Fracture Liaison Services
Baroness Lane-Fox of Soho Excerpts(3 weeks, 3 days ago)
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Baroness Merron (Lab)
We have rolled this out further, as we inherited a more limited coverage of fracture liaison services than we have currently, and we are looking at how to improve access. As I said to the noble Lord, 23 out of 25 ICBs have at least one fracture liaison service. We will push this forward through various means, including the Best Practice Guide for NHS Frailty Pathways, which recommends comprehensive neighbourhood-level frailty plans, and the modern service framework, to mention a couple of ways. I have to emphasise that this is about a complete change in the delivery of NHS services, from which fracture liaison will greatly benefit.
Baroness Lane-Fox of Soho (CB)
My Lords, I declare an interest as a patron of Day One Trauma Support and as someone with a relatively high knowledge of fractures. How does the Minister expect the new fracture liaison services to embed charities and other organisations on a fully funded basis, as they are vital in working alongside the health service to make sure that rehabilitation goes smoothly and that people from all backgrounds have the best chance of recovery success?
Baroness Merron (Lab)
That is absolutely key, as the noble Baroness says. We have to look at the way that we are working. I emphasise again that we are looking at how we can roll out the modern service framework, which will really push this forward. That will involve full consultation with the groups that the noble Baroness rightly mentioned. She spoke about funding. I cannot give specifics without knowing them, but we will be further delivering this already improved service, as well as taking other supportive actions. These include asking local authorities to include menopause in the NHS health check later this year, which will help greatly with earlier identification.
Healthcare Services: Acute, Primary and Community
Baroness Lane-Fox of Soho Excerpts(1 month ago)
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Baroness Lane-Fox of Soho (CB)
My Lords, I thank the noble Baroness, Lady Janke, for her incredibly powerful opening and the chance to speak in this important debate. I stand here with two hats on: first, as the survivor of a major trauma who has spent a disproportionate amount of time in all parts of the healthcare system, and, secondly, and far more importantly, as patron of Day One Trauma, which I shall describe later.
I will make three points. First, we must start with the patient, not with the system. Too often, it seems that, as policymakers, we think about the policy and the organisational structure rather than the experience of the patient in the system. That is particularly true for trauma victims. I start with them because trauma is perhaps the sharpest end of our healthcare services. Trauma patients have to go through so many of the different services that are offered, from intensive care to rehab and community services and then to the long-term support they may need as they live at home.
When someone is hit by a car, has a fall or experiences a major trauma, they do not think about the system that they are in—they think about surviving. They do not think, “I’ve now left acute care and I’m in the long-term recovery ward”; they think, “I want to recover”. What matters to them is whether they receive physiotherapy, occupational therapy, psychological support, pain management, speech and language therapy, and practical help to return to work and life. I have met many trauma survivors through Day One, a charity that helps people when they have a severe physical trauma, with about 30,000 people entering the system every year. The charity works alongside healthcare professionals in the most intense settings to help people navigate what is happening to them. It could be help with how to get benefits while they are off work for a long period or how to work out whether or not to amputate a limb—very brutal decisions at the most difficult time of their lives, often involving working with their families alongside them. At Day One Trauma, too often we see patients bumping up against different bits of a system as opposed to being seen as a patient and one person.
That brings me to my second point, which, perhaps inevitably, is about technology. I welcome much of what is in the NHS modernisation Bill, particularly around single patient records, but this sometimes feels far removed from the reality of what is happening in the system. We must engage more deeply with people who are expert in this area and give them power within the huge networks that exist in the NHS to change the patient experience. It is not acceptable that families and individuals, at the most difficult time of their lives, have to navigate so many different systems. We have already heard from the noble Baroness, Lady Janke, about how people will be put into an online system only then to be chucked out to the telephone. Imagine if you cannot actually move or speak: how do you navigate the system then? Too often, at the time when we most profoundly need help and we have the opportunity to use technology, it is absent, both for the people caring for the patients and for the patients themselves.
I read just this morning on a blog from OpenAI—perhaps it was PR—that 230 million people a week are now using ChatGPT for health questions. Goodness knows what the quality of that information is. It is so important that we recognise what is happening in the outside world and try to build it into the system more effectively. We must start with the patient. We must join up policy, as opposed to organisational structures, that reflects the needs of how people are actually living with and experiencing the system. We must use technology to make sure that people have a more effective journey through their recovery, and that clinicians, doctors, physiotherapists and all the people who work so hard in the system are given the best shot at delivering the care they most urgently want to deliver.
Finally, we must support charities in the system. Again and again, both in my own journey and now as proud patron of a couple of them, I have seen how difficult it still is for charities to get access to some of the parts of the NHS where they want to help and where they are providing a vital ballast to the people working in the system more directly. Day One Trauma works across multiple trauma centres in the north of England. When its members are in the care units or acute care units, they are welcomed by the staff, because they are doing much of the work that the staff have no time to do. Similarly, Horatio’s Garden, a fantastic charity that builds gardens for spinal patients, gives access to the outdoors, doing valuable work for people at those acute moments.
