9. Short Debate: Dis-jointed care: Tackling joint and bone health in Wales

– in the Senedd at 5:26 pm on 5 June 2024.

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Photo of Elin Jones Elin Jones Plaid Cymru 5:26, 5 June 2024

We will be moving on now to a short debate. Some Members may be leaving; I ask them to do so quietly whilst Altaf Hussain prepares to introduce his short debate. We'll allow Members to leave first, in order for you to be heard in silence.

Photo of Altaf Hussain Altaf Hussain Conservative

Thank you. A little over 20 years ago I published a research paper, 'Evaluation of one-year mortality rates in elderly patients with proximal femoral fractures'. During my career as a consultant orthopaedic surgeon, I was seeing a worrying rise in elderly people dying from a hip fracture. When I conducted the research, I found that a delay in operating within 48 hours of the fracture occurring resulted in a doubling of the mortality rate, regardless of age; a 65-year-old person was just as likely to die as a frail 95-year-old. This is one of the factors that led me into the Senedd, swapping the scalpel for a lectern. No matter how well the surgery went, external factors delaying the treatment had the greatest impact on the outcome of the surgery. In the intervening years, mortality rates have remained stubbornly high. One in three adults aged 50 and over dies within 12 months of suffering a hip fracture. Older adults have a five to eight times higher risk of dying within the first three months of a hip fracture, compared to those without a hip fracture. This increased risk of death remains for almost 10 years. 

It is not just hip fractures that we have to worry about. There has been an alarming increase in a whole range of musculoskeletal disorders. They are the most common cause of severe long-term pain and physical disability, affecting hundreds of millions of people around the world. Common disorders such as osteoarthritis and osteoporosis are the leading chronic conditions in the elderly, affecting almost 50 per cent of people aged 65 and above. Forty per cent of people over 70 suffer from osteoarthritis of the knee, and 25 per cent of all those over the age of 60 have significant pain and/or disability from osteoarthritis. Eighty per cent of patients with osteoarthritis have some degree of limitation of movement, and 25 per cent can't perform their major daily activities.

Using disability adjusted life years, osteoarthritis is the fourth most frequent predicted cause of problems worldwide in women, and eighth in men. Fragility fractures have doubled in the last decade. Forty per cent of all women over 50 years will suffer an osteoporotic fracture. Osteoporosis causes bones to become weak and brittle—so brittle that a fall or even mild stresses, such as bending over or coughing, can cause a break. And it is well said that you stumble, you fracture, then you try to put weight on that limb, you can't, and you fall. So, it is the fracture first, then you fall.


The Deputy Presiding Officer took the Chair.

Photo of Altaf Hussain Altaf Hussain Conservative 5:30, 5 June 2024

Osteoporosis-related breaks most commonly occur in the hip, wrist or spine. Bone is living tissue that is constantly being broken down and replaced. Osteoporosis occurs when the creation of new bone does not keep up with the loss of old bone. Osteoporosis affects men and women of all races, but white and Asian women, especially older women who are past menopause, are at highest risk.

And that is the picture now, yet according to the latest stats and forecasts, the number of over-65s in Wales is predicted to rise by around 45 per cent in the next two decades. So, unless we do something radically different, we are going to see a dramatic rise in unnecessary deaths and avoidable disabilities, to say nothing of the strain we will place on our health and social care services.

We can’t seem to get a grip on waiting times despite the doubling of the health and care budget over the past quarter of a century. The average median wait for hip surgery was 452 days in Wales. Swansea had the longest wait times for hip replacements with an average 668 days' wait. Ninety-six thousand five-hundred patients were waiting for trauma and orthopaedic surgery across Wales, with nearly half waiting longer than nine months. A lot of local authorities had an average wait in days for admission over 379 days.

This means we need to redouble our efforts on falls prevention. After all, prevention is better than cure. This is the focus of this short debate. I want each of us to think about how we can protect our joints and protect our bone health, so we can prevent falls in later life. Of course, for those of us already in later life, maintaining joint and bone health is equally important. If we do have the misfortune to take a tumble, we have a much better chance if we have strong bones and healthy joints. And we can take simple steps to take care of our joints and bones: making simple changes to diet, taking simple exercises, and simply being aware of our surroundings to prevent falls.

We also need a women’s health strategy that addresses the impact menopause has on bone health. It’s a fact that women lose bone density following menopause, but with preventative treatment, sometimes as simple as a vitamin D supplement, we can ensure that those women don’t go on to develop osteoporosis.

There's a great number of interventions we can take to lower our risk of joint disease, fractures and the resulting premature deaths, which cost little or are even free. We can stop smoking and drinking too much alcohol. Research shows that both smoking and regularly drinking too much alcohol can lead to bone loss and increase the risk of breaking a bone. If you have smoked or drank a lot of alcohol in the past, your bones may have weakened over time. It's very important that you get enough calcium and vitamin D and exercise regularly to keep your bones as healthy as possible.

Dietary changes can ensure we get enough calcium and vitamin D. Eating calcium-rich foods is the best way to get calcium into your body. It is recommended that adults have 700mg of calcium each day. Adding calcium-rich foods to meals or as a snack is important. Calcium-rich foods include milk, cheese, yoghurt, calcium-enriched soya products, leafy green vegetables and dried fruits.

Vitamin D helps our bones absorb calcium. If you don't get enough, then your body does not absorb the calcium needed for stronger bones. The main source of vitamin D is from our skin's exposure to sunlight. Most people get enough in summer by spending short amounts of time in the sun without sunscreen. Most people don't get enough vitamin D from sunlight in winter, and it is difficult to get enough vitamin D from food alone. You should speak to your GP to see if they have or they would recommend taking a daily vitamin D supplement.

