Fracture Liaison Services

Lord Haskel Excerpts

Thursday 16th October 2025 Grand Committee

[Lord Black of Brentwood (Con)]

My Lords, at the start of September the Prime Minister made it clear that his Government are now entering the delivery phase. I take him at this word and would like our debate today to focus on helping him to do just that, by setting out how they can deliver on three goals: reducing waiting lists and saving lives; boosting economic growth; and protecting the most vulnerable in our society, particularly the elderly. There is one simple way to deliver speedily on all three: publish the long-awaited bone plan before Christmas.

During the election, the Health and Social Care Secretary said, to his great credit, that developing the rollout plan for fracture liaison services would be one of his first acts in Government. Unfortunately, we are still waiting. In recent years we have had numerous debates on osteoporosis, resulting in clear commitments to move forward, but the truth is that, while their expansion has happened at pace in Wales, we have seen no progress at all in England.

The case for doing so is as strong as ever. Half of women aged over 50 and one-fifth of men will suffer disabling and potentially fatal fractures because of osteoporosis. There are effective medications that prevent fractures and preserve people’s independence, but, shockingly, two-thirds of osteoporosis patients are missing out on that treatment because this Government—and indeed the last one, I readily admit—have so far failed to match words with deeds. The end result of untreated osteoporosis is a broken hip, which results in a three-week hospital stay and kills one-quarter of people within a year. The majority of those who survive face a life infinitely smaller and consumed with pain. I know because I saw it with my own mum, whose latter years were dominated by agony and disability because her osteoporosis was not treated properly.

Campaigns run by two newspapers, the Sunday Express and the Mail on Sunday, have brought this injustice out of the shadows and achieved a consensus on the way forward. This is not a partisan issue; I suspect that we all agree on both the ends and the means. We just need to get on with it.

To turn back to delivery, during the election the Health Secretary made two commitments to people living with osteoporosis. The first was to increase the number of DEXA scans. I thank him and the Government for the £2 million for new scanners released to fulfil that first promise. That is a good start, but fracture prevention relies on more than just a scan. If heart disease patients got only ECGs but then no treatment, there would be outrage. If you want to prevent secondary heart attacks, you do not stop at a cholesterol test.

That is why the second commitment made by the Health Secretary is much more consequential. He promised to expand fracture liaison service clinics to all areas by 2030 so that we can prevent 74,000 fractures by that date, including 31,000 life-threatening hip fractures. Ministers have repeatedly given that commitment to Parliament and, thankfully, the policy is enshrined in the 10-year plan. Again, that is a good start but, despite those commitments, we have heard nothing about how or when it is to be implemented, hence this debate today. The time between now and Christmas is critical if we are to meet the Government’s promise. This afternoon, I ask the Minister to consider three reasons why publishing the bone plan is now extremely urgent.

First, the stakeholder community that will make implementation possible is ready and raring to go. It simply needs the starting gun to be fired. The Royal Osteoporosis Society has been in the vanguard, and I pay immense tribute to its tireless campaigning, but it is much more than one organisation. There is now a community of interest around fracture prevention, composed of 60 organisations with various stakes in women’s health, healthy aging, easing burdens on the NHS and keeping older employees in the workforce. On the medical side, that includes seven royal medical colleges along with the representative bodies for physiotherapists, radiographers, social workers and paramedics.

Leading business voices and the trade unions have called for nationwide FLS because economic growth is being stunted by older workers stopping or reducing work due to fractures. Last year, a dozen eminent societies formed a shadow implementation group to help Ministers deliver the FLS policy. An exemplar rollout plan and high-level recommended approach was submitted, but there has been no response from the Government. The current information vacuum is undermining confidence among these organisations. Unless the bone plan emerges by the end of the year, it will be impossible to maintain belief across the sector that FLS will ever become a reality.

