Health: Osteoporosis and Fractures

Lord Allan of Hallam Excerpts

Thursday 14th September 2023 Grand Committee

[Lord Allan of Hallam (LD)]

My Lords, I am grateful to the noble Lord, Lord Black of Brentwood, for securing the debate and to the Royal Osteoporosis Society for meeting me recently.

In the short time available, I shall focus on an aspect that many speakers have already raised: fracture liaison services. I was struck by looking at the Royal College of Physicians database of fracture liaison services, which has a map showing vividly just how variable the provision is across England. We have a protocol that we know both improves patient outcomes and is ultimately less expensive for the NHS, as the noble Lord, Lord Black, and the noble Baroness, Lady Hayter, have pointed out to us, and we have it working well in some areas—the noble Lord, Lord Shinkwin, has just given us an example of places where it is—but we do not seeing it rolling out everywhere in a timely way.

I wonder how the Minister feels about those areas of England where it is not rolling out. Is he disappointed, frustrated, irritated or all of the above? We should be frustrated, irritated and disappointed that people in England are not getting the service that will mean that they have fewer negative health outcomes and that we will all save on the NHS budget as they get cheaper care, rather than more expensive care further down the track.

I turn to the potential fixes, and we have discussed some of those today. How long will it be before the department intervenes more directly? I hope the Minister can talk about the kind of interventions that it is thinking of. My understanding is that the provision of a fracture liaison service is relatively straightforward in health terms. It requires trained nurses, administrators, access to systems and some tools, such as the scanners that the noble Lord, Lord Bilimoria, referred to, but these are not at the cutting edge or at least the most expensive end of what is needed in the health service, so it is certainly achievable.

Building on the point made by the noble Baroness, Lady Chisholm, about a national specialist leader, that seems to be essential. I would perhaps be even more aggressive: there needs to be someone whose responsibility is to get us from 51% to 100%. All they should think about when they wake up in the morning is, “How do I get to 100% coverage of fracture liaison services?” They should praise the best and make the worst feel very uncomfortable for not doing their job. They should help to build business cases for ICBs that, for whatever reason, have not built their own business case, to demonstrate to them how they would be stupid not to do so—and, if the ICBs still do not do it, make sure that everyone knows they are not doing it, because the evidence is there. They should look at creative ways to unblock any barriers and quite simply not accept no for an answer.

I hope the Minister can say that the department is thinking creatively about how it can put that kind of structure in place, where incentives exist to get from 51% to 100% in the shortest time possible.