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NHS: Osteoporosis Services

asked Her Majesty’s Government what steps they are taking to improve osteoporosis services within the National Health Service. The noble Baroness said: My Lords, I welcome this opportunity to raise in the House the issue of how the National Health Service currently diagnoses and treats osteoporosis. I also welcome the fact that a number of colleagues who take a keen interest in this subject are present; I particularly welcome the presence of the noble Baroness, Lady Cumberlege, who chairs the All-Party Parliamentary Group on Osteoporosis. I have no direct interest to declare, so I will begin by explaining how I first became interested in this issue. When I passed the landmark age of 60—a not unusual experience in this House—my GP said that she would have ideally liked me, in common with a number of her patients, to have a bone density scan, but that unfortunately the DEXA scanning facilities were not available in our area. As a result, I became interested in the availability of such scanning facilities. Through Parliamentary Questions, I became aware that the provision of DEXA scanners seems to be yet another example of the postcode lottery that we hear about and that provision is inadequate and patchy. I realise that routine scanning—say of all women over 60—is not the best way forward, but what particularly concerns me about the current situation is that women and men who are at risk of developing osteoporosis are not being systematically identified and offered scanning or other osteoporosis services on anything like the scale needed. It is true that the Government have increased funding for DEXA scanners, but not to the extent required for good provision throughout the country. Neither was the money for scanners ring-fenced; in Answers to Parliamentary Questions I was unable to get any reassurance that all the money had actually been spent on scanners. I am also concerned that, as I found from Answers given to my Parliamentary Questions and to those tabled by Members in another place, the department seems to hold so little information centrally on the availability not only of scanners but of other osteoporosis services throughout the country. Given that the Minister and the department are committed to improving services in this area, it is regrettable that so little information about what is actually happening on the ground is currently being collected or assessed at national level. Although my initial contact with the issue of osteoporosis arose from the specific problem relating to scanners, I have since become interested in the wider question of how effectively osteoporosis is diagnosed and treated throughout the country. I would like to say how grateful I am to the National Osteoporosis Society, whose briefings and expertise have been a huge help. I am also grateful to the other organisations that have shown an interest in this debate, including Help the Aged. There can be no doubt that osteoporosis is a very important issue for the NHS. It is said to affect as many as one in two women and one in five men in the UK. Although it principally affects older people, we must remember that, in a society like ours where life expectancy and the proportion of older people have increased, it is very significant. The National Osteoporosis Society has calculated that the combined cost of hospital and social care for patients with a hip fracture alone amounts to more than £1.73 billion, which is equivalent to the annual cost of treating coronary heart disease. I also understand from the Department of Health’s hospital episode statistics that fractures in patients aged 60 years or over account for 2 million hospital beds in England each year, which is more than for diabetes, heart failure and obstructive airways diseases. The timely diagnosis and prevention of osteoporosis is therefore a telling example of where the principle of spend to save applies. It applies both in cost terms to the NHS in the long term but, just as important, by helping to prevent people from suffering life-changing and life-worsening fractures and thereby allowing those people to retain a much better quality of life. There are three principal, interlinked ways in which the diagnosis and treatment of osteoporosis can be improved. They are all important if we are to get a properly integrated and effective national osteoporosis service. First, in relation to GPs, the quality and outcomes framework that rewards GPs and incentivises them financially to provide quality care in specific disease areas should be modified to include osteoporosis. I know that the National Osteoporosis Society has made a strong case for including clinical indicators for osteoporosis in the current review of the QOF and I hope that the Government will support this. It would ensure that a higher priority was given throughout the country to osteoporosis prevention and its treatment in GP practices. Secondly, there is the important issue of osteoporosis and the current guidance from the National Institute for Health and Clinical Excellence. I shall refer to two aspects of the NICE guidance. Perhaps the most pressing and the most timely issue from the point of view of this debate relates to the technology appraisal of drugs used in treating osteoporotic fractures. NICE issued its final appraisal determinations in this area on 26 June this year, but only this past Monday, 22 October, was an appeal against this heard. The outcome will be known shortly. Perhaps in her reply, the Minister can say precisely when this will be published. The guidance issued in June by NICE, which is mandatory, stipulates that the drug alendronate should be prescribed to women at high risk of osteoporotic fracture, but the appraisal fails to provide any alternative treatment for women—I understand that this applies to one in four women suffering from osteoporosis—for whom alendronate is unsuitable and for whom the side effects are unacceptable. It is not clear at the moment how such women will be treated and this is causing concern and confusion. Surely it is essential that such women are able to access effective alternative treatments on the NHS. The second aspect of NICE’s work in relation to osteoporosis is the clinical guidelines process. I understand that a clinical guideline on osteoporosis is in development. Such a guideline would be important in highlighting the best ways of preventing and treating the disease, but at the moment we have no publication date. Again, I would be grateful for any further information that the Government can give us on this. Lastly, there is the important question of the National Service Framework for Older People. As noble Lords present will be aware, this was published in 2001 and included welcome guidelines on improving falls services and osteoporosis services in the NHS. The main problem, however, has been the slow pace of implementation. The Healthcare Commission audit published in March last year detailed the shortcomings in the organisation of falls services, particularly in hospital departments, including A&E. As far as primary care trusts are concerned, there is some good practice. I have heard of examples in surgeries where specialist practitioner nurses look through records and identify people at particular risk of osteoporosis and then offer them a consultation. I would like to see that good practice translated throughout the country. However, I am not convinced that the mechanisms for translating such good practice are currently very effective. Again, the fact that the department collects so little information on these practices centrally reinforces the difficulty of trying to get good practice translated on the widest possible scale. All the aspects that I have mentioned—effective implementation of the national service framework, better NICE guidance and the inclusion of osteoporosis in the quality and outcomes framework—are interlinked. Those three taken together would provide a package of measures that would greatly improve the situation and show a good way forward. However, the present situation is not satisfactory and so, in concluding my remarks today, I hope that the Minister in her reply will be able to assure the House not only that the Government are giving this issue the serious attention that it deserves but that the shortcomings that clearly exist at present will be properly and fully addressed in the near future.