We must be able to answer these three questions. Are we starting with the patient in these policies? Are we using technology to the best of our advantage? Are we enabling charities to help support the system where we do not have the resources ourselves?
Wheelchair and Community Equipment Strategy
Baroness Lane-Fox of Soho Excerpts(7 months, 2 weeks ago)
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Baroness Lane-Fox of Soho (CB)
My Lords, it is great honour to listen to the noble Baroness, Lady Gerada, and to have enjoyed a small sample of the immense knowledge that she will bring to this House. It is, however, somewhat ironic that I am asked to talk about her in a time-limited debate when it is clear it is possible to fill a whole hour with her public achievements and contributions to public life.
As we heard, the noble Baroness qualified as a doctor in 1983 and trained in psychiatry in the Maudsley and Bethlem and then as a GP in south London. Her career has consistently sat at the intersection of general practice and mental health, including addiction, gambling harm and, critically, the well-being of the healthcare workforce itself.
From 2008 to 2022, the noble Baroness founded and led the NHS Practitioner Health Service. It is now the largest confidential mental health and addiction service for health professionals in the world, supporting nearly 50,000 clinicians across England and Scotland. From 2019 to 2025, she co-chaired the NHS Assembly, helping to bridge policy and patient experience at a national level. Ever the entrepreneur, she co-developed eConsult, now used by around a third of GP practices. She continues to lead the Primary Care Gambling Service and serves as patron of Doctors in Distress. As if all this was not enough, she has been chair and president of the Royal College of General Practitioners, only the second woman to hold both roles.
Before I end, I must mention perhaps the noble Baroness’s most remarkable career high: her stint as a stand-up comedienne in the show that she co-wrote, “Fifty Minutes to Save the NHS”. This should have been a clue to how effective she would be in a time-limited debate on an important subject. The noble Baroness, Lady Gerada, brings not only deep knowledge but wit to this House. I have no doubt that she will make an important and exceptional contribution.
We often file wheelchair and community equipment services under “health” or “social care”. In reality, they ought to be part of our national employment infrastructure. When those services fail, people lose not just mobility but their ability to contribute. The numbers tell the story starkly. Only around 53% of working-age disabled people in the UK are in employment, compared with 82% of non-disabled people. It is even wider for young disabled people, as a recent House of Lords report on the transition to work made clear. Some 1.2 million people rely on a wheelchair and many more rely on other equipment. When these systems fail, we are not talking about just inconvenience but large parts of the labour market losing the tools that make work possible.
For many disabled people, daily life and work depend on reliable access to the right equipment—wheelchairs, seating, mobility aids, home adaptations, assistive tech. When systems slip, when assessments take months and repairs take weeks, the consequences are immediate. Parliamentary inquiries have described these failures as “systemic”, as we have heard. Charities report people stuck at home with unsafe chairs or unable to start new jobs because their equipment simply has not arrived. Services designed to enable independence become gatekeepers to one’s ability to work.
This has an economic cost that we rarely acknowledge. If someone is unable to work purely because essential equipment is delayed or incorrect, the ripple effect hits every public budget. They are less likely to earn, pay tax or progress in their career. They are more likely to draw on welfare and to need avoidable support. Independent assessments show that timely wheelchair provision produces substantial net fiscal benefits over a lifetime. This is not charity. It is investment in people, productivity and public finances.
What can we do? The private sector has a bigger role than it realises. Many employers have disability inclusion strategies, but too often the effort stops at the workplace door. Rarely do companies engage with the upstream systems that determine whether someone can physically get to work or access equipment and the responsiveness of service providers and the basic accessibility of buildings and bathrooms.
Employers can change that. They can partner with local social care services and use procurement to demand guaranteed repair times, loan equipment or minimum quality standards. They can appoint a senior sponsor for end-to-end online accessibility, responsible for everything from recruitment to evacuation plans. They can embed requirements for accessibility and rapid occupational therapy assessments in their HR processes. They can also use their data to track how many dates slip because equipment is not in place, how many job offers fall away and how many days of work are lost to broken or missing equipment. They can work with unions and disabled staff networks to design no-detriment policies when external equipment failures prevent people from working.
Government and commissioners must stop treating equipment services as a marginal welfare line. They are essential economic infrastructure. Outcomes should be judged not just clinically but in terms of employment, education and participation. Services should publish transparent data on waiting times for assessment, delivery and repair, broken down by age, region and employment status. As a minimum we must know how many working-age disabled people are delayed or denied work because of delays to equipment. Access to work should be fully integrated with NHS wheelchair and community equipment pathways. Leaders such as Sara Weller, a non-exec at BT, have long been arguing that disability inclusion must mean more than good intentions. It means designing systems that work from end to end.
This is the core point. Mobility, accessibility and equipment are not optional extras. For many disabled people, they are the foundation that makes employment possible. I learned this the hard way when I was in a wheelchair for a year. However, before my own experience, I learned from another Lane-Fox, who terrorised the halls of this building in her electric wheelchair—my great-aunt, Felicity Lane-Fox. If we are serious about closing the disability employment gap, boosting productivity and unlocking talent, we must put disability equipment services in our growth strategy, not have it marooned on the edge of the health system.