Asked by: Baroness Merron (Labour - Life peer)
Question to the Department of Health and Social Care:
To ask His Majesty's Government, further to the reply by Lord Markham on 19 January 2023 (HL Deb col 1926), what is meant by “different versions” of the fracture liaison service.
Answered by Lord Markham - Parliamentary Under-Secretary (Department of Health and Social Care)
The Government and NHS England recognise the value of quality-assured secondary fracture prevention services, including Fracture Liaison Services (FLS). Some local health systems may offer secondary fracture prevention support without using FLS. Examples might include medication management for people at risk of osteoporosis, falls prevention services and frailty programmes.
Asked by: Baroness Merron (Labour - Life peer)
Question to the Department of Health and Social Care:
To ask His Majesty's Government what proportion of England has a full fracture liaison service.
Answered by Lord Markham - Parliamentary Under-Secretary (Department of Health and Social Care)
According to figures from a Freedom of Information request by the Royal Osteoporosis Society cited in an All-party Parliamentary Group inquiry report in 2021, 51% of National Health Service trusts in England provided a fracture liaison service in the same year. A copy of the report is attached.
Asked by: Baroness Merron (Labour - Life peer)
Question to the Department of Health and Social Care:
To ask His Majesty's Government what assessment they have made of the level of fracture care in areas where there is no full fracture liaison service.
Answered by Lord Markham - Parliamentary Under-Secretary (Department of Health and Social Care)
The National Institute for Health and Care Excellence (NICE) has published multiple best practice clinical guidelines on assessing and managing fractures, including assessing and managing the risk of fragility fractures in people aged 18 years old and over with osteoporosis. These include details on drug treatments and lifestyle information. NICE guidelines are not mandatory, although health and care commissioners are expected to take them fully into account.
Some local health systems may offer secondary fracture prevention support without using fracture liaison services. Examples might include medication management for people at risk of osteoporosis, falls prevention services and frailty programmes.
Asked by: Baroness Merron (Labour - Life peer)
Question to the Department of Health and Social Care:
To ask His Majesty's Government what actions they have taken in response to the Medical Research Council's UK primary care-based ‘Screening for Osteoporosis in Older People’ trial.
Answered by Lord Markham - Parliamentary Under-Secretary (Department of Health and Social Care)
The Government has not taken any specific action in response to the Medical Research Council's primary care-based trial, Screening for Osteoporosis in Older People. However, there are actions that the Government is taking more generally, to support people with osteoporosis and increase early diagnosis.
The Government is working to set up 160 community diagnostic centres (CDCs) across the country by March 2024. Some of these CDCs will offer bone density scans which can be used to diagnose or assess patients’ risk of osteoporosis. Our ambition is that 95% of patients needing a diagnostic check will receive it within six weeks, by March 2025.
On 24 January 2023, we announced our plan to publish the Major Conditions Strategy. The strategy will focus on six major groups of conditions, including musculoskeletal (MSK) disorders such as osteoporosis. We have since published our initial report Major conditions strategy: case for change and our strategic framework, which is available on the GOV.UK website, in an online only format. For MSK conditions such as osteoporosis, it sets out our aims to improve services where medical treatment is necessary. Together with NHS England, we will explore supporting the further provision of fracture liaison services. This could include identifying people at risk of further osteoporotic fragility fractures and implementing strategies to reduce the risk of future fractures, including from falls, and mortality.
Valuable research work is also being funded by the Department, through the National Institute of Health and Care Research, which has awarded £173 million to research into MSK conditions in the last five years.
The UK National Screening Committee (UK NSC) last reviewed the evidence to screen for osteoporosis in postmenopausal women in 2019, recommending that a population screening programme should not be introduced. The review identified that there were key areas of uncertainty around the test and treatment and that further research was needed. The research showed that screening all women for osteoporosis does not reduce the number of fractures compared to current care.
The UK NSC can be alerted to any new published peer-reviewed evidence which may suggest the case for a new screening programme via its annual call, which will open in July 2024.
Asked by: Baroness Merron (Labour - Life peer)
Question to the Department of Health and Social Care:
To ask His Majesty's Government what discussions they have had with the General Medical Council regarding the regulation of medical apprenticeships.
Answered by Lord Markham - Parliamentary Under-Secretary (Department of Health and Social Care)
The Department has regular discussions with the General Medical Council (GMC) on a range of issues, including all aspects of the introduction of the medical degree apprenticeship. People who undertake and successfully complete the medical degree apprenticeship will receive the same medical degree as those who study through a full-time university medical degree route and will need to achieve the same outcome standards set by the GMC.
Asked by: Baroness Merron (Labour - Life peer)
Question to the Department of Health and Social Care:
To ask His Majesty's Government what plans they have, if any, to further regulate medical apprenticeship programmes.
