Fracture Liaison Services

Question for Short Debate

19:36:00

Asked by

To ask His Majesty’s Government what progress they are making towards universal provision of fracture liaison services in England by 2030.

My Lords, it is a privilege to introduce this important debate, in which I declare an interest as co-chair of the All-Party Parliamentary Group on Osteoporosis and Bone Health. I am very grateful to all those taking part. I hope that, together, we will again demonstrate the strength of feeling on this issue across all parties in the House, and our determination to ensure action. It is a particular pleasure to welcome the noble Baroness, Lady Merron, to her place for her first debate on osteoporosis as Health Minister. She has always been immensely supportive on this issue, and I know how seriously she takes it. Her leadership will be crucial in advancing the cause of fracture prevention in the days ahead, and I look forward to hearing what she has to say. Fractures caused by osteoporosis are one of the greatest threats to people living well in later life, affecting half of women and a fifth of men over 50. They are the fourth most-harmful health condition, measured by disability and premature death. They have a profound impact on those who suffer from this debilitating condition —as I saw in the case of my own mother, whose later years were blighted by it—and on those who care for them. Yet—this is perhaps the most upsetting aspect of this debate—they are entirely preventable with safe and affordable therapies. Fractures impose devastating costs on people and the health service. The hospital episode statistics show that hip and other fractures are second and fourth on the list for total bed days lost to unplanned admissions to hospitals. Most of these patients are, on further investigation, found to have osteoporosis. Hip fractures alone cost the NHS £2 billion annually and are “heart attack-level” events that burden hospitals and our desperately overstretched social care system. However, it need not be that way. Half of these patients had a previous fracture that could and should have flagged them as being at risk. That is where fracture liaison services—FLS—come in and why the Government’s commitment, made during the election, to making them universal was so welcome. The Secretary of State for Health and Social Care told the Daily Mail, which, alongside the Sunday Express, has been a steadfast campaigner for universal FLS—I pay tribute to them—that one of his first acts in government would be to task NHS England with developing a rollout plan so that every part of the country could access these vital services. I commend his leadership and vision. As I said, the Minister has also been a determined campaigner. I recall her urging my noble friend Lord Kamall—whom I am delighted to see taking part this evening and who has also been extremely supportive —to acknowledge back in 2021 that two-thirds of people were not receiving the treatment they needed for osteoporosis. Three years on, that figure remains tragically unchanged. The postcode lottery for FLS means that 90,000 people are still missing out on urgently needed bone medications. In 2021, we also learned through a freedom of information request that only half of NHS trusts in England had a fracture liaison service in place. Yet again, almost nothing has changed since. Progress should be so easy, but the truth is that we are stagnating and, in the case of broken hips, that inaction costs lives. Earlier this year, the noble Baroness who is now the Minister from the other side of the Chamber asked my noble friend Lord Markham when would the Government’s “promise to establish more fracture liaison services actually be delivered?”.—[Official Report, 5/2/24; col. 1443.] We need to ask that again today, because time is running out. Fracture liaison services are the proven solution to the public health crisis of preventable fractures, offering a perfect fit with the Government’s laudable focus on moving from sickness to prevention and on getting people back into work. FLS are the world standard in this area. They ensure that, after a person suffers their first fracture, they are assessed for osteoporosis, put on treatment and helped to stay on it. That prevents this horrible disease progressing and reduces significantly the chance of further broken bones. In areas without an FLS, the story is different. Many patients who suffer their first fracture are fixed up in A&E and then forgotten about. No assessment for osteoporosis is carried out and no anti-osteoporosis medication is prescribed. Far too many therefore end up back in hospital with multiple, more severe fractures. Over a quarter of hip fracture patients die within 12 months. That is a human tragedy. FLS are perhaps the most powerful example that we have of preventive healthcare, which is why the Government’s commitment to rolling it out to every trust by 2030 is so critical. There is strong consensus in this House that this is the right thing to do. The Government support it, the Opposition support it and the Liberal Democrats support it. I can recall few other subjects where all parties are so united. So, in the interests of patients, the NHS, the taxpayer and the wider economy, let us get on with it, and fast. While 2030 may seem far away, the scale of work required to deliver universal FLS is substantial. We cannot afford to let this critical deadline creep up on us. The Royal Osteoporosis Society’s data, scrutinised by Department of Health and Social Care officials, shows that universal coverage would save 750,000 hospital bed days in just five years, prevent 74,000 fractures and save almost 9,000 lives—that is 9,000 people who are someone’s mother or grandma, husband or dad. The ROS, whose campaigning work on this issue has been exemplary, has identified six integrated care boards ready to go. They are like horses at the starting gate: eager, ready and waiting for the Minister and her colleagues to fire that starting gun. If we do that now, we can just about bring those ICBs online by April. The ROS has proposed following this with 12 more ICBs in 2026, 2027, and 2028 respectively. This proposal is a practical and cost-effective road map to real change. If those ICBs come online as planned, by 2029, FLS will save over 300,000 hospital bed days—that is 60,000 extra elective surgeries that the NHS can deliver by the next election. Further delay is not acceptable; if those first six ICBs do not start until 2026, by 2029 FLS in England will save only half the bed days—that means 30,000 fewer surgeries. Push it back two years and the benefits get pushed back even further into the future, with more preventable fractures, more lives lost, and more pressure on the overstretched NHS. Many health initiatives take a decade to pay off, but the department has seen the comprehensive analysis which shows that these services break even within 18 to 24 months. All that is needed is a modest pump- priming fund to cover the first two years. Then, after break-even point, the cost savings can keep them sustainable within local budgets. I understand that the former Secretary of State, Victoria Atkins, identified funds within her budget for this very purpose as part of the major conditions review before the general election. Releasing this funding now would kick-start the rollout of FLS. While the human cost of fractures will always be the most compelling reason to act, we cannot ignore the need to help older workers stay in the labour market, an important aspect of public policy. Independent analysis shatters the stereotype that people with osteoporosis are all retired, and lays bare the cost of inaction to our economy. Each year, osteoporotic fractures in working-age adults lead to over 1.5 million work days lost due to sick leave and carer absences, costing employers £130 million annually. The OBR has identified musculoskeletal conditions, a definition that includes osteoporosis, as the second greatest driver of long-term sickness. This has to change. When we last debated this subject in September 2023, I ended with these words: “This is a big strategic challenge for the whole of our society. Bold, visionary leadership from the Government could change the terms of the game, improving the lives of tens of thousands, relieving pressure on our beloved NHS and saving money for the taxpayer. We have such a huge opportunity here to save and change lives. I implore the Government to take that opportunity”.—[Official Report, 14/9/23; col. GC 232.] I make no apology for repeating those exact same words, with a new Government and a new chapter opening in the history of the NHS. Let us give people with osteoporosis back their lives and the future they deserve, and let us start now. Again, I implore the Government to act, and I beg to move.

