Royal Osteoporosis Society discussion in the House of Lords today

Peers discussed Fracture Liaison Services (FLSs) and the work of the Royal Osteoporosis Society (ROS) in the House of Lords today. 

Lord Guy Black began the exchange with a question to the Health Minister, Lord Bethell, about inequalities in provision of FLSs across the country – 61% in England compared to 100% in Scotland and Northern Ireland. 

Lord Black noted that one in five women who sustain a fracture have to break three or more bones before being diagnosed, and that less than half of women who sustain a hip fracture after the age of 50 receive treatment for osteoporosis the following year.

The Minister, Lord Bethell, responded by re-committing the Government to the achievement of 100% FLS coverage across the country – a campaign objective of the ROS.

Eight other Peers spoke in the exchange, raising a number of important themes for people living with osteoporosis, including: the importance of Vitamin D for prevention, the effects of lockdown in increasing the risks of fractures, the role of research conducted by the ROS’s Osteoporosis and Bone Research Academy, and the importance of timely GP referrals and scans.

Craig Jones, Chief Executive of the Royal Osteoporosis Society said: “We’re very pleased to see such unanimous sentiment in the House of Lords today about the effectiveness of Fracture Liaison Services (FLSs) and the avoidance of postcode lotteries for treatment.  The Peers and the Minister spoke powerfully of the need to keep osteoporosis high on the agenda of the NHS, particularly given inequalities in treatment and the effect on quality of life.

"We’re very grateful to the Minister for agreeing to meet with the Royal Osteoporosis Society.  We look forward to sharing our recommendations for how to achieve a step change in support for the 3.5m people living with osteoporosis”.

The ROS will act as Secretariat for the All Party Parliamentary Group on Osteoporosis, which will be relaunched over the coming weeks.

A link to the exchange in the Lords can be found here starting at 12.29 and the full transcript can be found below.

Transcript

Osteoporosis: Treatment

Question 12:29:00 Asked by

Lord Black of Brentwood
To ask Her Majesty’s Government what plans they have to ensure that people with osteoporosis have (1) equitable, and (2) timely, access to treatment.

The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Bethell) (Con)
My Lords, to reduce variation in osteoporosis services, NHS RightCare has published the pathway for falls and fragility fractures, which advises local commissioners on optimising osteoporosis services. The Government have also provided an extra £1 billion to fund elective recovery in 2021-22. Patients can also use the resources of the Royal Osteoporosis Society.

Lord Black of Brentwood (Con) [V]
My Lords, broken bones seriously impact on the lives of the elderly, causing significant ill health and premature death. Many arise unnecessarily as a result of undiagnosed or inadequately treated osteoporosis. Is my noble friend aware that one in five women who sustain a fracture have to break three or more bones before diagnosis and that fewer than half of women sustaining a hip fracture after the age of 50 receive treatment for osteoporosis the following year? As these are unacceptable figures, with huge costs to the NHS, what action will the Government take to ensure that patients are identified, treated and managed effectively in primary care, including proper access to fracture liaison services?

Lord Bethell (Con)
My noble friend is prescient to raise this issue on a day like today, which is slippy and dangerous for those who may take a fall. He is entirely right that the early diagnosis and treatment of osteoporosis are critical for those suffering bone fractures as well as for the system as a whole. The fracture liaison service can play a key role in reducing the risk of fractures in patients and to this end it has been promoted and recognised as best practice by NHS England. As part of the falls and fragility fracture audit programme the fracture liaison service database measures participation and standards in fracture liaison services.

The Lord Speaker (Lord Fowler)
Baroness Chisholm of Owlpen. No? I call the noble Baroness, Lady Bull.

Baroness Bull (CB)
My Lords, the Minister has rightly pointed to fracture liaison services and the vital role they play, but only half of the population in England currently has access to an FLS, compared to 100% in Scotland and Northern Ireland. Is the Minister aware of the recent economic analysis that suggested that upscaling provision to cover all over-50s in the UK could prevent an estimated 5,686 fragility fractures every year, with net cost savings of £1.2 million? Will the Government commit to 100% coverage for fracture liaison services and if not, why not?

Lord Bethell (Con)
The noble Baroness is entirely right. There is significant regional variation in the rates of fragility fractures within the older population with the lowest incidence observed in London, the east of England and the south-east and the highest in the south-west of England, Northern Ireland and Scotland. To reduce variation in osteoporosis services in 2017, NHS England’s RightCare programme published cases studies and pathways for the management of osteoporosis and fragility fractures. The noble Baroness is right that we should have high aspirations in this matter. I am not sure that I can commit to 100%, but I will return to the department and see if we could be doing more.

Baroness Quin (Lab) [V]
My Lords, I do not have a specific interest to declare, but I have been a member of the All-Party Parliamentary Osteoporosis Group and fully support the Royal Osteoporosis Society. Will the Government commit themselves to some kind of timetable for the achievement of a comprehensive system such as exists in Scotland and Northern Ireland? Will they meet the Royal Osteoporosis Society and interested parliamentarians to discuss the specific issue of delays in access to treatment which have understandably emerged during the current Covid crisis?

