Musculoskeletal Health

Question

11:16:00

Asked by

To ask His Majesty’s Government what steps they are taking to improve musculoskeletal health.

My Lords, in begging leave to ask the Question standing in my name on the Order Paper, I note my interest as co-chairman of the APPG on osteoporosis.

My Lords, improving health outcomes for the more than 17 million people in England with musculoskeletal conditions forms a key part of this Government’s missions to build an NHS fit for the future and kick-start economic growth. We are making a start by delivering a joint programme with the DWP—entitled Getting It Right First Time, the MSK community delivery programme—and working with integrated care board leaders to reduce NHS community waiting times and to improve data metrics and referral pathways.

My Lords, osteoporosis is one of the gravest musculoskeletal conditions, because fractures ruin lives and kill people. Can the Minister understand the frustration so many feel that, after years of promises, there is still no prospect of universal access to life-saving fracture liaison services in England? Each time this House debates osteoporosis, there is unanimous support and Ministers of both parties stand here and promise action. Each time there is an election, commitments are made, including one by the Secretary of State that rollout would be one of his first acts in post. Well, it was not, and 1,100 people have died since then. Will the Minister, without prevarication or diversion about widening access, specifically restate the Government’s commitment to universal rollout of FLS in England by 2030? If not, could she explain to thousands suffering often intolerable pain or grieving loved ones why they have reneged on it?

I pay tribute to the noble Lord’s campaigning, which is impressive in maintaining focus on what I regard as a very important area. He may be aware, but I draw it to his and your Lordships’ House’s attention, that a Written Ministerial Statement about addressing urgent challenges was laid today. It outlines the fact that planning guidance is soon to be published—it was not published as I entered the Chamber—and will reflect patient priorities that are important to those who have to contend with osteoporosis. These include cutting waiting times, improving access to primary care—bearing in mind that 30% of GP appointments are related to MSK—and improving urgent and emergency care. On the point the noble Lord asks about, as I have said before, we are working closely to consider a whole range of options to provide better quality and access to important preventive services as part of ending the postcode lottery. I will be pleased to keep him informed.

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We will hear from the noble Baroness, Lady Donaghy.

I am a member of the APPG on osteoporosis, and we are very worried that fracture liaison services have been deprioritised in the recent NHS planning guidance. We know that the pump-priming transformation fund works because we have seen it working in Wales. It saves lives, as the noble Lord, Lord Black, said, releases people into the labour market, releases beds in hospitals and improves quality of life for thousands of people. Can the Minister give us an assurance? If this milestone has been missed in the planning guidance, we need urgent clarity on how the 2030 target will be reached.

My noble friend raises a number of important points. In reference to the planning guidance, I hope she will understand that at this stage that is leaked information and I am therefore not in a position to comment. The Secretary of State has confirmed that planning guidance will be published in due course. I agree that patients around the country are waiting too long for care and treatment. I draw my noble friend’s attention to the plan for change, which will get the health service back on its feet. Part of the elective recovery plan, published just a few weeks ago, sets out funding to boost DEXA, which is bone density scanning capacity to support improvements in bone health and early diagnosis, including for osteoporosis. That will provide an estimated 29,000 extra scans per year, so I hope my noble friend will take heart from that node of direction.

My Lords, I declare a family interest in this condition. Will the Minister recognise that the failure to roll out the much-needed early diagnostic service, which, as the noble Lord, Lord Black, said, was promised during the general election campaign, will inevitably result in greater cost to the NHS in the years to come?

I certainly agree with the noble Lord that without the right services in place at the right time and in the right location, there is additional cost—not just to the NHS but to the economy and to individuals. We have found that musculoskeletal community services have the largest waiting lists in England, and I refer the noble Lord to our forthcoming 10-year plan on the move from hospital to community. That will be a key part of cutting waiting lists, and the measures I have already announced will also assist.

My Lords, did not the Health Secretary give an unequivocal commitment at last year’s general election that there would be universal fracture liaison services by 2030, with implementation starting immediately? Does that commitment still stand?

I thank the noble Lord for allowing me to reiterate that the department is working closely with NHS England to look at a whole range of options to provide better-quality care and access to those important preventive services. I emphasise that this is part of ending the postcode lottery. I remind your Lordships’ House that integrated care boards are responsible for the delivery of these services. We will continue with the further actions that we are taking, some of which I have already referred to, which will ensure that patients are getting the service they need.

Integrated Care Journal has indicated the potential to improve access pathways, giving an example of an AI physiotherapist service at home and covered by CQC. Will the Government develop and adapt something like this?

The noble Baroness raises an interesting point and I will be happy to look into what she suggests. I know she is aware that one of the main pillars of change will be about analogue to digital, and in that I put the contribution of AI. Just this afternoon I will speak to a conference about the role of AI in respect of women’s health, and osteoporosis will be very much part of that.

My Lords, I invite the noble Lord, Lord Campbell-Savours, to speak remotely.

As a sufferer of ankylosing spondylitis, a painful spinal musculoskeletal condition aggravated by a lack of physical movement, I can report that inactivity in underemployment can severely aggravate the condition. Would the state benefits system not be far better served if multi-patient group physio services and collective patient gyms—even open-air ones, as in the Far East—were available on a wider scale? Greater collective patient activity for this and other similar groups in large public venues would save money in the benefits system.

My noble friend raises a very important point from a position of a lot of experience. I can confirm that we recognise the importance of regular physical activity for those with MSK conditions. It helps to reduce pain and disability as well as improving well-being and helping with other conditions. The existence of MSK hubs with a non-healthcare workforce delivering physical activity-based interventions has been extremely helpful, and we will continue to encourage that and explore the role that hubs can play.

My Lords, we should pay tribute to my noble friend Lord Black for all his hard work in this area. I do not think the Minister answered his Question. On Tuesday evening she told the House she wanted to be honest, so in that spirit can she tell your Lordships whether the Government have agreed new dates, first, to begin the rollout and, secondly, to achieve universal fracture liaison services? If so, what are those dates? If not, can she tell us when we will have those dates, so that all the people waiting for these services are clearer about what they can look forward to?

I am afraid I cannot give the noble Lord the dates that he seeks, but I will be pleased to keep him updated on the development of services.