19:46:00

I am grateful to the noble Lord, Lord Black of Brentwood, for moving this debate so clearly and comprehensively. I hope that this is not an example of winning the argument, winning the campaign and then losing the starting gun. We need three things to happen immediately. We need that transformation fund to pump-prime fracture liaison services for the first 18 to 24 months when, as the noble Lord, Lord Black, has said, it is estimated that they will start paying for themselves. We need to allow the six integrated care boards that are ready now to begin commissioning services to go ahead, if necessary with some of that transformation fund to support them and, if necessary, before the national rollout plan. We need clear leadership from the Government and the NHS so that there is a deliverable timetable to ensure that the half of the population not covered by fracture liaison services will be covered by 2030. Just one year’s delay will halve the total hospital bed days saved by 2029, compounding the burden on the NHS. Leadership is vital, because patients find it challenging to keep taking common osteoporosis medications, because they must be taken in a particular way and can cause side-effects. Patients do not feel better from taking them; they reduce long-term fracture risk rather than addressing any current symptoms. One GP who is extremely knowledgeable and committed in this area described how difficult it was to keep patients motivated to take their medication because of ignorance of the subject, no visible changes and the pressures in the system which mean failures to follow up. In England, only 36% of potential patients are reached. Also, access to diagnostic services varies by region. There is a shortage of DEXA bone density scans and a shortage of radiographers. NHS England indicated that, in September 2024, 56,366 patients were waiting for a DEXA scan and 18.5% had been waiting for more than the target of six weeks. Believe it or not, that is an improvement on the 33.6% waiting more than six weeks in September last year. I am a member of the Royal Osteoporosis Society and I believed, when I joined it 12 years ago, that we had no osteoporosis in our family. I then discovered, 18 months ago, that my only brother had been diagnosed with it. This can hit in the most unexpected circumstances. I therefore urge the Government to give some indication of when the rollout may happen and when that transformation fund might become available.

