Health: Osteoporosis and Fractures

Lord Black of Brentwood Excerpts

Thursday 14th September 2023 Grand Committee

Asked by

[Lord Black of Brentwood]

To ask His Majesty’s Government what plans they have to improve access to, and quality of, services in England for people with osteoporosis and those at risk of fractures, including Fracture Liaison Services.

[Lord Black of Brentwood (Con)]

My Lords, I note my interest as co-chair of the APPG on osteoporosis. I am incredibly grateful to all colleagues who have stayed late today to take part in this important debate. Osteoporosis is an urgent public health crisis; half of women over 50 and a fifth of men will suffer fractures due to the condition. Osteoporosis weakens bones, so they break after simple everyday occurrences: a cough, a fall, even a hug from grandchildren can be enough to cause a debilitating fracture with often life-changing consequences. I saw this at close hand with my own mother, the last years of whose life were blighted by this cruel disease. It was diagnosed and treated too late, robbing her of her independence and, above all, quality of life because of multiple fractures.

Such fractures are no minor inconvenience; they are the fourth-worst cause of premature death and disability in the UK. As many people die of fracture-related causes as of lung cancer or diabetes. Fractures are also the second-highest driver of bed occupancy in the NHS. Today, they cost the health and social care system £4.6 billion. By 2030, this will edge towards £6 billion as we all live longer. Furthermore, fractures account for 2.62 million sick days annually in the UK, and spinal fractures in particular are a significant cause of older workers exiting the workforce in their 50s and 60s—figures of which the Treasury should take careful note.

But it need not be that way, as osteoporosis is treatable with safe, effective therapies that are highly affordable for the NHS. We do not need a miracle cure; the medicines already exist to halt the progress of the condition. The newest therapy can even rebuild bones. The stark problem is simply that we are overlooking 90,000 people every year who desperately need these drugs, because we are falling behind the rest of the world on modern diagnostics. The key to all of this is fracture liaison services—or FLS—which are the world standard for diagnosing osteoporosis early, straight after the first break, so that life-changing spine and hip fractures can be prevented.

In our 2021 inquiry, the APPG found that FLS have an unrivalled record in identifying people who need treatment. That is up to 95% of at-risk patients in a local population being put on a treatment plan and monitored so that they stay on their medication. Yet, incredibly, only half of NHS trusts in England have them. In areas without FLS, people are fixed up in A&E and forgotten about. They have their first break mended, but no one assesses them for osteoporosis and the disease is left to continue its deadly path. These are the people who present later with devastating hip and spinal fractures.

That is why 88 Members of this House have endorsed the better bones campaign that has run for the last two months in the Sunday Express. Week by week, in partnership with the Royal Osteoporosis Society, the paper has been setting out the enormous opportunities FLS can deliver. I take this opportunity to thank the Sunday Express and praise it for its fantastic coverage. The campaign calls for all areas to have quality FLS, for the provision of a very modest amount of funding to set them up and for a new national specialty adviser in the NHS to drive the step change we need. The level of support for the campaign has been staggering, demonstrating the public, professional and political demand for FLS. As noble Lords know, it is rare that such a wide coalition comes together in full and passionate agreement.

Already, 240 parliamentarians across the UK have backed the campaign, along with seven royal medical colleges. Their president spoke powerfully as part of the campaign on the role FLS can play in reducing waiting lists, freeing up operating theatres and releasing terrible pressure on A&E. The representative bodies for care home providers and ambulance workers have joined the call, along with 42 other charities and organisations, and business leaders and trade unions have joined forces because they know that FLS can help keep people in work.

The stark truth is that 31,000 hip fractures can be prevented over the next five years if we make FLS universal and high quality. We would stop treating the symptoms and prevent the damage in the first place. Today, we are spending money the wrong way around, managing the costs of failure rather than preventing harm in the first place. To coin a phrase, that is voodoo economics. Hip fractures are the most costly fragility fractures to treat: the average length of stay in hospital is three weeks, and a million acute hospital bed days are taken up by patients every year. Yet half the people with a hip fracture have suffered a previous fracture, which could have flagged them as being at risk and led to prevention. But, of course, they needed an FLS to do the flagging.

That can all change. If we front-end just 1.5% of our current spend on fixing hip fractures into setting up an FLS in every area, we can prevent a tenth of hip fractures happening. That is 31,000 people’s lives changed for the better, around 8,000 of whom would otherwise have died shortly after injury. Ending the postcode lottery for FLS would cost just £27 million per year in additional funding but have a total benefit of £440 million over five years. FLS, which break even in just 18 to 24 months—another point that the Treasury should note—deliver return on investment of roughly £3.26 for every pound invested. Is £27 million not just a rounding error in the grand scheme of NHS budgets compared with the £4.6 billion cost of unprevented fractures today?

For the population, the benefits of FLS would be vast, with 74,000 fractures prevented by 2028. It would also release 750,000 hospital bed days, which must be worth doing. If the Prime Minister wants to meet his pledge to reduce hospital waiting lists, this would be an easy win. In fact, I doubt he can do so without it. It would be a win for patients and their families, who have to care for so many of those suffering, for the hard-pressed NHS and for the taxpayer.

I know that the Government support the FLS model: NHS England has signalled to integrated care boards that they are a good thing. But there is nothing holding ICBs and trusts accountable for their delivery. That is why we are flatlining. The hard power of NHS England KPIs in 63 other areas is crowding out fracture prevention. Why would a commissioner spend £1 on something that the Government say may be a good idea when that pound is pulled away from 63 other areas in which they are publicly held accountable by NHS England and Ministers? These stubborn factors have led to fracture prevention flatlining since the APPG—I am pleased to see so many members of it here—published its report in 2021. There has not been a single percentage point of improvement: 90,000 people are missing out, which is 90,000 lives at risk.

The current approach has failed, and we need a step change in leadership from Ministers. A very modest, simple policy change, backed by limited investment, can deliver huge savings for the NHS and a significant boost for economic productivity among people in their 50s and 60s. We all want to see this, and it is of real importance to the Government. It can be a real demonstration that they are committed to the prevention elements of the long-term plan. That is vital. As our population continues to live longer, which is fantastic, broken bones caused by osteoporosis are a demographic time bomb. Without urgent action, a longer life will not be a better life.

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.