Lord Bethell (Con)
My Lords, the noble Baroness is right to press me for a timetable but, unfortunately, that is not something I can commit to from the Dispatch Box today. However, I would appreciate the opportunity to meet the Royal Osteoporosis Society and will put an appointment in the diary for as soon as possible.

Baroness Bowles of Berkhamsted (LD) [V]
My Lords, given the high incidence of osteoporosis in women aged over 50, of whom 50% are affected, and low levels of vitamin D in the population, what plans are there to help increase the consumption of vitamin D, which helps prevent osteoporosis? Is the mandatory nutritional fortification of some foods under consideration?

Lord Bethell (Con)
My Lords, the CMO has recently issued new guidance on the consumption of vitamin D and there has been widespread discussion about its dosage level. My understanding is that we are leaving the matter at that for the moment. I am not aware that the mandatory application of vitamin D to food is on the runway at the moment, but I am happy to check that point and write to the noble Baroness.

Baroness Wheeler (Lab)
My Lords, your Lordships’ House recently discussed the importance of medical research and government financial support for the fundraising and work of key charities on new brain tumour research treatments. With an estimated 3.5 million people aged over 50 currently affected by osteoporosis, many suffering chronic pain and disability, research on this is also vital. What resources does the NHS currently spend on osteoporosis research? Will the Minister undertake to consider the financial support, including match funding, that the Government can provide to the Royal Osteoporosis Society’s newly launched research academy and its potentially game-changing road map, which charts the key steps for researching a cure for this extremely debilitating disease?

Lord Bethell (Con)
My Lords, I do not have the figures for the precise amount that the Government spend on osteoporosis research at the moment, but I am happy to write to the noble Baroness with them if they are available. We are enormously grateful to the Royal Osteoporosis Society for its contribution to medical research. I can confirm that it has received a grant of £258,000 to support important work providing support for the vulnerable during the pandemic. That comes out of the package of £750 million that the Chancellor of the Exchequer announced to support the charity and voluntary sector during the Covid pandemic.

Lord Brownlow of Shurlock Row (Con) [V]
My Lords, I take this opportunity to congratulate my noble friend the Minister and thank him for his dedication at the Dispatch Box over the past 11 months. I declare my interest as a patron of the Royal Osteoporosis Society. Further to the comments of the noble Baroness, Lady Bull, is my noble friend aware that only 55% of the population in England have access to fracture liaison services, which have been shown to diagnose people with osteoporosis faster and move them on to treatment quicker? What plans do Her Majesty’s Government have to improve this and make access to fracture liaison services more available?

Lord Bethell (Con)
My Lords, the Royal Osteoporosis Society estimates that there are 95 fracture liaison services across England and Wales. While it is true that many cover more than one hospital, it should be remembered that they are non-specialist services and therefore CCGs are able to refer patients to fracture liaison services beyond their area. As I mentioned, we have a RightCare programme publishing case studies and pathways to encourage the greater rollout of best practice, but we are conscious that gaps remain and are working hard to close them as soon as possible.

Baroness Stuart of Edgbaston (Non-Afl)
My Lords, if the Minister were to go to Birmingham, he would find acclaimed fracture liaison services in the south, but in the north and east of the city they are not available, yet they are all part of the same clinical commissioning group. Will he encourage that group to ensure that there is equality of access across its geographical area and not to create a postcode lottery within it?

Lord Bethell (Con)
The noble Baroness alludes to a point slightly beyond the reach of the junior Minister in the department; we have a degree of federalisation, as she knows. However, I completely agree with and applaud the sentiment. We need more comprehensive coverage of fracture liaison services. We believe in the principle of 100% coverage, to which the noble Baroness, Lady Bull, alluded. I will look into whether we can do more in Birmingham to get a wider service.

Baroness Massey of Darwen (Lab) [V]
My Lords, the Royal Osteoporosis Society points out the enormous cost to the NHS of osteoporosis-related fractures and the distress of those who suffer. This implies that prevention should be improved. Will the Minister say how diagnostic services will be enhanced in relation to, for example, bone density scans and GP practices?

Lord Bethell (Con)
My Lords, we do a lot of work on prevention. Vitamin D is made available and we have fracture liaison services to look at those who present themselves with a fracture to diagnose osteoporosis. A vast amount is already done. I am sure that more could be done, but this is an elusive and difficult to diagnose condition, which relies on those who fear that their bone density may be low presenting themselves to their GP for diagnosis.

Lord Addington (LD)
My Lords, it is quite clear that preventive healthcare can assist here, through not only vitamin D but exercise patterns. Have the Government considered getting a comprehensive exercise plan for the over-50s that will encourage them to undertake activity that improves muscle mass and bone density, both of which protect against this?

Lord Bethell (Con)
My Lords, last year we launched a massive campaign, the Better Health campaign, to encourage healthier living with respect to both eating habits and fitness—I can report to the House that I have committed myself to that campaign and it is bearing some good fruit. We are spending hundreds of millions on marketing, we have engaged dieting services for those who wish to be involved in them, and we have mobilised a huge number of exercise regimes, including the park runs. These are bearing up well, but I encourage all those who wish to have a healthier life to do more.