19:50:00

My Lords, I thank the noble Lord, Lord Black of Brentwood, for securing this debate and for his tireless work in championing fracture prevention. I also ask the House to note that I am an ambassador for the Royal Osteoporosis Society. Over the past 30 years, osteoporosis and bone health have been a blind spot in the women’s health policies of successive Governments. Some 50% of women over 50 will suffer fractures due to the condition, and the vast majority of the 90,000 people missing out on anti-osteoporosis medication are women. For this reason, the Fawcett Society, the British Menopause Society, Mumsnet and Gransnet are among the many charities and organisations supporting the Better Bones campaign. The noble Lord, Lord Black, raised the idea of pump-priming new fracture liaison services with a time-limited transformation fund. I want to highlight the compelling example of exactly this approach in Wales, where the noble Baroness, Lady Morgan of Ely, has shown courageous leadership on the issue. In February 2023, as the then Welsh Health Secretary, the noble Baroness, Lady Morgan, made a bold commitment to mandating fracture liaison services in all health boards within 18 months. By September 2024, that target had been met, with every acute health board in Wales now providing fracture liaison services—an extraordinary achievement, but it did not happen by mandate alone. As we heard, fracture liaison services quickly prove their value, breaking even within just 18 to 24 months. Beyond this point, they become cost-saving, preventing fractures and reducing hospital admissions to more than cover their ongoing costs. This is why pump-prime funding is so crucial, as it bridges that short window before the benefits become fully realised. The noble Baroness, Lady Morgan, recognised this when she pump-primed new fracture liaison services. As a result, Wales achieved universal coverage in under two years, showing what can be accomplished when ambition is backed with resource. During the last QSD on this matter, the noble Lord, Lord Evans of Rainow, responded for the Government and warmly endorsed the idea of what he called a “fracture tsar” within NHS England. Unfortunately, the previous Government did not follow through to establish such a role. The APPG on osteoporosis also noted the need for strong, visible leadership across local systems to get these services up and running. Osteoporosis falls between the cracks of clinical specialties, which is one reason it has been neglected historically. The APPG’s 2022 report recommended the appointment of a “national specialty adviser”—a tsar by another name—to address the lack of ownership and cut across historic boundaries between medical specialisms. I hope that this Government might take action on this where the previous one did not. The Welsh example shows that a universal fracture liaison service is achievable, but it requires strong leadership and pump-priming to succeed. The Minister has been a steadfast advocate for universal fracture liaison services over many years. I hope that, in responding, she will confirm that the Government are willing to put both leadership and funding in place, so that the ambition for universal coverage is no longer just a commitment but becomes a reality.

