Fracture Liaison Services

Lord Black of Brentwood Excerpts

Wednesday 4th December 2024 Lords Chamber

Asked by

[Lord Black of Brentwood]

To ask His Majesty’s Government what progress they are making towards universal provision of fracture liaison services in England by 2030.

[Lord Black of Brentwood (Con)]

My Lords, it is a privilege to introduce this important debate, in which I declare an interest as co-chair of the All-Party Parliamentary Group on Osteoporosis and Bone Health. I am very grateful to all those taking part. I hope that, together, we will again demonstrate the strength of feeling on this issue across all parties in the House, and our determination to ensure action. It is a particular pleasure to welcome the noble Baroness, Lady Merron, to her place for her first debate on osteoporosis as Health Minister. She has always been immensely supportive on this issue, and I know how seriously she takes it. Her leadership will be crucial in advancing the cause of fracture prevention in the days ahead, and I look forward to hearing what she has to say.

Fractures caused by osteoporosis are one of the greatest threats to people living well in later life, affecting half of women and a fifth of men over 50. They are the fourth most-harmful health condition, measured by disability and premature death. They have a profound impact on those who suffer from this debilitating condition —as I saw in the case of my own mother, whose later years were blighted by it—and on those who care for them. Yet—this is perhaps the most upsetting aspect of this debate—they are entirely preventable with safe and affordable therapies.

Fractures impose devastating costs on people and the health service. The hospital episode statistics show that hip and other fractures are second and fourth on the list for total bed days lost to unplanned admissions to hospitals. Most of these patients are, on further investigation, found to have osteoporosis. Hip fractures alone cost the NHS £2 billion annually and are “heart attack-level” events that burden hospitals and our desperately overstretched social care system.

However, it need not be that way. Half of these patients had a previous fracture that could and should have flagged them as being at risk. That is where fracture liaison services—FLS—come in and why the Government’s commitment, made during the election, to making them universal was so welcome. The Secretary of State for Health and Social Care told the Daily Mail, which, alongside the Sunday Express, has been a steadfast campaigner for universal FLS—I pay tribute to them—that one of his first acts in government would be to task NHS England with developing a rollout plan so that every part of the country could access these vital services. I commend his leadership and vision.

As I said, the Minister has also been a determined campaigner. I recall her urging my noble friend Lord Kamall—whom I am delighted to see taking part this evening and who has also been extremely supportive —to acknowledge back in 2021 that two-thirds of people were not receiving the treatment they needed for osteoporosis. Three years on, that figure remains tragically unchanged. The postcode lottery for FLS means that 90,000 people are still missing out on urgently needed bone medications.

In 2021, we also learned through a freedom of information request that only half of NHS trusts in England had a fracture liaison service in place. Yet again, almost nothing has changed since. Progress should be so easy, but the truth is that we are stagnating and, in the case of broken hips, that inaction costs lives. Earlier this year, the noble Baroness who is now the Minister from the other side of the Chamber asked my noble friend Lord Markham when would the Government’s

“promise to establish more fracture liaison services actually be delivered?”.—[Official Report, 5/2/24; col. 1443.]

We need to ask that again today, because time is running out. Fracture liaison services are the proven solution to the public health crisis of preventable fractures, offering a perfect fit with the Government’s laudable focus on moving from sickness to prevention and on getting people back into work.

FLS are the world standard in this area. They ensure that, after a person suffers their first fracture, they are assessed for osteoporosis, put on treatment and helped to stay on it. That prevents this horrible disease progressing and reduces significantly the chance of further broken bones. In areas without an FLS, the story is different. Many patients who suffer their first fracture are fixed up in A&E and then forgotten about. No assessment for osteoporosis is carried out and no anti-osteoporosis medication is prescribed. Far too many therefore end up back in hospital with multiple, more severe fractures. Over a quarter of hip fracture patients die within 12 months. That is a human tragedy.

FLS are perhaps the most powerful example that we have of preventive healthcare, which is why the Government’s commitment to rolling it out to every trust by 2030 is so critical. There is strong consensus in this House that this is the right thing to do. The Government support it, the Opposition support it and the Liberal Democrats support it. I can recall few other subjects where all parties are so united. So, in the interests of patients, the NHS, the taxpayer and the wider economy, let us get on with it, and fast. While 2030 may seem far away, the scale of work required to deliver universal FLS is substantial. We cannot afford to let this critical deadline creep up on us.

