My Lords, Amendment 50 is supported by the noble Lords, Lord Hunt of Kings Heath and Lord Rennard, and the noble Baroness, Lady Masham, underlining the cross-party interest in and support for this vital issue. I am grateful to them. I note my interest as co-chairman of the APPG on Osteoporosis and Bone Health. I also support Amendment 101B in this group, on mental health, and much look forward to the debate on the other amendments.
Amendment 50 is, at heart, about equality of access to services for people with osteoporosis. If accepted, it would end the current appalling postcode lottery which means that so many people are suffering unnecessarily from the pain and distress of avoidable broken bones. It will do this by making the provision of fracture liaison services—FLS—one of the core services that an integrated care board must consider for the people for whom it has responsibility, alongside dental and ophthalmic services and others.
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I will give noble Lords a little background. We are fortunate to live in a country where each generation has lived longer than the last, but that brings with it many issues about how people can achieve a good quality of life in their later years. One of the biggest issues is broken bones. The uneven patchwork of fracture liaison services across England and Wales means that every year around 90,000 people with a new fracture who should have treatment are not being treated with the bone strengthening medication they need, so problems which need not become acute are routinely left to escalate, with numerous missed opportunities for prevention.
The lack of equitable access to fracture prevention services has led to entrenched health inequalities. People who live just the wrong side of a catchment line are being left to suffer life-changing spinal and hip fractures that with modest investment and better planning could have been avoided. These people are falling through the cracks in the system every day, and they are at the heart of the amendment.
Some 3.5 million people in the UK have osteoporosis and a fracture is, sadly, often the first sign of their condition. If the fracture is picked up and the underlying osteoporosis treated, further fractures can be prevented. Fracture prevention is therefore clearly beneficial to the patient, but also cost effective to the NHS. Fragility fractures caused by osteoporosis currently cost the NHS a staggering £4.5 billion each year, yet for every £1 spent on FLS the taxpayer can expect £3.28 back. Currently, however, access to an FLS to identify people at increased risk of fragility fractures and prevent future fractures is a postcode lottery in England and Wales. People will often have several fractures and no treatment before underlying osteoporosis is identified. There can be no excuse for that.
Secondary prevention is a well-established concept in clinical practice and should be at the heart of the work of the integrated care boards. After a heart attack, for instance, emergency treatment can be life-saving but it is the package of rehabilitation and treatment that supports a full recovery and reduces the chances of a further heart attack. Similarly, orthopaedic treatment to fix the fracture is essential for the 1,300 people who break a bone every day in the UK.
For people with underlying osteoporosis, a seamless package of identification, assessment and treatment is critical to support a full recovery and reduce the chance of further fractures. Without this, their risk of fracture remains high. This is exactly what a fracture liaison service is designed to provide and why this amendment is so important. An FLS identifies and treats people aged 50 or over who have had a fragility fracture, to reduce their risk of further fractures. The FLS model is an evidence-based, cost-effective, preventive intervention that can help to improve the health of the population and reduce health and care service demand.
The APPG on Osteoporosis and Bone Health launched an inquiry into FLS provision in March 2021 to understand the scale of the problem, the factors behind it, and what is required to ensure that everyone who breaks a bone due to osteoporosis receives the best care. The inquiry learned how in England only 51% of NHS trusts provide a fracture liaison service, while both Scotland and Northern Ireland provide 100% coverage. The inquiry’s report made a number of recommendations for government and policymakers on how to drive up both quality and access to FLS, the key one being a government commitment to ensure that all patients have equitable access to a quality-assured FLS, thereby delivering on the mantra that the first fracture should be the last fracture. Amendment 50 would achieve that aspiration.
The impact of osteoporosis on individuals can be devastating. Fragility fractures can lead to the loss of independence, mobility and the capacity to carry out
everyday tasks. The Royal Osteoporosis Society conducted a survey last year of over 3,000 people living with the condition. Three in five respondents said that their osteoporosis affected them physically; 55% had suffered height loss or change in body shape; 22% had digestive difficulties; 19% experienced breathlessness; and 10% experienced incontinence. Many people expressed anger, frustration, resentment and sadness about the activities that they could no longer do. Fragility fractures can cause pain, both acute at the time of fracture and in the longer term. The survey found that more than one in four people experienced long-term pain; of these, one in three said that their pain was either severe or unbearable.
A fragility fracture is a red flag that predicts further fractures. This is particularly the case with vertebral fractures, which are powerful predictors of future vertebral, hip and other fractures. Without identification and treatment, a person with a vertebral fracture is nearly three times more likely to have a hip fracture, and five times more likely to have another vertebral fracture.
Hip fractures are the costliest fractures to treat. The average length of stay in hospital is 20 days. Hip fractures account for about £2 billion of the £4.5 billion cost of fragility fractures per annum to the NHS. When we consider that 50% of people with a hip fracture have broken a bone in the past, it is clear that investment in secondary fracture prevention makes both clinical and financial sense. I also point out that, tragically, around one in four of those who fracture their hip will die within a year of doing so.
The current variation in services and outcomes for those with osteoporosis is sobering but the amendment underlines how straightforward the process of change can be. There is no need for any discovery phase for new solutions: the British-born fracture liaison service model has been shown the world over to be a game-changer for dramatically reducing the risk of further fractures. But a repeated theme has been the doggedness among a few individuals it takes to get an FLS set up. This is where the leadership role of government—I say to my noble friend—can transform the picture through clear strategic direction. This amendment would drive 100% population coverage of FLS, ending the postcode lottery. This is what this Bill should be all about.
If we get this right, we can disrupt the pathway from first fracture through to devastating hip fracture, preserving people’s independence and making Britain a safer place in which to grow old. I hope that this amendment will find support on all sides of the Committee and, indeed, from the Government. I beg to move.