19:54:00

My Lords, earlier on today, I googled the meaning of the phrase, “It’s a no brainer”. Apparently, it applies to a question that is very easy to answer and, although it did not give an example, I suspect we could all think of one. As my noble friend Lord Black of Brentwood said, there is unanimity across your Lordships’ House on this. As someone who lives with a bone condition, I am something of a reluctant expert on fractures, or at least on the excruciating pain they cause. The crunch as the bone fractures is immediately followed by the weird sensation of there being a void, because suddenly the broken bone cannot bear any weight. There is literally nothing there, and into that vacuum comes this all-consuming shockwave of pain. I make this point because some may assume that rollout is not urgent because, as my noble friend Lord Black of Brentwood mentioned with regard to hip fractures, it is not normally life-threatening. But this ignores the unnecessary human, as well as financial, cost. I think of Stephen Robinson, a forklift truck operator, who suffered chronic, agonising back pain, dismissed for years as muscular by his GP. The doctor insisted that he should leave his manual job if he wanted his pain to improve. Eventually, the choice was taken away because the pain was so severe that Mr Robinson had to leave work altogether at 61. He remembers “living in the chair, drugged up to the eyeballs, counting the minutes until I could take the next painkiller”. My Lords, I have been there. It is not nice. A private DEXA scan is not easy to afford when you are unemployed, but it showed that Mr Robinson had 10 undiagnosed spinal fractures. An early assessment through a fracture liaison service would have given him back years of his life and saved him so much unnecessary pain. In contrast, Alison Smith retired at 60, feeling fit, healthy and ready to embrace her new-found freedom. But nine months later a fall left her with fractured ribs and an alarming sense that something was wrong. Seen quickly by medics, she was referred to a fracture liaison service, which identified severe osteoporosis and started her on treatment. With the support of the fracture liaison service team, Alison received lifestyle advice and ongoing care, which prevented any further fractures happening and saved the NHS and the taxpayer money. In conclusion, any further delay in the rollout of these vital services would represent an inexplicable, unjustifiable false economy, because it is actually costing money not to proceed with universal provision. I look forward to the noble Baroness the Minister giving us reason to hope.

19:58:00

My Lords, it is very good to participate in this important debate on the fracture liaison service, especially since the issue of prevention in healthcare seems to be gathering pace. I thank the noble Lord, Lord Black, for having moved this debate. We have heard that the fracture liaison service identifies people at risk of osteoporosis and reduces the risk of long-term fractures. Treatment provided by the fracture liaison service is often excellent, and often nurse-led. But, as we have heard, there are just not enough of them. Like many aspects of healthcare that we discuss in your Lordships’ House, provision varies by region, and there are also other inequalities of access to these services. We know that bone density decline can be accelerated by other factors, including smoking, diet and other illness. We often discuss the fact that those living in the most deprived areas have consistently worse health outcomes and are therefore likely to be most impacted by the lack of coverage of this service. We have already heard in the debate that another element of inequity is that osteoporosis impacts women more than men: 50% of all women over 50 are affected. Last month, a study showed that menopausal women of Chinese and black African backgrounds are almost 80% less likely to be prescribed hormone replacement therapy, and less likely to receive appropriate care during menopause. While this debate is not about hormone replacement therapy, it has a lot to do with equitable access and is therefore significant to this debate. Fracture liaison services demonstrate genuine value for money, as we have heard, and the Government should be keen to recognise and promote this. It is through services such as these that the shift from sickness to prevention and from hospital to community will happen. Evidence shows that for every pound spent on a fracture liaison service, £3.26 is saved. Given that hip replacements take up 1 million acute bed days a year and are often preventable, rolling this out is an important decision in forwarding the Government’s agenda on the NHS. We have heard already in this debate that many ICBs may well be ready to go with such services. However, the Royal Osteoporosis Society reported earlier this year the closing of the South Nottinghamshire Fracture Liaison Service, with the ICB citing serious financial pressures and the lack of a government mandate as reasons for stopping commissioning the service. Commissioning pressures on the part of ICBs is an issue that often comes up when we talk about prevention, particularly shifting from acute to preventive services. I know that ICBs face serious financial pressure and challenges from acute services that often override prevention; however, if the Government are going to prioritise prevention and reduce health inequalities, there must be a way for ICBs’ commissioning decisions to stand against that pressure. I welcome the promise of 100% coverage by 2030, so I look forward to hearing from the Minister what actions the Government will take to make that happen. Will this be considered in the formation of the NHS 10-year plan, so that health inequalities can be prioritised?