Secondly, every year that we delay we see a cascade of preventable fractures, and that costs money, which we all know is in short supply. If we had rolled out FLS in summer 2024, by now we would have saved £60 million, two-thirds of the money needed to pump-prime every FLS across England up to break-even point. I sympathise with the Health Secretary’s comments, reported in the press last week, about “invest to save” initiatives such as FLS needing investment before savings accrue, but achieving the shift that he rightly wants to make from treatment to prevention must start somewhere. You will not find many other treatment models that break even within just 24 months and deliver £1.88 for every £1 invested. This is about replacing badly-spent money with sensible investment in prevention.

It is not just about the money that is being wasted. Every year that we delay the FLS rollout, another 2,500 people die following broken hips, which FLS clinics could have prevented. That’s 2,500 mums and dads, grandmas and grandpas.

Thirdly, the vacuum of information around FLS is in fact causing perverse outcomes which undermine the prevention of fractures. For the last 16 months, government spokespeople have consistently told newspapers that a national rollout of FLS is imminent. Ministers have given the same commitments repeatedly to both Houses of Parliament. That is great but it should therefore not surprise the Government that commissioners who would have acted on FLS independently have, as a result, paused their plans awaiting a national rollout plan and that, since the election, no new FLSs have opened. That is why I make this appeal to the noble Baroness and her colleagues: please publish the bone plan. You may otherwise be unintentionally harming the important cause of fracture prevention rather than advancing it.

A huge amount of energy and impetus have built up around this issue over recent years. Numerous organisations want to help Ministers, in good faith, to turn it into an example of NHS reform under this Government—serving all three of the strategic shifts that the Health Secretary wants to drive. But uncertainty is eroding that energy and good will, when it could so easily be harnessed for the public good.

I am sure that in her response, to which I much look forward, the noble Baroness will repeat the reassurances given repeatedly to Parliament that FLSs will be implemented by 2030. But I beg her to ask her colleagues, please, to fire the starting gun now by publishing the implementation plan by year-end. Everyone here today—I thank noble Lords so much for taking part, which shows how important this debate is—wants simply to get on with it. Let us make it happen by Christmas. For thousands of families and vulnerable individuals, it would be the best possible present they could ever receive.

[The Deputy Chairman of Committees (Lord Haskel) (Lab)]

My Lords, the timer seems to have stopped. We will take a short break while it is being fixed.

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[The Deputy Chairman of Committees (Lord Haskel) (Lab)]

My Lords, the Grand Committee has been suspended as a result of technical issues. We will now resume and finish at 5.16 pm. Will noble Lords please bear that in mind and maybe knock a minute or two off their speeches?

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[Baroness in Waiting/Government Whip (Baroness Blake of Leeds) (Lab)]

My Lords, I congratulate the noble Lord, Lord Black, on securing this important debate and thank all noble Lords for their significant contributions. I pay tribute to his personal background; it has brought such depth and strength of feeling to the subject, and I am sure many noble Lords have similar experiences. His persistence in carrying on with this is noted and welcomed. He is right to highlight the importance of reducing waiting lists, driving economic growth and safeguarding the most vulnerable members of our society.

We know that patients, including those with osteoporosis fragility fractures, are waiting too long for care and treatment, which needs to change, as I think all noble Lords have mentioned. This is why, between July 2024 and August 2025, the NHS provided more than 682,000 DEXA scans to patients across the country. As announced earlier this year, we are investing in 13 DEXA scanners to support improvements in early diagnosis and bone health and provide an estimated 29,000 extra scans a year once operational. I completely understand the points in the noble Lord’s speech about the need for follow-up action once the scans have been implemented.

I shall pick up the comments made by my noble friends Lady Royall and Lady Hayter. I think there is an enormous recognition of the need to focus on women’s health; that is an accepted aspect of all the work that we are doing. More generally, we want every person, including those with osteoporosis, to receive the highest quality compassionate care. In the past three years, two new drugs have been recommended by the National Institute for Health and Care Excellence for the treatment of osteoporosis in postmenopausal women, for example. Going back to women’s health, through our 10-year health plan and the women’s health strategy update, we are delivering our manifesto commitment that never again will women’s health be neglected.

