Light the spark, so things can change

This comment piece was published in the Sunday Express on 5 November 2023.

Sometimes politicians ask me ‘If Fracture Liaison Services (FLS) are such a no-brainer, why aren’t more NHS Trusts commissioning them?’

It’s all about awareness, both amongst doctors and the public.  Put simply, osteoporosis is about five years behind the menopause.  Until the high-profile campaign led by Davina McCall, menopause was clouded by silence and stigma.  Now every responsible workplace has a Menopause Policy.  For decades, falls and weak bones have misleadingly been seen as ‘just part of getting older’, rather than a medical issue.  The silhouette of the hunched older woman on the road-signs says it all.  It wasn’t the passing of the years that curved her back, but the fractures in her spine.  Early diagnosis and medication can prevent them.   

These ageist, sexist stereotypes have stopped us seeing osteoporosis for the treatable condition it is.  For decades, a culture of passivity and defeatism stopped people taking control.  Low public awareness has meant most people have little to no expectation of their GPs and other services.  Few people know what good treatment looks like, so few people get it.

Bone health and osteoporosis hardly feature on doctors’ training curricula.  No branch of the medical profession owns it, so it falls through the cracks.  That’s why there are so few clinical champions in local communities lobbying Trusts to set up FLS.  Compounding this, NHS England has never asked Trusts to prioritise fracture prevention, so - unsurprisingly - most never have.  That’s why we need a mandate to send a clear message to local commissioners to fund these services.  

At the minimum, someone needs to light the spark.  A transformation fund from Government could be enough to change the picture.  Once FLSs are set-up, Trusts will quickly see the returns, with services breaking even in 18 months and delivering a £3.26 return for every £1 invested.  Beds, ambulances and operating theatres will quickly start seeing the gains.  Given a few years to show what they can do, these services will be there for good. 

The alternative – to do nothing – is the most expensive option of all.  It’ll mean we waste £665m of taxpayers money over the next five years on preventable fractures.  The NHS can’t afford it.  The economy will be denied the skills of the 67,000 older workers with fractures, a third of whom will quit work.  And 8,000 people will die of hip fractures who could have lived.

A few lines in the Government’s Major Conditions Strategy, without funding, will mean nothing will change.  We’ll be back here in the same place, with the missed opportunities mounting up.  Meanwhile, our ageing population will mean the costs to the taxpayer will spiral.

Give the overlooked 90,000 people the life-saving medication they desperately need.  Light the spark, so things can change.