20:02:00

My Lords, I begin by thanking the noble Lord, Lord Black of Brentwood, for securing this vital debate. I welcome my noble friend the Minister to the Front Bench and declare an interest as a breast cancer survivor who is osteopaenic and therefore required to avail of bone density examinations in Northern Ireland, where there is excellent provision of fracture liaison services and where research has shown that there is 100% coverage. I hope that my experience and those of many people in Northern Ireland will be helpful to my noble friend in seeing the benefit of such service provision to many people, particularly those in the older cohort of the population. We have seen encouraging signs in recent weeks that the Government are ready to act decisively on bold, proven ideas. There is a growing appetite for initiatives that will tackle ill health, reduce pressures on the NHS and keep people in work. Fracture liaison services, as we all know, are a perfect example across all three: a gold-standard, internationally recognised intervention that was invented here in Britain and has been adopted across the world. Yet, unfortunately, around half the trusts in England still lack access to this life-changing service. We now have six integrated care boards across England that are ready to take action. These ICBs have done the groundwork, mapping pathways, securing local support and developing clear plans to establish high-quality fracture liaison services, so I ask my noble friend when they will be able to do that. Crucially, there is a clear road map to take us from these early adopters to full national coverage by 2030. With a phased rollout approach, we can learn from these trailblazers and build momentum over the coming years. What is needed now is targeted pump-priming funding to bridge the short 18 to 24-month period before fracture liaison services become cost-saving—an approach that has already proven successful in Wales, as pointed out by the noble Baroness, Lady Bull. It is not just the ICBs that are ready to act. Across the country, there is a coalition of support poised to make universal FLS a reality. A shadow national implementation steering group has convened to support the Government in making FLS one of its early successes in prevention—a true example of a Darzi reform in action. Its members include the Royal College of Physicians and the Royal College of GPs, as well as Age UK and several other expert societies: pooled expertise to help the Government make quick progress. What we need now is a clear plan setting out how these services will be delivered by 2030 or even sooner. The groundwork has been done, the support is in place and the opportunity is here; let us not waste it. By acting now, the Government can turn their ambition into reality, saving lives, easing NHS pressures and strengthening the economy. Acting together, along with the Government, we should take this opportunity and make it happen. I look forward to the Minister’s response outlining how that will happen.

20:06:00

My Lords, it is a pleasure to follow the noble Baroness, and I thank my noble friend Lord Black for securing this debate. I refer noble Lords to my interests, as listed in the register, as a member of the osteoporosis APPG and a supporter of the Royal Osteoporosis Society. My father and mother taught me that, “If you have nothing useful to say, don’t say anything”. I am afraid that, being seventh on the list this evening, I will not trouble noble Lords with the carefully timed and crafted four-minute speech I have prepared, because I follow six excellent and comprehensive speeches. But I will make two quick points. First, I thank and congratulate Her Majesty, Queen Camilla, who has been associated with the Royal Osteoporosis Society for 30 years and its president for 23 years. I know politics is not business, but I hope the Government recognise that there is a business case here, on behalf of the patient and the taxpayer. I urge the Government to follow the recommendations they made when in opposition. The Government of the day promised, if they had been returned, to make speedy progress on the rollout of FLS across this country.

20:08:00

My Lords, I join in the congratulations to the noble Lord, Lord Black of Brentwood, on initiating this debate. I know, as another long-standing member of the all-party group, how active he has been in promoting the goal of a proper system of fracture liaison services. I remember initiating a similar debate on NHS provision for tackling osteoporosis not long after I joined your Lordships’ House, way back in October 2007. At that time, I was focusing on the patchy provision and availability of DEXA scans across the country, and highlighting the postcode lottery whereby, while you might be identified as needing access to services aimed at preventing osteoporosis, whether those services were available depended very much on where you happened to live. It is therefore very frustrating that, even now, so many years later, we are still complaining about postcode lotteries and that, in England, we still do not have the nationwide system of fracture liaison services which everyone who has spoken in this debate has favoured. As a long-standing supporter of devolution, I also find it frustrating that England, the most populous country, has once again been lagging behind the rest of the UK. I firmly believe that if devolution is to count as a UK success, it should be a process that fosters high standards of service to all our citizens in whatever part of the UK they live. I also hope that, perhaps with the emergence of regional mayors in England, there will be a renewed effort, supported by the Government, to tackle inequalities in healthcare provisions in different regions of our country. I accept of course that my noble friend the Minister who will reply to the debate and the Government of which she is part have been in office for only a very short period of time. I am very pleased that the current Secretary of State for Health, in already committing himself to rolling out a system of fracture liaison services across the country, fully recognises not only the benefits this will bring to NHS patients but the financial savings to the NHS in the long term through the establishment of these much-needed preventive services. I pay warm tribute to the Royal Osteoporosis Society for the work it has done over the years in raising awareness of osteoporosis and the various ways it can be prevented and tackled. It has been particularly successful in promoting national media coverage of the issue, which in turn has increased public awareness and public consciousness of its importance. In correspondence with me, the Royal Osteoporosis Society has made the point that fracture liaison services fit very well into the recent update on the National Health Service from the noble Lord, Lord Darzi, particularly in the three key shifts that he highlighted and deemed necessary: a move from sickness to prevention, from analogue to digital, and from emergency-based care to community-focused models. Surely it is the case that fracture liaison services offer a practical example of how we can deliver on all three of these worthwhile aims, and do so in the short term as well as the long term. Many speeches this evening have made very telling points, and I am sure the Minister will have listened carefully to them. Like others, I look forward very much to her reply to this debate.

