Fracture Liaison Services

Lord Black of Brentwood Excerpts

Thursday 16th October 2025 Grand Committee

Asked by

[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.