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NHS: Osteoporosis Services

My Lords, as a man, I find myself in a minority group in this debate. That is a reversal of the usual balance between the sexes in this House. That brings me to the point that we do not consider men to be a stereotypical group of those who have problems with osteoporosis. As the noble Baroness, Lady Wilkins, has just pointed out, one of the stereotypical groups is that of elderly woman. Many people probably do not know that men can suffer from osteoporosis. One of the reasons why women are more susceptible to this condition is that they live longer and any other progressive condition may not manifest itself to the same degree. The fact that men have larger, thicker and denser bones than women also makes them less susceptible to the condition. However, the condition can be very damaging to men. If we are to achieve a greater equality in health for men, we shall have to address this problem, first and foremost by creating a greater awareness among the male population and healthcare professionals. One of the themes running through the debate is that we are not paying enough attention to creating preventive methods and not raising awareness among medical practitioners and those who may suffer from the condition. The NHS is better at dealing with acute problems as they are presented than it is at creating long-term strategies for preventive healthcare. This applies not only to the NHS; it runs across the entire framework of government. We are much better at dealing with problems as they occur than at preventing them. We are also much worse at investing in prevention than we are at investing in a problem once it is presented. The usual way in which we deal with such a problem, once we are aware of it, is to wait until it becomes acute; then there is a degree of pressure and there is a reaction. As the noble Baroness, Lady Wilkins, said, a series of case studies is brought forward, people then think about the problem and then we go back. The whole governmental structure in Whitehall tends to react in this way. It is our responsibility, and particularly the responsibility of whoever is in power, to address this problem and to get in early. As we heard from the speech of the noble Baroness, Lady Wilkins—to which I can relate strongly from my experience with my previous portfolio—government departments tend not to support one another. The ongoing costs of not addressing this problem in the disabled community means that much of the Government’s drive towards getting people off benefits and into work may well be wasted. If we do not get departments to live up to their duties and make sure that they know that one group is more likely to suffer from osteoporosis than another, it does not matter how many interviews you have at various job centres or restart projects—call them what you like—you will still fail to bring in the money. I totally agree with the points made about the legislation that the noble Lord, Lord Ashley, has been championing. Unless we talk to one another across the silos, we will miss our targets. We must ensure that the NHS decides what NICE is going to do and decides that NICE gives higher priority to preventive care. If we are to carry on with NICE, there is a case for us in Parliament to become the ultimate stage for appeals on its decisions, as opposed to saying that someone should give it better criteria to work to. We must ensure that we intervene more clearly and that on-costs are taken into account by other departments, otherwise we will always come back to saying, ““If only we’d intervened quicker; with all the expertise going around, we could have done something else””. To return to the under-represented male group, what do we actually know? The research that I did for this debate from the information provided for me pointed out that the male menopause is, as I am assured by most females, a reality, although not a medical reality, because we do not have the huge chemical change in our bodies. However, we produce less testosterone, the preventive and supportive hormone; the level of help and prevention that it provides reduces over time. That is what leads to this problem. The symptoms of wanting to buy motorbikes and fast cars as we hit the age of 45—I have about a year to go—may be psychological, but the fact is that we are suffering many of the same problems as women, although we have them at a slightly slower rate. Will the Government do some work to find out what is the safe, normal level of testosterone? What sort of supportive care can we offer at the moment? What are we doing to make people aware of the diagnosis of osteoporosis in men? If you have a comparatively light fall and you break a bone, and you are male, what training is given to medical professionals to decide whether you should then be tested for osteoporosis? What is the guidance? Are we taking this seriously? Do people know that signs of height loss, for instance, can be seen as a sign of the condition? Is this being taken as seriously for the male of the species as it is for the female? Are we addressing height loss and testosterone level testing seriously? Are all these packages being brought together and presented as something that doctors should know about? If we are successful in the testing, the benefits will roll out. If we manage to keep the average man living almost as long as the average woman, these problems will become more acute. I look forward to hearing the Minister’s reply, but I would appreciate having some guidance given to us about where we are fitting the structure of preventive healthcare into our overall planning and what safeguards we have that any budget put forward cannot be raided the next time we have a cash-flow problem.