The three shifts that I will go on to talk about—hospital to community, analogue to digital and treatment to prevention—are key aspects of the work that we need to do. Following from that, the 10-year workforce plan will ensure that the NHS will have the right people in the right places with the right skills to care for patients when they need it. That is a critical aspect. I will write to my noble friend Lady Royall with the more specific detail, if that is okay.

As the noble Lord, Lord Black, illustrated so powerfully, fracture liaison services can play a vital role in reducing the risk of refracture, improving the quality of life and increasing the years lived in good health. This Government and NHS England support the clinical case for services that help to prevent fragility fractures and support patients who sustain them. As we have heard, we are committed to rolling out fracture liaison services to every part of the country by 2030. As my noble friend Lady Hayter said, this is a genuine commitment. One of the early priorities of the 10-year plan will be a modern service framework for fragility and dementia. This is the first time that this has been introduced.

Going back to the 10-year plan, it is absolutely critical that we provide better care for people with osteoporosis, fragility fractures and other MSK conditions. The noble Lord, Lord Rennard, mentioned the problems with public health that we all know—as a former local government leader I know them only too well. Supporting the shift to prevention, the health system is working to prevent fractures occurring in the first place. Advice from NICE for clinicians includes information and advice on lifestyle changes a person can make to reduce their risk of fragility fracture, which the noble Earl, Lord Effingham, mentioned. These include increasing vitamin D intake, eating a balanced diet, drinking alcohol in moderation, stopping smoking if applicable and participating in a combination of exercise types. These are all absolutely fundamental in working towards the prevention agenda.

We are working to deliver the Getting It Right First Time MSK community delivery programme. The specific teams in this area are working with integrated care board leaders to reduce community waiting times and improve data, metrics and referral pathways to wider support services. Under the 10-year health plan, patients with MSK conditions will soon be able to bypass their GPs and directly access community services, including physiotherapy, pain management and orthopaedics, via the NHS app.

Our vision for a neighbourhood health service is also core to achieving the three shifts. The Department of Health and Social Care and NHS England are working closely together to progress our commitment to shift to a neighbourhood health service. The 10-year plan includes fracture liaison services as a specific example of the services that neighbourhood health centres could host.

As we have heard, fracture liaison services are commissioned by integrated care boards, which we believe are well placed to make decisions according to local need. This Government are committed to giving integrated care boards the freedom and autonomy they need to focus on the job of meeting patients’ needs and improving the communities they serve. I am pleased to say that 41 out of the 42 ICBs have a women’s hub. We need to make sure that they are delivering in this space.

Officials in the Department of Health and Social Care are working closely with NHS England to consider a range of options to ensure the improved quality of and access to these important preventive services. We need to be honest about the scale of the action needed, the challenges faced across the health and care system and the fact that change will not be possible overnight.

I recognise that many are dedicated to campaigning for fracture liaison service expansion. I thank the noble Lord, other contributors to this debate and the All-Party Parliamentary Group on Osteoporosis and Bone Health for its work. It is absolutely critical that we raise awareness of this vital issue and try not to wait until it is too late and a fracture has occurred. This is a very important aspect of the work that everyone is pulling together. I thank the clinicians and commissioning bodies that play such a vital role in delivering fracture liaison services.

In response to the noble Baroness, Lady Chisholm, on this point, we talk about politicians, but over the past year, officials, including senior civil servants, have engaged on various occasions with the Royal Osteoporosis Society on fracture liaison services, and they will continue to do so.

I do not have time to respond to all the comments, but I will pass on the comments of the noble Lord, Lord Shinkwin, to the Secretary of State. I thank him for his very clear exposition of his experience. I also undertake to pass on the comments of the noble Baroness, Lady Royall.

I close by simply restating the Government’s commitment to ensuring access to care where and when it is needed. Once again, I thank noble Lords for today’s discussion on such an important topic.

[The Deputy Chairman of Committees (Lord Haskel) (Lab)]

My Lords, I am sure we all thank the speakers for their brevity in reaction to the technical issues.

Committee adjourned at 5.06 pm.