My Lords, the steps we are taking in this area include guidance via a commissioning toolkit to support organisations on effective falls and fracture prevention and management, NICE's published guidance on osteoporosis, falls and fractures-NICE is also working on clinical guidelines for hip fractures for publication in spring 2011-and a best-practice tariff which offers financial incentives to hospitals meeting quality standards for hip fracture patients, including a fracture prevention assessment.
My Lords, I thank my noble friend for his comprehensive reply and welcome the progress that has been made. We must bear in mind that last year alone, some 65,000 people were admitted to hospitals for hip fractures, which represents an increase of 17 per cent on the previous decade and is one of the highest figures in Europe. Will my noble friend ensure that the outcomes framework currently under review, which concentrates mostly on hip fractures, also includes indicators to reduce all fragility fractures? That would ensure that the NHS puts a comprehensive fracture preventive service in place.
My Lords, my noble friend is right to say that the outcomes framework will be central to assessing the performance of the NHS and driving up quality generally. The framework is still in development, and my department is currently looking at the responses to the recent consultation and carrying out the necessary analysis to ensure that it is as balanced and robust as possible. Having said that, the consultation document contained a number of proposed indicators that relate to falls and fragility fractures which are candidates for inclusion in the framework, although the department cannot take any final decisions until we have digested all the consultation responses.
My Lords, is the Minister aware that drugs are now available that can halt the progression of osteoporosis? Is he satisfied that there are sufficient facilities in hospitals across the country to carry out bone density measurements, from which the position can be assessed at an early stage to allow those at risk to be given appropriate treatment?
My Lords, the NHS in England has invested in additional diagnostic capacity over recent years, including the provision of more DEXA scanners, which are bone density scanners. The most recent data I have show that only 145 people in England waited for more than six weeks for a bone scan, and of those only seven had been waiting for over 13 weeks. That does not suggest that there is undercapacity. However, the noble Lord is right to say that several treatments are available, along with many messages put out by the department to promote a healthy lifestyle in order to prevent fractures.
My Lords, is the Minister aware that a number of excellent leaflets containing information about the prevention of osteoporosis are available? What initiatives are in place to encourage the distribution of these leaflets in libraries, supermarkets, gyms and so on to enable women and men to get the information they need?
My Lords, information is produced by the National Health Service on the risk of fragility fracture and, indeed, on how to prevent it. A number of good and authoritative sources of information exist on this topic, not simply from the NHS, but I would just say that information on osteoporosis is available on the NHS Choices website, which of course is accessible on computers, including those in libraries.
My Lords, if the normal communal incidence of osteoporosis were to be applied to your Lordships House, it is likely that half or even more than half of its membership would be suffering from it, even if they were not aware of any symptoms. That tells us what a common disorder we are dealing with. Does my noble friend agree that it is important to raise public awareness not just of diagnosis and treatment, but of how lifestyle changes to diet, smoking behaviour and alcohol consumption are extremely important in making sure that these adverse consequences do not arise?
My noble friend is right. The job of the NHS in its public health role is to provide information about healthy lifestyle choices. NHS Direct does this at the moment, and in the future we will be looking to the new national public health service to maintain the provision of high quality and authoritative health advice. Moreover, as my noble friend says, that advice includes information about the value of a diet rich in vitamin D from oily fish, liver, cereals, eggs and so forth, as well as from safe exposure-I emphasise the word "safe"-to natural daylight.
My Lords, it is difficult for the House to decide between the noble Baronesses, both of whom I am sure noble Lords would like to hear. Perhaps if one takes priority over the other, we might get both in. I am asking for one of them to give way.
My Lords, it is well known that if an elderly or frail person living at home has a fall which results in a hip fracture is monitored, a great deal of future pain, distress and huge expense to the NHS can be avoided. Does the Minister agree that installing a fracture liaison service in every health area would reduce this serious situation and that the Government ought to make public that aim?
The noble Baroness is correct: fracture services have produced some positive results where they have been used in various parts of the country. I can best answer her question in two brief ways. While decisions about the provision of particular services are best taken locally, it will be the outcomes framework, which I have mentioned, and the incentives that go with it, that will determine the extent to which the NHS locally responds to needs related to this area. Funding for the NHS is protected and will increase above inflation every year of this Parliament. In this difficult climate, that demonstrates the Government's determination to provide the best outcomes from services, including falls and fractures services.