Part of the debate – in the House of Commons at 12:05 pm on 26 October 2023.
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,
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.