The Royal Osteoporosis Society’s data, scrutinised by Department of Health and Social Care officials, shows that universal coverage would save 750,000 hospital bed days in just five years, prevent 74,000 fractures and save almost 9,000 lives—that is 9,000 people who are someone’s mother or grandma, husband or dad. The ROS, whose campaigning work on this issue has been exemplary, has identified six integrated care boards ready to go. They are like horses at the starting gate: eager, ready and waiting for the Minister and her colleagues to fire that starting gun. If we do that now, we can just about bring those ICBs online by April. The ROS has proposed following this with 12 more ICBs in 2026, 2027, and 2028 respectively.

This proposal is a practical and cost-effective road map to real change. If those ICBs come online as planned, by 2029, FLS will save over 300,000 hospital bed days—that is 60,000 extra elective surgeries that the NHS can deliver by the next election. Further delay is not acceptable; if those first six ICBs do not start until 2026, by 2029 FLS in England will save only half the bed days—that means 30,000 fewer surgeries. Push it back two years and the benefits get pushed back even further into the future, with more preventable fractures, more lives lost, and more pressure on the overstretched NHS.

Many health initiatives take a decade to pay off, but the department has seen the comprehensive analysis which shows that these services break even within 18 to 24 months. All that is needed is a modest pump- priming fund to cover the first two years. Then, after break-even point, the cost savings can keep them sustainable within local budgets. I understand that the former Secretary of State, Victoria Atkins, identified funds within her budget for this very purpose as part of the major conditions review before the general election. Releasing this funding now would kick-start the rollout of FLS.

While the human cost of fractures will always be the most compelling reason to act, we cannot ignore the need to help older workers stay in the labour market, an important aspect of public policy. Independent analysis shatters the stereotype that people with osteoporosis are all retired, and lays bare the cost of inaction to our economy. Each year, osteoporotic fractures in working-age adults lead to over 1.5 million work days lost due to sick leave and carer absences, costing employers £130 million annually. The OBR has identified musculoskeletal conditions, a definition that includes osteoporosis, as the second greatest driver of long-term sickness. This has to change.

When we last debated this subject in September 2023, I ended with these words:

“This is a big strategic challenge for the whole of our society. Bold, visionary leadership from the Government could change the terms of the game, improving the lives of tens of thousands, relieving pressure on our beloved NHS and saving money for the taxpayer. We have such a huge opportunity here to save and change lives. I implore the Government to take that opportunity”.—[Official Report, 14/9/23; col. GC 232.]


I make no apology for repeating those exact same words, with a new Government and a new chapter opening in the history of the NHS. Let us give people with osteoporosis back their lives and the future they deserve, and let us start now. Again, I implore the Government to act, and I beg to move.

HIV Care: Access

Lord Black of Brentwood Excerpts

Wednesday 11th September 2024 Lords Chamber

Asked by

[Lord Black of Brentwood]

To ask His Majesty’s Government what estimate they have made of the number of people with diagnosed HIV in England who are not accessing HIV care.

[Lord Black of Brentwood (Con)]

My Lords, I beg leave to ask the Question standing in my name on the Order Paper and declare my interest as a patron of the Terrence Higgins Trust.

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

My Lords, in 2022 England exceeded the joint United Nations programme on HIV and AIDS targets, with 98% of people diagnosed with HIV receiving treatment. The UK Health Security Agency estimates that between 6% and 15% of people living with diagnosed HIV in England did not access HIV care that year. Re-engaging people into HIV care is a priority for the current HIV plan for England and for the new plan that is in development.

[Lord Black of Brentwood (Con)]

My Lords, we know from the opt-out testing programme in A&Es introduced by the last Government that up to 15,000 people in England who are aware that they have HIV are not accessing life-saving care, with devastating personal consequences for them and profound ramifications for public health, because if you are not on medication, you can pass on the virus. Is the Minister aware of the case of a 45 year-old man, out of care for several years, who went to hospital with a headache and was found to have a CD4 count of just four. He was diagnosed with cryptococcal meningitis, an AIDS-related illness. He went blind and died three months later, one of a growing number of tragic preventable deaths. Can the Minister ensure that we get an HIV action plan as soon as possible and that this issue—with funding, if necessary—will be a key part of it, to ensure that we get those lost to care back into it?

[Baroness Merron (Lab)]

My Lords, Ministers have already commissioned officials for advice on how to progress the development of a new HIV action plan. On the very tragic case that the noble Lord refers to, he will be aware that since April 2022, NHS England has funded emergency departments in London, and in areas of very high diagnosed HIV prevalence, to provide routine blood-borne virus testing for HIV as well as for hepatitis B and hepatitis C in everyone aged over 16. That attention at the point of contact is crucial in this area.