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NHS: Osteoporosis Services

My Lords, I would like to thank the noble Baroness, Lady Quin, for securing this debate, for her clear exposition of the issues involved and for her prompt that I should mention that I am co-chair of the All-Party Parliamentary Group on Osteoporosis. I am delighted to see the noble Baroness, Lady Royall, on the Front Bench. I know that she is extremely sincere and hard working and tries to be well informed, but she covers three departments. I am disappointed that the health Minister has felt unable to come today to answer what I think is a very important debate. After all, he is responsible and accountable to this House and, with his fellow Secretary of State and Ministers, for taking steps to improve services for osteoporosis and shaping the Government’s policy. I am sure that he is very diligent and will, in his busy life, read Hansard, but that is not quite the same thing as answering this debate. It is a very important debate because osteoporosis affects almost half of all women and one in five men over the age of 50 who will break a bone due to this distressing condition. In 1993, when I was a health Minister, in the country osteoporosis was rarely talked about. As part of my portfolio I was responsible for women’s health. In an interview on ITV, I was asked what the Government of that day were doing about women’s health. I mentioned breast and cervical cancers, and maternity. In a throwaway line I mentioned osteoporosis. I was astounded: in the next few weeks I was bombarded by women asking me exactly what the Government were doing about this disease, and I had to say that they were doing very little. So I set up an expert group under the chairmanship of Professor David Barlow to give advice on exactly how to take the issue forward. I asked the group to take a long, hard look at what was already known and to suggest what more could be done. In 1994, a year later, the group produced a comprehensive and a coherent programme directed at preventing, diagnosing and treating osteoporosis, and I was very grateful to it for its diligence. I welcomed the report and accepted its advice on four major elements: first, that bone scans should be available for women at high risk of developing osteoporosis; secondly, that guidelines for treatment should be prepared; thirdly, that further work should be done on preventive measures, such as dietary calcium and physical activity; and fourthly, that specific research should be undertaken. Much progress has been made in the intervening 13 years, a lot of which is due to the dedication of clinicians in the field; the National Osteoporosis Society—the noble Baroness mentioned that—and not least its patron, the Duchess of Cornwall; and women themselves. The network of 115 branches nationwide work hard not only to help themselves but also to give publicity to the condition and to raise funds for research. I have to say though that research is still wanting. There is a paucity and we need major funding to carry out a specific programme. Osteoporosis is often referred to as the silent epidemic, and it is, in that those who have it are unaware. With an increasingly elderly population, the numbers are growing. That is why it is so critical to raise awareness among not only the population as a whole but among GPs and other clinicians, so that it is diagnosed and actively managed before a break or a fracture occurs. About 20 per cent of those who suffer a hip fracture die within a year, if they do not die earlier from MRSA or C. difficile, while those who survive are no longer able to live independently. In 2000, in a survey of older women published in the BMJ, 80 per cent said that they would rather die than experience the reduced quality of life that follows a serious hip fracture. Vertebral fractures are typically under-diagnosed and under-treated, with only one-third of those evident on an X-ray brought to the attention of medics. Some 40 per cent of patients sustaining a clinical vertebrae fracture will be in constant pain and the majority will have difficulties with everyday activities. I should like to ask the noble Baroness, Lady Royall, to bring to the attention of the Minister the need to deliver better access to integrated osteoporosis services for men and women who are at risk. It is the necessity for GPs, rheumatologists, geriatricians, orthopaedic surgeons, obstetricians and clinicians working in emergency care not only to be aware so that they diagnose correctly, but also to act together so that information about a specific patient is shared and the patient properly treated. As the noble Baroness, Lady Quin, has mentioned, the National Institute for Health and Clinical Excellence is developing a clinical guideline on osteoporosis to help clinicians to identify and treat those individuals at highest risk of a fracture. But this work is ongoing and the report is not due for some time. The noble Lord, Lord Darzi, has a unique opportunity in the review of the NHS to address this issue and include it in his final report to be published in the spring of next year. I should like to ask the noble Baroness to put this suggestion to the Minister, as sadly he is not with us today. For some time, the All-Party Parliamentary Group on Osteoporosis has been campaigning to include osteoporosis indicators in the quality and outcomes framework, which was mentioned by the noble Baroness, Lady Quin. Those indicators should be in the GP’s contract. The renegotiation of the contract is also under review. Again, it is an opportunity to incentivise GPs to take this condition seriously and think of osteoporosis when in consultation with patients. The inclusion of indicators would support the achievements of policy objectives in the four nations of the UK. Will the noble Baroness ensure that this suggestion is put to the ministerial team? Looking to the future, the population of 50 year-olds is expected to increase by 10 per cent by 2010 and by 25 per cent by 2020. By 2020, the number of osteoporotic fractures is set to increase annually by 21 per cent and the cost of treating people with hip fractures is expected to rise by 20 per cent at a cost of £20 billion per year. Those figures are based on the minimum costs of treating a single hip fracture, although recent evidence suggests that this figure could be up to three times higher than previously predicted, even without the cost of social care being included. The all-party group also campaigned to get falls into the National Service Framework for Older People. The framework is now half way through its allotted life of 10 years, yet healthcare providers are still failing to roll out the standards of care that it recommends. These failures are recognised in separate reports by the Royal College of Physicians and the national director for older people, Professor Ian Philp. We know that frameworks in themselves are not executive. It is the implementation of them which is so difficult. What levers do the noble Baroness and her colleagues have to ensure the national service framework is fully implemented? Finally, in the knowledge that a range of drug treatments exist to reduce the risks of patients suffering an osteoporotic fracture, some costing as little at 14p per day, does the noble Baroness agree that it is infinitely more cost effective to prevent than to treat, in which case can she suggest how this might be achieved and whether the PPRS system is a possible vehicle to do this?