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Volume 738: debated on Thursday 26 October 2023

Motion made, and Question proposed, That this House do now adjourn.—(Julie Marson.)

I am grateful for the opportunity to raise once again the importance of osteoporosis provisions and support. As many hon. Members know, I have campaigned on this issue for many years. Today’s debate is an important opportunity to highlight the deficiencies in support for a health condition that affects so many women and a large number of men in this country.

Historically, osteoporosis has been a condition shrouded in mystery. I have chaired the all-party parliamentary group on osteoporosis and bone health for some time now, along with Lord Black of Brentwood. Today’s debate coincides with our very first national media campaign on osteoporosis, co-ordinated by the APPG and the Royal Osteoporosis Society—the Better Bones campaign. I encourage all hon. Members to give their support to this important campaign.

Support for the Better Bones campaign has been staggering. It shows the public, professional and political demand for change, because nearly 250 parliamentarians, 44 charities, seven royal medical colleges, business leaders and trade unions are collectively calling on the Government to end the postcode lottery on access to crucial osteoporosis services in this country.

The hon. Lady is making a critical speech on osteoporosis treatment and support, and on absolutely the right day as well, when her campaign goes national. Is she aware that one in three people over the age of 50 who break a hip die of that injury or related complications within a year? That is a terrifying statistic. A large proportion of those fractures are osteoporotic, so does she agree that prevention and screening are key? There is groundbreaking work going on in Southend. The fracture clinic at Southend Hospital, which I had the pleasure of visiting a couple of weeks ago, is to launch a new fracture liaison service next spring, with the support of Mid and South Essex Integrated Care Board. It will be the first FLS screening service in the UK to offer consistent screening support across a whole region.

Order. If the hon. Lady wishes to make a speech, I think there may be time, but she is making an intervention.

The hon. Lady raises some important points. I agree that screening and prevention are key to tackling osteoporosis, and I congratulate her and Southend on getting their FLS up and running. It will make a real difference to the lives of people in Southend.

My hon. Friend is doing a fantastic job in this policy area. Given only half of NHS trusts have a fracture liaison service, does she agree that it is vital that that 50% figure grows week in, week out, to ensure that everyone gets get that service?

My hon. Friend makes a valuable intervention. He has been a staunch advocate for those suffering from osteoporosis and has backed the Better Bones campaign, for which I am very grateful. I agree that this issue is all about ensuring equity in access to NHS services, including FLS.

I am lucky enough to represent a constituency with a fracture liaison service, which can identify 91% of fragility fractures, but other constituencies are not so lucky. Does the hon. Lady agree that a modest transformation fund would make such a big difference?

I welcome that intervention and I absolutely agree. The whole tone of the campaign and my speech will address those very issues, because it is so important that we recognise that prevention is key to tackling osteoporosis. We cannot prevent the condition unless we ensure first that people are diagnosed. Osteoporosis receives too little attention, given the scale of numbers affected by the condition: half of all women and one in five men over 50.

The hon. Lady makes a point about statistics and the distribution of those who are affected. Just last weekend, I was grateful to attend a training workshop at Sacred Heart church provided by a guy called Sherwin Criseno, who explained to men and women over 50 the impact of this dreadful condition. Does she think it is really important that men are better informed about the impact of the condition, so they prepare accordingly and perhaps change their lifestyle?

I thank the hon. Gentleman for that important intervention. The condition predominantly affects women, but it does affect men as well. Small changes to lifestyle, as well as detection and prevention, are very, very important.

Osteoporosis often develops during menopause, when a decrease in oestrogen can lead to a 20% reduction in bone density. A loss of bone density affects people of all sexes as they age, but women lose more bone density more rapidly than men.

I thank the hon. Lady for securing the debate. I referred to this point earlier in the debate on menopause, but my staff and I deal every day of the week with benefit issues relating to osteoporosis. It is clear that the understanding and capacity that maybe should be there in the health sector is not there. Mindful that the Minister is not responsible for the Department for Work and Pensions, does she think that within the Department there should be a better understanding when assessing those with osteoporosis to ensure they can gain the benefits in the system that the Government have set aside and have a better quality of life?

I thank the hon. Gentleman for that important intervention. Osteoporosis suffers from some mystery, and any light that we shine on the condition is welcome. It is entirely possible for someone with osteoporosis to work and have a very full life, given detection and treatment.