20:12:00

My Lords, it is a great pleasure to take part in a debate in which there is such strong consensus. The noble Lord, Lord Black of Brentwood, is again to be congratulated on raising this vital issue of fracture liaison services and asking the new Government about progress towards achieving the previous Government’s target of 100% coverage by 2030. In 2021 we were given the figure of 51%—or 63 out of 123—NHS trusts across England having fracture liaison services. There is now 100% coverage in Scotland, Wales and Northern Ireland, so it is disappointing if the figure is still the same 51% for England. We have heard how osteoporosis affects 3.5 million people in the UK, causing more than half a million fractures each year, and that, according to the Royal Osteoporosis Society, two-thirds of the people who need treatment are missing out, leaving them vulnerable to further life-altering fractures—and we have heard how women are disproportionately affected. Both the Sunday Express and the Mail on Sunday have been mentioned for partnering with the Royal Osteoporosis Society to campaign for an end to the postcode lottery that leaves so many people without fracture liaison clinics. The new Government have promised to roll out a plan to ensure that every part of the country has access to FLS. All the main parties in the general election promised this, but we have heard tonight that investment needs to be made now if the Government are to achieve the target by 2030. We have heard how the Royal Osteoporosis Society has estimated that just a £30 million investment in fracture liaison services could prevent 74,000 fractures, including 31,000 hip fractures, over five years—but, we are all asking, will this expenditure take place and will it be soon? The issue of providing universal cover for fracture liaison clinics may not create such big headlines as those about cancer treatments or accident and emergency waiting times, but, as we have heard, the issue affects so very many people. The political will really must be there if we are to address the need to reduce the number of hip and other fractures. I have always advised people that whichever party wins an election, the Treasury stays in power, and that the Treasury often adopts a very short-term approach demanding a rapid return on any investment. This approach needs to change across the health and care sector if we really want to move towards more prevention and needing less cure. As the noble Baroness, Lady Bull, said, fracture liaison services provide a relatively rapid return on that investment. There are still considerable challenges. The clinical workload of those expected to undertake roles within the services is immense. Rheumatology services were hit enormously by Covid and years of underinvestment. We can work with multidisciplinary teams and new technologies such as AI in order to streamline care, improve efficiency and help clinicians to manage growing demand, achieving economies of scale, but technology alone is not the answer; we also need meaningful investment in preventive services.

