Fracture Liaison Services: National Coverage

Tuesday 27th October 2026 Lords Chamber

Question

14:40

Asked by

[Baroness Murphy]

To ask His Majesty’s Government what progress they have made in developing a delivery plan to achieve national coverage of fracture liaison services in England by 2030.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Merron) (Lab)]

My Lords, the 10-year health plan committed to rolling out fracture liaison services by 2030, and it outlines our vision for a more devolved health service. The 10-year health plan and, more recently, the renewed women’s health strategy highlight community-based models of fracture prevention services. Integrated care boards are responsible for commissioning these services and are best placed to determine how they should be delivered to meet local need, while supporting overall development of fracture prevention outcomes.

[Baroness Murphy (CB)]

My Lords, I am very aware that the Minister has had this Question in almost identical wording, and I think there is another one soon to come from somebody else. So I will move away, if I may, and ask: does the Minister agree that the importance of these fracture liaison services is not simply to pick up fractures of the long bones, which are associated with osteoporosis, and to treat them—the fundamental purpose of the liaison service—but to establish connections between orthopaedic surgeons and geriatric medicine, so that, with other problems such as, for example, older people not getting their operations quick enough after a fracture, which Dr Mark Porter mentioned in the Times today, it will speed up the total relationship between the two departments and get better access to care for frail older people? Does the Minister agree that that is the most vital thing about these liaison services?

[Baroness Merron (Lab)]

I agree with the noble Baroness that that is one of the most important functions, because of course prevention and recovery are also key. As I have mentioned, ICBs are focused on providing services closer to home. Also, we are working with NHS England so that we can improve frailty services in acute settings as a priority, including through same-day emergency care and through comprehensive geriatric assessments.

[Baroness Pidgeon (LD)]

My Lords, what assessment have the Government made of the workforce and funding required to deliver national coverage? Will those requirements be reflected in the delivery plan?

[Baroness Merron (Lab)]

I refer the noble Baroness to the forthcoming 10-year workforce plan, which will make sure that the NHS has the staff that it needs, including in frailty services. Fracture liaison services deploy multidisciplinary teams to ensure prompt diagnosis and appropriate treatment. We have made available, through the Department for Education, loans for living costs to support students from the lowest income families to make sure that they can train and be part of the workforce. That is one area where we are developing recruitment and training.

[Lord Black of Brentwood (Con)]

Can the Minister confirm my understanding that, despite the Government’s commitment to a national rollout of FLS by 2030, the patient assessment rate, which is the key treatment measure, has shockingly increased by only 3% since 2024? At this rate of expansion, it will take 38 years—until 2064, my 100th birthday, incidentally—to fulfil their pledge, with tens of thousands of people dying unnecessarily.

[Baroness Merron (Lab)]

I hope we will all get to celebrate the noble Lord’s 100th birthday with him. As he will recall from just last week, we are taking a whole-pathway approach to fracture prevention, including improving access to diagnosis, adopting effective treatments and encouraging local systems to develop services that focus on those at greatest risk. I am always open to the points the noble Lord makes—he is right to make them—but it is important to acknowledge the actions and improvements taking place and the way we are supporting the development of services, particularly for those who need them most.

[Lord Weir of Ballyholme (DUP)]

My Lords, fracture liaison services is one area in which the three devolved institutions are, in effect, ahead of England; it is provided universally in Scotland, Wales and Northern Ireland and has been of great benefit in those jurisdictions. Can the Minister say what liaison is taking place with the three devolved institutions to learn lessons so that, when rollout happens in England, those lessons can be adapted to make sure we get the best service in England?

[Baroness Merron (Lab)]

I suggest some caution about the situation under the devolved Governments. Without any wish to disregard any improvements that have been made, the situation is not quite as the noble Lord describes, and I would be very pleased to write to him to confirm why. We certainly liaise closely and regularly with the devolved Governments to ensure that we can see progress across the whole of the United Kingdom.

[Lord Kamall (Con)]

My Lords, the Minister has just told the House that decisions on fracture liaison services will be made by local ICBs, yet at the national level the Government have made a welcome commitment to universal coverage in England by 2030. Does she accept that leaving delivery to the discretion of individual ICBs risks creating inconsistencies? Would such disparities be an example of where the Secretary of State could use their power of direction, as proposed in the Health Bill?

[Baroness Merron (Lab)]

I am sure we will discuss that at great length in Committee. While I absolutely accept there is a difference in the service level across the country—that is not acceptable, as I am sure we would all agree—it is not the hands-off approach that is often suggested. We have made, through the medium-term planning framework, the neighbourhood health framework and the 10-year health plan an identification that those at risk of frailty are a priority cohort. Our best practice guide was recently updated to give the NHS and local government joint ownership of delivery. In all these ways and a number of others, we support local decision-making and provision.

[Baroness Nargund (Lab)]

My Lords, osteoporosis disproportionately affects more women at menopause. Tens of thousands of women under the age of 40 who undergo menopause tend to receive a delayed diagnosis, and some end up with fractures before their menopause diagnosis is made. Does my noble friend the Minister agree that the fracture liaison services need to be integrated into women’s health hubs, so that younger women with menopause receive not only an early diagnosis and treatment but advice on fracture prevention?

[Baroness Merron (Lab)]

My noble friend is right to identify that there is a higher incidence of osteoporosis in women than men; it is more common. Some 80% of osteoporotic vertebral fractures are not identified and not managed appropriately, which again is unacceptable. That is why NIHR research has investigated the use of a new questionnaire to improve the diagnosis of these fractures in women. If it is successful—I hope it will be—it will reduce fracture risk and change clinical practice, particularly for older women with back pain.

[Lord Patel (CB)]

My Lords, in response to the question asked about the devolved Administrations, the Minister suggested we should interpret the data with caution. The caution is this: Scotland established one of the world’s first fracture liaison services, which is recognised globally as the most effective. Claims of a 50% reduction in repeat fractures might be exaggerated, but not by much. So what is the caution?

[Baroness Merron (Lab)]

The caution—I am very happy to write to noble Lords with more details on this —is that it has been suggested that it has 100% coverage, but I am advised that that is not exactly the case.