Fracture liaison services are integral to that. They are essential because throughout our lives our bones continuously renew themselves in a process called bone turnover. With osteoporosis, bone turnover becomes out of balance. Bones lose strength and become more fragile, bringing an increased risk of fractured bones time and time again. The FLS can identify osteoporosis at the first fracture through methods including DEXA scanning, and offer treatment that can reduce the risk of further fractures. The FLS also systematically monitors patients after an osteoporosis diagnosis to ensure they get the best out of their treatment plan. With the FLS, patients who would otherwise face a fracture or multiple fractures can continue to lead healthy and fulfilling lives.

With osteoporosis designated as the fourth most consequential health condition when measured in terms of disability and premature death, we have to question the Government’s current record on assessment, treatment and prevention. There is a postcode lottery for access to these vital life enhancing and lifesaving services, with only 57% of the eligible population in England currently having access to the FLS. What we desperately need is a central mandate requiring integrated care boards to invest in established FLS for everyone.

Let me stress not only the moral imperative of acting on this issue, but the clear financial argument for establishing 100% FLS coverage in England. One million acute hospital bed days in England alone are taken up by hip fracture patients. Research shows that FLSs reduce the refracture risk by up to 40%. Applying that to the national picture, we find that a staggering 750,000 bed days would be freed up over five years, saving the NHS £665 million. This would have a significant and positive impact on the social care system. For every pound invested in FLS, the return is more than threefold. With the NHS in crisis, the Government must be bold and recognise the value of services such as FLS.

The future of the NHS lies in prevention, but this argument extends beyond the NHS. Every year, 670,000 people of working age suffer from fractures due to osteoporosis, and a third of those will leave the workplace permanently owing to the impact of chronic pain. We also know that every year 2.1 million sick days are taken in England as a result of disabilities caused by fractures. Any Government would surely understand how consequential this is for our economy. A new analysis provided for the Treasury shows that universal access to FLS can prevent up to 750,000 sick days every year, and that is why trade unions, the TUC, the Federation of Small Businesses and other business groups have joined the campaign to extend FLS access to everyone aged over 50.

It is clear that the Chancellor cannot succeed in addressing labour shortages without taking decisive action on FLS. To provide this vital support—to provide 100% FLS coverage in the UK—would cost an estimated £27 million per annum, which is less than 2% of the UK’s current expenditure on hip fractures. Preventive osteoporosis treatment not only presents a sound financial case for the NHS, but presents a strong business case by ensuring that so many women can continue to work. Improved osteoporosis treatment does not just mean that people can work for longer; it means—perhaps much more important—that those living with osteoporosis can enjoy a higher quality of life beyond their work.

It is time to do away with the stigma because, with people in the UK living to an older age than ever before, 50 has become the new 40. Osteoporosis is no longer an old person’s condition. We have allowed it to become accepted as a natural part of ageing, but it does not have to be. In this country, we have a choice: to diagnose and treat it, or to simply continue to ignore it. This is an opportunity to address old prejudices. Osteoporosis is one of many conditions, mostly experienced by women, that have historically been swept under the carpet. In the 19th century, during the period of its earliest identification, studies crudely described the condition in terms of women tripping over “their long skirts”. Even today, people refer to osteoporosis in crude and demeaning terms such as “a dowager’s hump”. Raising awareness of this long-overlooked condition is essential, and I am grateful for the opportunity provided by today’s debate to further demystify osteoporosis as a health issue which affects so many people across this country.

After centuries of inattention in the world of medicine, we now have revolutionary new technologies and systems such as DEXA scanning and FLS. These services have the potential to transform the lives of so many women throughout the country—women who have so much to offer, who should not be left undiagnosed, but whose quality of life is left literally to crumble along with their bones; women who are left to suffer in pain when treatment can and should be made available. The decision to provide full FLS coverage is not only fiscally responsible and right, but it would be an historical leap forward in terms of women’s healthcare. Today, two thirds of those who need anti-osteoporosis medication are left untreated. That is roughly 90,000 people, every year, missing out on necessary treatment due to Government inaction. This is life-changing medicine. As many people die from osteoporosis-related issues as die from lung cancer or diabetes, so FLS and fracture prevention need to be part of the mandated NHS core contract. We must establish new guidelines to support the establishment of FLS across England.

