King’s Speech

Baroness Donaghy Excerpts

Thursday 9th November 2023 Lords Chamber

[Baroness Donaghy (Lab)]

My Lords, it is always a pleasure to follow the noble Baroness, Lady Browning. I found myself in the position that she has just described only last year.

I appreciated the tone of the Minister’s introduction to the debate. The gracious Speech referred to delivering on the NHS workforce plan, the first long-term plan to train the doctors and nurses that the country needs. If I had taken 13 years to produce a workforce plan, I would not want to crow about it—and if I had possibly fewer than 12 months in which to deliver it, I would expect a sceptical response.

To give equal weight to minimum service levels to prevent strikes undermining patient safety is a useful electioneering point, but it neglects the fact that most people do not blame the NHS staff for fighting their corner but they do blame this Government for bringing the health service to its knees.

I want to concentrate on two omissions in the gracious Speech relating to the health service. One omission, for which I am profoundly grateful, is that there is no major reorganisation of the health service planned. How much time, money and effort have been put into reorganisations by this Government in the last 13 years, which could have been spent on positive progress?

The second omission is any reference to osteoporosis care. If mental health is the Cinderella service, treatment for the prevention and care of osteoporosis is even further behind. I want to press the Minister on what steps the Government intend to take to end the postcode lottery, whereby some people access a world standard of care while others are fixed up and forgotten in A&E fracture clinics, leaving them at high risk of further injury.

On 14 September this year, we had an excellent debate led by the noble Lord, Lord Black of Brentwood, on improving access to and quality of services in England for people with osteoporosis and those at risk of fractures. The Minister, the noble Lord, Lord Evans of Rainow, said in his summing up:

“We are proposing to announce, in the forthcoming Autumn Statement, a package of prioritised measures to expand the provision of fracture liaison services and improve their … quality”.—[Official Report, 14/9/2023; col. GC 241.]


Some of us were pleased and, frankly, quite surprised by the positive response from the Minister to the debate. However, the following day we sank back down into the slime of low expectation and inaction when we received a “what I should have said” letter from the Minister. I should emphasise that this is not a personal attack on the noble Lord, Lord Evans of Rainow, who sent a detailed response to all those who took part in the debate and who was positive and constructive throughout—perhaps too positive for HM Treasury, which does not like what it regards as premature announcements. The letter from the noble Lord to participants said:

“I should have said ‘the Government will continue to consider options for further work to support those with osteoporosis and at risk of fractures’”.


He concluded by saying:

“I hope this clarification is of use”.

I am prepared to swallow my disappointment at the retraction and even accept that there may have been a breach of Treasury etiquette, but the real issue is whether the Treasury will fund a proposal for a package of funding to support fracture liaison services. This is currently offered to only 51% of NHS trusts in England.

If funding for the package is included in the Autumn Statement, it will be possible to free up 750,000 hospital bed days by 2028, including prevention of 31,000 life-threatening hip fractures. This is an invest-to-save measure that would free up hospital beds—1 million acute hospital bed days are taken up by hip fracture patients—and would prevent disability, or further disability. A universal fracture liaison service would reduce re-fracture levels by up to 40% and improve the chances of providing anti-osteoporosis medications. The stark and horrific fact is that two-thirds of people at risk are missing out on anti-osteoporosis medication—that is 90,000 people.

Fractures caused by osteoporosis affect half of women over 50 and one-fifth of men. They are the fourth most consequential health condition measured in disability and premature death. Hip fracture care costs £2 billion per year, and family carers give 227 hours per year to sufferers. Preventing fractures can help the economy, because 2.62 million sick days a year are caused by osteoporosis fractures, and can help levelling up, because people from lower-income households have a 25% higher risk of fractures and a higher mortality rate following hip fractures.

The Sunday Express has been running a Better Bones campaign, which has attracted widespread support. This needs some strong, visible leadership from the Government and NHS, so that everyone over 50 should have access to quality-assured services. There is already a ministerial model available, adopted in Wales from February 2023. Osteoporosis sufferers have missed out because of the short-term planning forced on the NHS. With focused funding and determined leadership, we might just catch up with the best providers.