20:16:00

My Lords, I thank my noble friend Lord Black for securing this debate. As noble Lords have acknowledged, he has championed this issue in this House and outside. In fact, I recall that during one of my earliest Oral Questions as a Minister, my noble friend explained to me the vital role that fracture liaison services play in identifying and treating osteoporosis; that osteoporosis is considered a silent disease, causing over half a million broken bones each year—one every minute; and that there are as many deaths from fractures as from lung cancer and diabetes. As my noble friend Lord Black and indeed the noble Baroness, Lady Bull, said, fractures caused by osteoporosis affect half of all women and a fifth of men over 50. As the right reverend Prelate mentioned, those from lower-income households have a 25% higher risk of fractures, a higher mortality rate and slower recovery times from hip fractures. As the noble Baroness, Lady Donaghy, said, it can be unexpected. Each year, 1 million acute hospital bed days are occupied by hip fracture patients, and around £2 billion is spent on hip fracture care. I pay tribute at this point to my noble friend Lord Shinkwin, the noble Baroness, Lady Ritchie, and others for sharing their experience. That really brought it home and made it about more than figures. As we move to a system of preventive healthcare, FLS have a huge role to play since they systematically identify people aged 50 or over who have had a fragility fracture in order to reduce the risk of further fractures. The Royal Osteoporosis Society, to which many noble Lords have paid tribute tonight, estimates that fracture liaison services reduce the risk of a patient refracturing the same bone by up to 40%. Unfortunately, despite the attempts of previous Governments, only 51% of trusts in England currently provide fracture liaison services, covering only 57% of the population, as alluded to by the noble Baroness, Lady Quin. Earlier this year my right honourable friend Victoria Atkins, then the Secretary of State for Health and Social Care, pledged to expand fracture liaison services to every integrated care board in England and achieve 100% coverage by 2030, a target repeated in the Conservative Party manifesto. But as the noble Lord, Lord Rennard, and others have said, there is consensus—there is no political disagreement on this issue. Indeed, the Minister used to press me from this Dispatch Box when I was in her position. In June this year, the then shadow and now current Secretary of State for Health and Social Care said that delivering a rollout plan for fracture liaison services would be an area for “immediate action” if Labour won the election. Noble Lords understand that these are still early days for the Government, but I am sure that my noble friend Lord Black and other noble Lords who have spoken in this debate wish to understand what the Secretary of State for Health and Social Care meant by “immediate action”. I have to concede that that sounds a lot better than “in due course”—a phrase I tried to avoid when I was a Minister, but not always successfully. Unfortunately, no plan for the rollout of these life-changing diagnostic and preventive services has yet been released by the Government. Are they working on a rollout plan for fracture liaison services and, as the noble Baroness, Lady Donaghy, said, when do they intend to publish it—preferably avoiding the answer “in due course”? Can I tempt the Minister into sharing some clues or details on what might be in the plan? I know that many noble Lords of all parties and none support expanding this vital, preventive and effective service to as many people who need it as possible. Fracture liaison services are a world-beating preventive approach that we can all be proud of. If expanded, it would be good for those suffering from osteoporosis, good for the NHS and good for the Treasury.