In August, the Minister publicly stated that the Government would make an announcement on establishing more fracture liaison services by the end of this year. In September, the Minister in the other place said that the autumn statement would include

“a package of prioritised measures to expand the provision of fracture liaison services and improve their current quality.”—[Official Report, House of Lords, 14 September 2023; Vol. 832, c. GC241.]

I understand that, since then, there has been a walking back of this commitment. On behalf of the 90,000 people missing out on life-saving, life-changing medication, I yet again ask the Government to hold their nerve and act quickly.

Now is the time for this Government to turn their back on outdated attitudes towards osteoporosis, now is the time to protect women whose quality of life would otherwise be left to crumble along with their bones, and now is the time to commit to 100% FLS coverage across England. By ensuring that every person in the UK has access to fracture liaison services, we have the power to make this vision of life-saving early intervention and prevention a reality.

I congratulate the hon. Member for Bradford South (Judith Cummins) on securing this debate. She has made a brilliant speech on a critical topic. As she brilliantly points out, osteoporotic fractures can be prevented and screening is the first step. If we could stop these breaks in the first place, not only would we save lives but we would save the NHS money and enable all our residents and constituents to live longer, healthier lives.

As I said earlier, the statistics are truly terrifying. One in three people over the age of 50 who break a hip go on to die of that injury within a year. We are talking about saving lives. The hon. Lady rightly mentioned that FLS is the start of this. The first FLS to roll out a consistent screening and prevention process across an entire trust will launch at Southend Hospital next spring. It is estimated that the service will prevent 550 fractures in mid and south Essex, saving the trust approaching half a million pounds and, critically, 1,300 bed spaces each year. If that were rolled out across the entire country, we would be looking at preventing 74,000 osteoporotic fractures, saving three quarters of a million bed days and hundreds of millions of pounds, to which the hon. Lady rightly referred.

The hon. Lady is right that this is the future of the NHS—we should be aiming at prevention—and that stopping women, in particular, suffering these osteoporotic fractures has to be done by rolling out FLS across the whole country. I hope the Minister will agree that other regions should follow Southend’s example. It is an exemplar and I thank him and the hon. Lady for giving me this opportunity to speak.

I commend the hon. Member for Bradford South (Judith Cummins) for bringing this issue to the House’s attention. As chair of the all-party parliamentary group on osteoporosis and bone health, she has long been a champion for those with osteoporosis. She will know that many of the points raised today echo arguments made in the other place only last month. As ever, she articulately and eloquently made a powerful and persuasive case, and I very much look forward to working with her and the charities that specialise in this area to improve service provision and support for those with osteoporosis.

As the hon. Lady set out in her speech, osteoporosis represents a growing challenge in this country as our demographics shift, particularly for older people. It is estimated that in the UK more than 3 million people have osteoporosis, including approximately one in 10 women aged 60 and one in five women aged 70, with more than 500,000 fragility fractures occurring each year. As she rightly pointed out, this silent disease does not just affect older people. Many people of working age suffer preventable fractures, with an estimated 2.6 million sick days taken every year in the UK due to osteoporotic fractures. Studies suggest that over 22% of the population aged 50 to 64 will suffer a fracture.

Impassioned calls have been made of late for increased Government support for FLS, both within Parliament, not least from the hon. Lady, and in the media. I thank colleagues across both Houses and the Sunday Express, which has led on this issue, for helping to raise the profile of these important services, which have long been recognised as best practice for secondary fracture prevention by both the Department of Health and Social Care and NHS England. Indeed, in our “Major Conditions Strategy: A case for change and strategic framework”, published this summer, we made it clear that we would continue to explore supporting the provision of FLS.

As the hon. Lady will know—indeed, she raised this in her speech—fracture liaison services are locally commissioned. My hon. Friend the Member for Southend West (Anna Firth) rightly pointed out, first in her intervention and then in her short speech, the importance of FLS. I thank her for drawing attention to and championing the service in Southend, which is an exemplar that we hope other integrated care boards will follow.

