Fracture Liaison Services

My Lords, our 10-year health plan committed to rolling out fracture liaison services nationwide by 2030 and outlines our vision for a more devolved health service. We have cut the number of NHS planning guidance targets from 130 in 2022 to 18 in 2025, and that has given local leaders greater flexibility to adapt and serve local needs. Expectations have been set through the new women’s health strategy that ICBs prioritise community-based models when commissioning new fracture prevention services.

My Lords, I apologise to the Minister for bringing her back yet again to this issue. However, it is now two years since the former Secretary of State said that a national fracture liaison service rollout would be one of the Government’s first actions in office. Two years on, we are still waiting for something—for anything—to happen, and people have died as a result. I have two questions for the Minister. First, does she really believe, in the light of all the evidence she has been given, that it is still possible to achieve universal coverage by 2030? Secondly, if she does, do the Government have funding to make it happen and a timetable and implementation plan which she will publish? If the answer to either of those questions is no, would it not be better to be honest and say that the Government have dropped their commitment?

The noble Lord does not need to apologise for raising this extremely important matter. I am grateful for his campaigning on this, as I am to other noble Lords. There has been a lot of progress. In answer to his first question, I believe that it is possible, not least because all but two ICBs in the new, reconfigured groups have fracture liaison services already, with some having more than one. With respect to his specific request, as with other policies, I cannot give him exactly what he asks for, but I have already referred to some of the Government’s actions. We are looking, through the UK National Screening Committee, at screening women for osteoporosis, and a public consultation is about to start. We are cutting waiting times, and we have expanded community diagnostic centres and DEXA scanners. These, along with a whole range of other measures, show real commitment to tackling the matter that the noble Lord rightly raises, which affects lives and costs lives.

My Lords, people from deprived areas have a 25% higher risk of fractures, spend longer in hospital recovering and die in greater numbers after hip fractures. The rollout of fracture liaison services is important to help tackle health inequalities. The Minister mentioned 2030, but how can this be rolled out faster to make sure that we help all these communities?

We have rolled this out further, as we inherited a more limited coverage of fracture liaison services than we have currently, and we are looking at how to improve access. As I said to the noble Lord, 23 out of 25 ICBs have at least one fracture liaison service. We will push this forward through various means, including the Best Practice Guide for NHS Frailty Pathways, which recommends comprehensive neighbourhood-level frailty plans, and the modern service framework, to mention a couple of ways. I have to emphasise that this is about a complete change in the delivery of NHS services, from which fracture liaison will greatly benefit.

My Lords, I declare an interest as a patron of Day One Trauma Support and as someone with a relatively high knowledge of fractures. How does the Minister expect the new fracture liaison services to embed charities and other organisations on a fully funded basis, as they are vital in working alongside the health service to make sure that rehabilitation goes smoothly and that people from all backgrounds have the best chance of recovery success?

That is absolutely key, as the noble Baroness says. We have to look at the way that we are working. I emphasise again that we are looking at how we can roll out the modern service framework, which will really push this forward. That will involve full consultation with the groups that the noble Baroness rightly mentioned. She spoke about funding. I cannot give specifics without knowing them, but we will be further delivering this already improved service, as well as taking other supportive actions. These include asking local authorities to include menopause in the NHS health check later this year, which will help greatly with earlier identification.

My Lords, the noble Lord asks a very important Question. Can the National Health Service make sure that there is a checklist for all fractures, just as an aircraft pilot does when he is taking off? There are numerous examples in the NHS—I speak from personal experience—of patients not being screened for bacteria before they go down to theatre. That should be a routine check. Further, it is very common for patients to be discharged from hospital when there is a lack of liaison between the hospital and local services. Sometimes, a wound may not be dressed for several days until somebody visits, where there is a risk of bone infection. This is a very serious and common problem.

I understand my noble friend’s point. He referred to checklists. Requirements are in place; I believe he is suggesting that they are not always followed, so I will certainly pick that up. As we move towards a neighbourhood health service, I feel ever more confident that we will attain the right standard of care, along with cutting waiting times. For example, we will make sure that, by 2028-29, for the first time, 80% of community health service activity should take place within 18 weeks. That has not been the case thus far.

My Lords, there seems to be a problem for men suffering from prostate cancer, who are also likely to get osteoporosis. Last week, my noble friend and I heard from a consultant neurologist who said that there is not a joined-up approach going back to primary care. The GP should be aware that these people are more likely to have fractures, but they are quite often having these fractures without having been told that that is a possibility, and they are not then getting the care that they need. We need a bit more joined-up thinking, if that is possible.

I understand that point well and I am grateful to the noble Baroness for raising it with me separately. Similar to my response to my noble friend, I will gladly follow that up.

My noble friend Lord Black specifically asked about fracture liaison services implementation plans, timelines and milestones on progress towards universal coverage in 2030, to which the Government have committed. To double-check, does the Minister agree with the principle that there should be a published implementation plan, and that timelines should be published and annual milestones set?

I am sure noble Lords would welcome that, and I have heard that call in here, but the noble Lord will know that that is not something we do with every single policy; rather, we take the steps to actually make them happen. The commitment and progress are there, and that will continue.

My Lords, unfortunately, at the moment, progress has almost flatlined—I think it will take 38 years to get to the 2030 target. My noble friend said to me on 9 June that the Government have not set milestones. If there are not such milestones as those just referred to, how is the department monitoring this, and will it speed up to reach its own target?

As I have said, delivery will be through ICBs. Of the new clusters, we know that only two do not have fracture liaison services. As my noble friend is very aware, ICBs are held to account through NHS England. Of course, when we make a change through the NHS Bill, that will come within the department. There are many ways we drive progress, including cutting waiting times, opening new community diagnostic centres, investing in DEXA scanners and upping the game on osteoporosis screening, as well as on medication and research. In all these ways, we are contributing to the development of the service that I know my noble friend seeks.