Wales celebrates FLS roll-out, but there is still lots more to do

Services have a “backlog” for scans and issues with “capacity, quality and workforce”

The roll-out of Fracture Liaison Services across Welsh Health Boards has been achieved - but there is still a lot more work to do, the Welsh Government has announced.

Following a campaign by the Royal Osteoporosis Society to end the postcode lottery for patients in Wales, more than £1m has been invested to develop the specialist bone fracture services in areas that didn’t have one, and to expand and improve existing services. Fracture liaison services (FLSs) are crucial in diagnosing and treating osteoporosis early.

In a statement, Jeremy Miles, Wales’s Cabinet Secretary for Health and Social Care, said services are still experiencing serious challenges in “capacity, quality and workforce”, but he committed to fixing the problems.

Mr Miles said: “While we can celebrate rolling out fracture liaison services across Wales, the journey does not end here. Each health board has made a long-term commitment to continue to develop and improve their service to support the needs of their local population and to reduce the impact falls and fractures have on individuals and on the NHS.”

Outlining what has been achieved by the September 2024 deadline, Mr Miles said: “Fracture liaison services have been established in the six university health boards and mutual agreements are in place between Powys teaching Health Board and adjacent district general hospitals to ensure access to services for people living in Powys communities. The funding has enabled the recruitment of 13 clinical nurse specialists and 11 administration staff.”

While recognising “the dedication of Dr Inder Singh, the National Clinical Lead for Falls and Frailty and his team”, Mr Miles highlighted serious challenges to existing services.

He warned: “DXA services in Wales are facing a number of challenges in relation to capacity, quality and workforce. Dr Singh and the Fracture Liaison Service Quality Assurance and Development Group will work with health boards over the coming 12 months to address the backlog in DXA services; improve access to scans and reporting and invest in workforce training and development.

Mr Miles added: “Our priority in the next phase of this work will be to nurture the ongoing development of services and continuing to work with Powys teaching Health Board to strengthen its fracture liaison service provision by considering what can be delivered in the community. 

“Timely access to Dual-Energy X-ray Absorptiometry (DXA) services is essential for the effective management of people with osteoporosis and those at high risk of fractures and is key to the continued success of the fracture liaison service model in Wales.”

Craig Jones, Chief Executive of the Royal Osteoporosis Society, said:

“People in Wales can be proud that their government was the first to mandate universal fracture liaison services to end the revolving door of fracture patients in hospitals.

“An important first step has now been taken, with all acute health boards across Wales now providing these life-changing bone services. We must now build on this foundation by setting out a phased plan for every one of the services to mature to cover the whole local population. Otherwise, we’ll continue to miss most opportunities to prevent devastating fractures. We’re pleased the Welsh Government has signalled that further plans will be published before the end of the year.  We re-commit to work closely with the strong team there to achieve 100% coverage and protection for the public”.  

Fracture liaison services ensure people aged 50 and over have their bone health checked and managed following a fracture. They can prescribe medication to reduce the risk of subsequent breaks.

DXA is a medical imaging technique used to measure bone mineral density; it is considered the gold standard for diagnosing osteoporosis and assessing fracture risk.