Answered by Lord Markham - Parliamentary Under-Secretary (Department of Health and Social Care)
The Department has regular discussions with the General Medical Council (GMC) on a range of issues, including all aspects of the introduction of the medical degree apprenticeship. People who undertake and successfully complete the medical degree apprenticeship will receive the same medical degree as those who study through a full-time university medical degree route and will need to achieve the same outcome standards set by the GMC.
Asked by: Baroness Merron (Labour - Life peer)
Question to the Department of Health and Social Care:
To ask His Majesty's Government what discussions they have had with (1) medical royal colleges, and (2) medical professional bodies, about the establishment of medical apprenticeships.
Answered by Lord Markham - Parliamentary Under-Secretary (Department of Health and Social Care)
NHS England is providing £150,000 of funding per medical degree apprentice over the term of the programme, as an Employer Support Fund, for cohorts that commence in 2024 and 2025.
Medical schools will receive the Strategic Priorities Grant, funded by the Office of Students, for cohorts commencing in 2024 and 2025. Employers can utilise their apprenticeship levy up to a maximum of £27,000 over the term of the programme as a contribution to medical school tuition fees.
The Department has regular discussions with the medical royal colleges and medical professional bodies about a range of issues, including the introduction of the medical degree apprenticeship.
Asked by: Baroness Merron (Labour - Life peer)
Question to the Department of Health and Social Care:
To ask His Majesty's Government how much funding has been provided for medical apprenticeships by (1) Health Education England, and (2) other sources.
Answered by Lord Markham - Parliamentary Under-Secretary (Department of Health and Social Care)
NHS England is providing £150,000 of funding per medical degree apprentice over the term of the programme, as an Employer Support Fund, for cohorts that commence in 2024 and 2025.
Medical schools will receive the Strategic Priorities Grant, funded by the Office of Students, for cohorts commencing in 2024 and 2025. Employers can utilise their apprenticeship levy up to a maximum of £27,000 over the term of the programme as a contribution to medical school tuition fees.
The Department has regular discussions with the medical royal colleges and medical professional bodies about a range of issues, including the introduction of the medical degree apprenticeship.
Asked by: Baroness Merron (Labour - Life peer)
Question to the Department of Health and Social Care:
To ask His Majesty's Government, further to the Written Answer by Lord Markham on 9 February (HL2206), whether a specific body will be set up to lead their joint exploration, with NHS England, of supporting the provision of fracture liaison services.
Answered by Lord Markham - Parliamentary Under-Secretary (Department of Health and Social Care)
As per the Major Conditions Strategy: Case for change and our strategic framework, the Government, together with NHS England, will explore supporting the provision of fracture liaison services. The Government has no current plans to set up a specific body to lead this joint exploration, as this is part of the ongoing policy engagement between the Department and NHS England.
Asked by: Baroness Merron (Labour - Life peer)
Question to the Department of Health and Social Care:
To ask His Majesty's Government whether they intend to commission further research into the accuracy of BMI thresholds for (1) adults, and (2) children.
Answered by Lord Markham - Parliamentary Under-Secretary (Department of Health and Social Care)
The National Institute for Health and Care Excellence (NICE) recommends that Body Mass Index (BMI) for adults and BMI centile, adjusted for age and sex, for children and young people should be used as a practical measure for estimating and defining adiposity, the measure of fatty tissue. In September 2022, NICE reviewed evidence on the most accurate methods and thresholds for assessing the risk associated with overweight and obesity in adults, children and young people, which included BMI.
The Government accepts NICE’s evidence review and recommendations on BMI, including that: BMI is used as a practical measure of overweight and obesity in both adults and children and young people but needs to be interpreted with caution because it is not a direct measure of central adiposity, the accumulation of excess fat in the abdominal area which directly relates to health risks such as type 2 diabetes, hypertension and cardiovascular disease; in adults with a BMI below 35 kilograms per metre squared, waist-to-height ratio should be measured and used as well as BMI, as a practical estimate of central adiposity; in children or young people with a BMI on or above the 91st centile, waist to height ratio should be measured to estimate the degree of central adiposity to help identify or predict future health risks; and a child’s BMI centile should always be plotted on the Royal College of Paediatrics and Child Health UK-World Health Organization growth charts and BMI charts.
NICE also recommended further research, for adults as well as children and young people, on the most accurate and suitable measurements and boundary values to assess the health risks associated with overweight, obesity and central adiposity in people of different ethnicities, particularly those from black, Asian and minority ethnic family backgrounds.
The Department have noted NICE’s recommendations for research. The Department delivers research through the National Institute for Health and Care Research, which funds and supports research across all areas of health and social care, including obesity. Research proposals in all areas compete for the funding available, with awards made on the basis of scientific quality, value for money, and importance of the topic to patients and the health and care system.