20:20:00

My Lords, I congratulate the noble Lord, Lord Black, on securing this important debate and pay tribute to his very effective campaigning over many years. I am always touched when he refers to his mother; personally, I always feel that his campaigning shows great respect to his mother, and I am sure that the whole House appreciates that. I also enjoyed, as I am sure the noble Lord, Lord Kamall, did, his reminder to me and the now Opposition Front Bench of what we said when we were on the other side, and we are suitably—not chastened exactly—brought to book by his comments. I thank other noble Lords for their many insightful and accurate contributions. As I am sure noble Lords will be aware, I have much sympathy with many of the points that have been made. I know this is an issue close to many, either because of their own experience or that of those to whom they are close. As we have heard, including from the right reverend Prelate the Bishop of London, inequalities in access to and the quality of fracture liaison services have a significant impact on so many people across the country. Over half a million people in England alone suffer a fragility fracture every year. More than 40% of those will suffer another fracture within a decade. As the noble Lord, Lord Black, so powerfully illustrated, fracture liaison services can play a vital role in reducing the risk of refracture, improving quality of life and, importantly, increasing the number of years that can be lived in good health. Many noble Lords referred to the postcode lottery, including my noble friend Lady Quin and the noble Lord, Lord Rennard. Noble Lords spoke of the difference in access coming at a substantial cost. I agree; it is not only a cost for the NHS and social care, but there are also many personal costs of life-changing injury and increased mortality and morbidity. This cannot continue. Today’s debate refers to the progress towards universal provision by 2030. The noble Lord, Lord Black, and other noble Lords powerfully advanced the case for moving swiftly and the potential consequences of not doing so. It was suggested that there was funding from the previous Government for the expansion of fracture liaison services. All investigations show that no funding was ever confirmed or announced, including as part of the Major Conditions Strategy. I remind your Lordships’ House that the 2030 ambition for the rollout of fracture liaison services was first announced by the previous Government on the day after the election was called. On that point, I am very grateful for the understanding of a number of noble Lords, including the noble Lord, Lord Kamall, and my noble friend Lady Quin, that these are early days for the Government, but I will attempt to be helpful. This mission-led Government will expand access to fracture liaison services, alongside, importantly, delivering 40,000 more appointments each week and increasing diagnostic capacity to meet the demand for diagnostic services. Why? It is because fracture liaison services play a vital role in the mission to build an NHS for the future, where waiting times are reduced and more care is moved to the community, closer to where people need it. We have to be honest about the scale of the action needed, as noble Lords will know that this Government have been. I will make some points about the background and the challenges ahead. As the Chamber will understand, it will not be solvable overnight. My right honourable friend the Secretary of State commissioned an independent investigation into the NHS as one of his first actions in government. The findings by the noble Lord, Lord Darzi, laid bare the fact that the NHS currently has the longest waiting lists, the lowest patient satisfaction and a deterioration in the nation’s underlying health, with widespread problems for people accessing services. This includes fracture liaison services. In response, the Government announced the 10-year plan, which will be published next spring. The plan will be shaped by input from the public, patients and health and care staff through an engagement exercise—on which noble Lords heard me answer a Question from the right reverend Prelate earlier this week, who was good enough to raise it again today. The exercise was launched as: “The biggest national conversation about the future of the NHS”. It will include consideration of the three fundamental long-term shifts for health reform, as emphasised by my noble friend Lady Quin and the right reverend Prelate: hospital to community, analogue to digital and changing from sickness to prevention. I agree with noble Lords that fracture liaison services encapsulate all three. This is a long-term challenge and will take time to deliver, so the plan will consider what immediate actions are needed to get the NHS back on its feet and get waiting lists down, as well as long-term changes. We are continuing our close working relationship with NHS England to tackle issues related to provision of fracture liaison services, which are a crucial prevention service. The noble Lord, Lord Black, my noble friend Lady Donaghy and the noble Baroness, Lady Bull, along with other noble Lords, suggested a number of potential solutions. We are considering a wide range of options as we seek to identify the most effective ways of improving the quality of and access to the fracture liaison service model and the interventions it provides. I look forward to continuing work with noble Lords and being able to bring more information to this House. My noble friend Lady Ritchie referred to the role of ICBs, and this point was raised several times helpfully in the debate. As noble Lords are well aware, fracture liaison services are commissioned by ICBs and are making decisions according to local need. National expectations of ICBs and trusts for the next financial year will be set out in the 2025-26 NHS planning guidance. I know that the matter of finance has been raised a number of times, including by the right reverend Prelate. Along with many noble Lords here, we have benefitted from continuing engagement with the Royal Osteoporosis Society and a number of partners. The noble Lord, Lord Brownlow, rightly paid tribute to the role of Her Majesty the Queen. I felt that was an extremely important recognition with which I want to associate myself. In our engagement with our stakeholders, we are looking at the best ways to support the systems that work. The noble Lord, Lord Shinkwin, raised matters relating to those of working age. It is the case that osteoporosis and the risk of repeated fragility fractures remain significant contributors to economic inactivity. I was pleased to hear the noble Lords, Lord Black and Lord Shinkwin, recognise the significance of musculo- skeletal conditions as drivers of long-term sickness absence. It is absolutely the case that those conditions are the second leading cause of sickness absence and the leading cause of a reduction of years lived in good health and employment. There is much joint working going on between DWP, DHSC and NHS England under the Getting It Right First Time teams to deliver a programme, working with ICBs to reduce waiting times and improve data and referral pathways. The recent Get Britain Working White Paper included an announcement of £3.5 million in funding for this year to provide a model for musculo- skeletal community services to kick-start economic growth. The noble Baroness, Lady Bull, and the right reverend Prelate raised women’s health. The noble Lord, Lord Black, was kind enough to draw attention to my previous interest in the issue of fracture liaison services. That now chimes in very well with one of my responsibilities, as I am the Minister for women’s health. I am dismayed at how often women’s health needs are not considered when designing services, and even worse are the additional stark inequalities referred to by the right reverend Prelate. I assure your Lordships’ House that it is a priority for us to ensure that all women receive the high-quality care that they deserve. I close by restating our commitment to expanding access to these vital fracture liaison services. The work continues, and I look forward to updating noble Lords a number of times as we make progress together.