For local systems requesting support to review and improve their secondary fracture prevention pathways, NHS England is producing system-level data packs, which include data from a variety of sources. That includes the FLS database to highlight where there may be unwarranted variation; the impact of, and upon, existing health inequalities, which we should always be concerned about; and where there are opportunities for transformation. The Royal Osteoporosis Society outlines that, for every £1 spent on FLS in the UK, the taxpayer can expect to save £3.28. So by levelling up provision to cover everyone over the age of 50, we could prevent just under 5,700 fragility fractures every year. If that is the case, it is only right that NHS England continues to support ICBs to develop their secondary fracture prevention services. As the hon. Lady rightly pointed out, the benefits are clear and I trust that commissioners will be exploring how best to support the needs of their patients in this important area.

The major conditions strategy is not the only headline workstream that we are taking forward to improve osteoporosis care. The first ever Government-led “Women’s Health Strategy for England” was published in July 2022, marking a reset in the way in which the Government are looking at women’s health. As part of that work, we are investing £25 million in women’s health hubs, with each ICB set to receive £595,000 over the current and next financial year to establish a women’s health hub within their system. As we have outlined in the women’s health hubs core specification, specific services will vary depending on population health needs, the existing set-up of services and the workforce skills in a local area. The core specification outlines osteoporosis assessment and care. For example—the hon. Lady rightly alluded to this —DEXA bone density scanning or FLS are areas that local systems could consider when establishing their hub.

As important as FLS is, it is not the only way in which we can ensure that people with osteoporosis receive the care they need. NHS England’s “Getting it Right First Time” programme has a specific workstream on musculoskeletal health and is exploring how best to support integrated care systems in the diagnosis and treatment of osteoporosis. There is also, alongside that, a range of NICE guidelines to support equity of care for people with osteoporosis, which healthcare professionals and commissioners should absolutely note.

As we know, the economic burden of fragility fractures can be significant. That is why in this year’s spring Budget we announced a package of measures to support individuals at risk of, or experiencing, musculoskeletal conditions to live and work well. Those include: making best use of digital health technologies to support people to better manage symptoms and increase mobility; designing and scaling up MSK community hubs, expanding access to community-based services delivering physical activity interventions; and alongside that, integrating employment advisers into musculoskeletal pathways, building on the success of the NHS talking therapies programme.

Finally, I would like to highlight some of the exciting work that we are supporting on the future of osteoporosis care, and that is about research. Valuable research into MSK conditions such as osteoporosis is being funded by the Department of Health and Social Care, through the National Institute of Health and Care Research. NIHR has awarded £173 million for research into MSK conditions in the last five years. That includes studies into understanding and improving patient experience of diagnosis for vertebral fracture, physiotherapy rehabilitation for osteoporotic vertebral fracture and other treatments for MSK conditions.

In addition, in 2021-22 alone over £30 million has been spent on NIHR infrastructure supported studies and, alongside that, trials into MSK conditions, and six of the NIHR biomedical research centres have MSK conditions as a research theme. NIHR, in collaboration with Versus Arthritis—I referenced earlier some of the fantastic charities working in this space—also funds a dedicated UK musculoskeletal translational research collaboration, which aligns investment in MSK translational research and creates a UK-wide ambition and alongside that a focus to drive cutting-edge research and improve outcomes for patients.

I do not for a second underestimate how painful and debilitating this silent disease is, but I am confident that real advances have been made. I know that we have further to go, but I am confident that, working together, such advances will continue to be made.

This Government are committed to improving the provision of osteoporosis treatment and support. I once again extend my sincere thanks to the hon. Lady for bringing forward this really important debate, and I especially thank the individuals, and indeed the charities and other organisations, who do so much to support people with osteoporosis.

Sitting suspended (Order, 24 October.)


1.23 pm

Message to attend the Lords Commissioners delivered by the Lady Usher of the Black Rod.

The Speaker, with the House, went up to hear His Majesty’s Commission; on their return, the Speaker sat in the Clerk’s place at the Table.

Royal Assent

I have to acquaint the House that the House has been to the House of Peers where a Commission under the Great Seal was read, authorising the Royal Assent to the following Acts:

Online Safety Act 2023

Worker Protection (Amendment of Equality Act 2010) Act 2023

Energy Act 2023

Non-Domestic Rating Act 2023

Procurement Act 2023

Levelling-up and Regeneration Act 2023

Economic Crime and Corporate Transparency Act 2023.