The other important step we can take is regular exercise. Weight-bearing exercises are the best for your bones. These exercises involve standing up and moving your feet and legs, for example, brisk walking, dancing and running. Making your muscles stronger can protect your bones and improve your balance. Muscle-strengthening exercises don’t have to involve you lifting weights at a gym. There are simple exercises you can do in the comfort of your own home, using items from around the house, such as tins of food or bottles of water.

If we can do these simple things, we can reduce our risk of joint pain and fractures. Simple interventions that can help us to maintain a healthier later life, but also reduce the strain on our NHS and social services departments. Diolch yn fawr.

Photo of David Rees David Rees Labour 5:36, 5 June 2024


And I call on the Cabinet Secretary for Health and Social Care to reply to the debate, Eluned Morgan

Photo of Baroness Mair Eluned Morgan Baroness Mair Eluned Morgan Labour

Diolch, Dirprwy Lywydd. I'd like to thank the Member for South Wales West for tabling this short debate today about the important topic of tackling joint and bone health in Wales. It's always intimidating to respond to Altaf Hussain, this incredible clinician, but this is his specialist area, so it's particularly intimidating this evening, but I'm sure he'll be pleased to hear that I attended and I spoke at the second national bone health conference in Wales at the end of April. 

Our long-term strategy for health and care, 'A Healthier Wales', emphasised the importance of well-being, prevention and early intervention to ensure that our health and care systems are more effective, equitable and sustainable. It highlights the need for better management of long-term and chronic conditions, and giving people the confidence and ability to manage and take greater control of their own health. It focuses on the need to enable and encourage good health and well-being throughout life, while anticipating and predicting poor health and well-being. 

But despite this preventative agenda and the particular focus on improving bone health, people are still experiencing falls and breaking bones. Now, the data tells us that one in two women and one in five men over 50 will break a bone in their lifetime. So, just imagine, that's half of you lot. Well, you're not all over 50. [Laughter.] But it's a lot of you. Let's just say that a lot of you will break a bone at some point. And the fact is that there's almost a million people in Wales with a musculoskeletal condition; that's about a third of the population. Now, with an ageing population and the added risk factor of more people living with chronic conditions, that I think is an incredibly high number.

Despite how common some of these conditions are, how frequent fractures and falls are, and the impact on people's lives, the fact is that joint and bone health do not always receive the level of attention that other major health conditions do. It's because of the impact it has on an individual's life and their independence, and the impact and the cost for the health service—not just the health service, as he pointed out, but social services—and the wider community that I've made it a priority. 

So, the evidence shows that fracture liaison services bring clear benefits to individuals in the long term, and have been shown to be clinically effective and cost-effective. That's why, last year, I made a commitment to achieving 100 per cent fracture liaison service coverage in Wales by September 2024, which would be I think nation leading, and we're well on our way to achieving that. Much of this progress would not have been possible without the excellent clinical leadership of Dr Inder Singh. He's working closely with members of the fracture liaison service, the quality assurance group, and the dedicated health board clinical leads. And I've made £1 million available specifically for this service.

We continue to fund participation in the internationally renowned falls and fragility fracture audit programme, which provides us with a suite of data to help us measure what's working and where we need to focus our attention to improve bone health services. Following the publication of our national planned care recovery plan in 2022, we've also seen significant improvements in the reduction of long waits in orthopaedics. You can imagine, I have been breathing down their necks, all over the country, when it comes to orthopaedic surgery and getting those longest waiting lists down, and they are coming down very dramatically. Out-patient waits of more than 52 weeks have fallen by 71 per cent since April 2022, and two-year waits for treatment have fallen by 72 per cent.

Photo of Baroness Mair Eluned Morgan Baroness Mair Eluned Morgan Labour 5:40, 5 June 2024


There's a lot more for us to do to reduce long waiting times, but these reductions do show the attention that we and the health service have been giving to orthopaedics. With partners, every health board has a local action plan, and these follow good clinical practice in terms of the Getting It Right First Time approach, GIRFT, and a local review of that approach. Assistance before and after treatment has also been important, and our national policy supports people on the orthopaedic pathway, particularly in managing symptoms. It also assists them in strengthening before treatment.

In addition, the national 3Ps policy, waiting well, has been developed with Cymru Versus Arthritis. It addresses the needs of people on the musculoskeletal pathway, or MSK, who perhaps need more support as they wait. This focuses specifically on secondary care, but prevention is also very important. We need to ensure that people are aware of these conditions and the support available through primary care and in the community, and we're very fortunate that the third sector supports us in this regard.

I'm pleased that the new body of the NHS executive has acknowledged the importance and impact of these conditions. It has given priority to the strategic clinical network for MSK and established clinical operational networks for bone health and orthopaedics within this network. These groups will bring health workers, the public, primary care, secondary care and tertiary care together with the third sector and with communities.

Last year, we published the quality statement for MSK. We are now creating a quality statement for bone health. These documents set out our vision for improved healthcare for MSK and bone health throughout people's lives and across Wales, and they will assist us to integrate health services, to provide tailored care and to make improvements to the quality of care for musculoskeletal conditions.

So, thank you once again for raising this issue, and for the opportunity to highlight the steps that we are taking to make improvements in bone and joint health in Wales.

Photo of David Rees David Rees Labour 5:43, 5 June 2024


I thank the Cabinet Secretary, and that brings today's proceedings to a close.


The meeting ended at 17:43.