NHS: Fracture Liaison Services

Debate between Lord Black of Brentwood and Lord Markham

Monday 5th February 2024 Lords Chamber

[Lord Black of Brentwood (Con)]

My Lords, I beg leave to ask the Question standing in my name on the Order Paper, and I declare my interest as co-chairman of the APPG on Osteoporosis.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Markham) (Con)]

The Government recognise the value of the quality-assured secondary fracture prevention services, including the fracture liaison services, or FLS. More than 500,000 fragility fractures occur annually in the UK, and up to 40% of fracture patients will suffer from another. FLS are commissioned by integrated care boards, which are well placed to make decisions according to local need. The Major Conditions Strategy: A Case for Change and Strategic Framework outlines that, with NHS England, we will explore supporting the additional provision of FLS.

[Lord Black of Brentwood (Con)]

My Lords, I thank my noble friend for that Answer, but all we ever seem to get are warm words and then broken promises. We were promised money for FLS in the elective recovery plan by the Chancellor himself, with announcements on FLS before the end of last year. A package of measures was promised in the Autumn Statement, as well as a national specialty adviser on osteoporosis. None of those promises has been kept.

To go back to basics, can my noble friend tell me whether he accepts that the 90,000 people who need anti-osteoporosis medication are missing out on it because of no access to FLS; that universal coverage of FLS in England could prevent 31,000 hip fractures over five years; and that investment in FLS would pay for itself in just 18 months? If he does accept those points, can he tell us why on earth these promises have not been honoured, and why the needless suffering of tens of thousands of people has not been brought to an end? When will words finally become deeds?

[Lord Markham (Con)]

First, I thank my noble friend for his tireless campaigning in this space. I agree that there is a very good case to be made. Many of us will know the advantage of the fracture liaison services. A lot of studies show that you are at least 10% less likely to suffer from another fracture, so it is a vital part of the prevention programme. There is a very strong case behind it, and my noble friend can rest assured that it is something that we are really looking to progress.

Sexually Transmitted Infections

Debate between Lord Black of Brentwood and Lord Markham

Tuesday 5th December 2023 Lords Chamber

[Lord Black of Brentwood (Con)]

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

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Markham) (Con)]

We remain committed to improving sexual health in England. The UK Health Security Agency conducts comprehensive surveillance of sexually transmitted infections and supports local areas to use this data to inform sexual health services delivery. We are working with it and other key delivery stakeholders to explore options for the best use of both existing and innovative preventive interventions, as well as strengthening messages to the public on how to reduce the transmission of STIs.

[Lord Black of Brentwood (Con)]

My Lords, PrEP has been a game-changer in the fight against HIV, and making sure that as many people at risk of infection as possible have access to it is fundamental to meeting the target of ending new HIV cases by 2030, but at the moment we are failing to ensure that access because of the immense pressure on sexual health services. Nearly 60% of people are forced to wait more than three months to access PrEP through that route. Does my noble friend agree that one way to deal with this problem is to make PrEP available through pharmacists, as contraception now is—an initiative backed by the Royal Pharmaceutical Society—and does he recognise that such a policy, in line with the ambition of Pharmacy First, would not just relieve pressure on sexual health services but encourage uptake among women, who make up 31% of people accessing HIV care but represent only 2% of PrEP users?

[Lord Markham (Con)]

I thank my noble friend for all the work he does in this space and absolutely agree that we are world leaders in the use of PrEP. We have 86,000 people currently using it. It is a key prevention tool and something that we want to expand as widely as possible. There is an excellent pilot happening in Brighton at the moment, where you can get PrEP online, and I absolutely agree that we should look at Pharmacy First as a way to expand that even further.

National Health Service: Major Conditions Strategy

Debate between Lord Black of Brentwood and Lord Markham

Monday 18th September 2023 Lords Chamber

[Lord Markham (Con)]

AI is a key point. Take stroke, which is one of these conditions. I saw a very good example in the Royal Berkshire the other day of what we all know as the golden hour, and the results from it. The Royal Berkshire has AI scans that go straight to the responsible physician, who can say straightaway whether a thrombectomy, for instance, is needed, the timing of which is critical. That is now being used in that cluster of hospitals and will be one of the six key technologies, the roll out of which we will encourage across the board to others.

