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NHS: Osteoporosis Services

My Lords, I thank the noble Baroness, Lady Quin, for asking this important Question. If osteoporosis services are improved, not only will it help human suffering, it will also be cost effective to the National Health Service in the long run. It is most appropriate that the noble Baroness, Lady Royall of Blaisdon, is replying to this debate, because she understands the problems of osteoporosis. As she works so hard answering so many of your Lordships’ health debates and Questions, would it not be possible to make the health Minister’s position in your Lordships' House a shared one? The noble Lord, Lord Darzi—Professor Darzi—is working part-time so that he can continue his vocation as an important surgeon. Would this not be a solution to solve the concern of the noble Baroness, Lady Cumberlege? My aunt, my mother’s sister, daughter of a doctor, developed osteoporosis in later life. She was such an uncomplaining person, but as she shrank she suffered many falls and fractures. When one sees this distressing situation, the need for prevention becomes obvious. I wonder whether, had she taken HRT, her osteoporosis would not have been so severe. Someone I know who lives in my home village of Masham and who was a theatre sister for years, with a very lively personality, is now wracked with arthritis and is very osteoporotic. She is in agony and implores the doctors to relieve her pain, which does not seem to be possible. Every time I see her, she has grown smaller. This is a condition which needs attention immediately, as we are an ageing population. The situation will only get worse unless it is tackled as a priority now. Almost half of all women and one in five men over the age of 50 will break a bone due to osteoporosis. These fractures, which occur most frequently in the hip, wrist or spine, have the potential to severely curtail a person’s quality of life. And now, when they have to be admitted to hospital, they have the added worry of acquiring a dreaded hospital infection. Each year, fractures in patients aged over 60 years account for more than 2 million hospital bed days in England alone. The overall issue with the National Service Framework for Older People is a lack of implementation in relation to Standard 6, which concerns osteoporosis and the reduction of falls. Reports published over the past three years by the All-Party Parliamentary Group on Osteoporosis, by the Healthcare Commission and the National Clinical Director for Older People indicate a lack of progress in the development of a specialist falls service and integrated osteoporosis services as recommended in Standard 6 of the NSF. Despite the fact that the NSF is a mandatory 10-year national programme, the lack of uptake across the country has prevented any real improvements in osteoporosis services being achieved. Action must be taken to encourage PCTs to put the necessary standards in place as soon as possible. It will help to have a clinical guideline to assist clinicians in appropriately identifying and treating those individuals at highest risk of osteoporotic fractures, and a technology appraisal on the use of drugs to prevent primary and secondary fractures occurring in post-menopausal women. The General Medical Services Contract guides the practice of the vast majority of GPs working in the UK. A component of this contract is the Quality and Outcomes Framework, the QOF, which covers some, but not all, clinical conditions. Through measurement of clinical indicators resulting in the award of points from which payments to GPs are allocated, the QOF is a crucial driver of practice for the achievement of many national standards and implementation of guidance, including some areas of medicine that have been selected for inclusion. But no indicators for osteoporosis are included in the QOF, despite the importance of the primary care setting in the prevention of osteoporotic fractures. Consequently, unlike other chronic conditions that are manageable in primary care, such as heart disease, there are no incentives to treat osteoporosis. On Tuesday, I attended a very interesting health breakfast in another place on the subject of pain in women. We were told that pain in women could spread differently from pain in men. When research was being done on rats, only male rats were used. I asked why this was so and was told that female rats are more complicated, as is the pain in women. This could be a relevant matter in researching pain in women associated with osteoporosis. I hope that this matter will be looked at in the future.