to this debate and the All-Party Parliamentary Group on Osteoporosis and Bone Health for its work. It is absolutely critical that we raise awareness of this vital issue and try not to wait until it is too late and a fracture has occurred. This is a very important aspect of the work that everyone is pulling together. I thank the clinicians and commissioning bodies that play such a vital role in delivering fracture liaison services.
In response to the noble Baroness, Lady Chisholm, on this point, we talk about politicians, but over the past year, officials, including senior civil servants, have engaged on various occasions with the Royal Osteoporosis Society on fracture liaison services, and they will continue to do so.
I do not have time to respond to all the comments, but I will pass on the comments of the noble Lord, Lord Shinkwin, to the Secretary of State. I thank him for his very clear exposition of his experience. I also undertake to pass on the comments of the noble Baroness, Lady Royall.
I close by simply restating the Government’s commitment to ensuring access to care where and when it is needed. Once again, I thank noble Lords for today’s discussion on such an important topic.
The Deputy Chairman of Committees (Lord Haskel) (Lab)
My Lords, I am sure we all thank the speakers for their brevity in reaction to the technical issues.