[Lord Black of Brentwood (Con)]

My Lords, osteoporosis must surely be included in the major conditions strategy, as fractures are the fourth-worst cause of premature death and disability in the UK, with as many people dying of fracture-related causes as lung cancer and diabetes. Does my noble friend agree that the inclusion of osteoporosis in the strategy would need to be backed up by investment in fracture liaison services to make it effective? Would not a two-year transformation budget of just £54 million to pump-prime universal coverage of FLS in England, which would quickly pay for itself, be a game-changer for patients, the NHS and the taxpayer?

[Lord Markham (Con)]

I thank my noble friend. I think that is covered by musculoskeletal conditions, which is one of the six major conditions we are looking at. Key to pathways is moving treatment away from individual silos to patient-based treatment that looks across the board. We know that 55 year-olds have, on average, at least one condition, and that 80% of those over 85 will have one, two or three of these conditions. We need to ensure that we look at this across the board, rather than in silos.

Osteoporosis: Early Detection

Debate between Lord Black of Brentwood and Lord Markham

Thursday 19th January 2023 Lords Chamber

[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 co-chairman of the APPG on Osteoporosis and Bone Health.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Markham) (Con)]

The Government are committed to improving outcomes for those living with osteoporosis. NHS England, through its Getting It Right First Time programme, is exploring how best to support integrated care systems in the detection and management of osteoporosis. This includes a focus on improving provision of and equity of access to high-quality secondary fracture prevention services, such as fracture liaison services that help to identify those most at risk and offer preventive support.

[Lord Black of Brentwood (Con)]

My Lords, osteoporosis affects half of women and a fifth of men over the age of 50, but all too frequently its late diagnosis means broken bones, pain, reduced independence and, sometimes, life-changing disability. Yet there is no excuse for that, because we have it in our power to identify those most at risk. Is my noble friend aware that almost two-thirds of people with one of three major risk factors have never received a bone health assessment, while a simple and cheap assessment tool proven to prevent hip fractures can be used in five minutes in a GP’s surgery? As the costs of helping people recover from fractures are far higher than the costs of identifying and treating those at risk, should the National Screening Committee not urgently reconsider the case for a targeted national screening programme, so that as a country we invest just millions of pounds in preventing harm rather than billions in managing failure?

[Lord Markham (Con)]

I agree with my noble friend that prevention is always better than cure. The beauty of these processes is that I get to swot up, and I learned that the second largest bed-intake cause is actually a fractured femur from osteoporosis, so he is correct. We have a target that 95% of patients will get a check within six weeks by March 2025. It is good that musculoskeletal services are now part of the national improvement programme, but we clearly need to make sure we are on top of that.

Health: Pancreatic Cancer

Debate between Lord Black of Brentwood and Lord Markham

Monday 21st November 2022 Lords Chamber

[Lord Black of Brentwood]

To ask His Majesty’s Government what steps they are taking to improve survival rates for pancreatic cancer.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Markham) (Con)]

Improving early diagnosis is incredibly important to help boost cancer survival, and the Government are committed to the NHS Long Term Plan ambition of diagnosing 75% of cancers at stage 1 or 2 by 2028. Pancreatic cancer is difficult to diagnose due its unspecific symptoms. To help diagnose these cancers, we have opened 91 community diagnostic centres and 96 non-specific symptoms pathways which are transforming the way those with symptoms not specific to one cancer are diagnosed.

[Lord Black of Brentwood (Con)]

My Lords, this is Pancreatic Cancer Awareness Month, a time to remember those who have died prematurely of this cruel and unforgiving disease, but also a time angrily to reflect on the shocking statistics that surround this least-survivable and quickest-killing cancer: three in five pancreatic cancers are diagnosed at a late stage—worse than any other cancer; half of those diagnosed die within three months—worse than any other cancer; almost 60% of people are diagnosed in A&E—worse than any other cancer. These statistics are shameful. Would my noble friend tell us what has happened to the 10-year cancer plan, which is so vital in this area, and commit to a strategy within it to ensure early diagnosis of pancreatic cancer patients within 21 days of presenting with symptoms? Will he explain why there is so little investment in research in this area—just 3% of the total UK cancer research budget—when we vitally need a test to stop this horrible disease in its tracks?

[Lord Markham (Con)]

My noble friend is correct: pancreatic is probably one of the cruellest of cancers. We have a 10-year cancer plan; to answer his question, we are going through 5,000 responses, and we are analysing them and will report back shortly. On research, we are performing over 70 different pancreatic cancer studies. Key to all of this is not just early diagnosis; more important than ever, in this awareness month, is making sure that people are aware and go to their doctors early if they have any concerns at all.