Fracture prevention cannot remain a postcode lottery – ministers must deliver on their promise
4 min read
“Never again will women’s health be neglected.” Labour’s manifesto could not have been plainer. Wes Streeting promised that one of his first acts in government would be to task NHS England with a rollout plan so that every part of the country had a fracture prevention service by 2030.
It was a well-chosen promise. Fracture prevention services exist for one reason: to find and treat osteoporosis in the people who have broken a bone because of it. Some 2.5 million women in England have the condition, and one in two over 50 will fracture as a result. 700,000 men also have it, but it is overwhelmingly a women’s condition.
Part of the problem is the language. “Brittle bones” sounds like something that comes with age, like reading glasses. It is nothing of the sort. Left undiagnosed, osteoporosis ends in a broken hip, and more than a quarter of those who break a hip are dead within a year. Many of the rest never go home again. Measured in healthy years lost, it is the fourth greatest thief, behind heart disease, dementia and lung cancer. Few would guess that.
The cost to the individual is obvious – independence gone, stairs no longer climbed, the daughter who becomes a carer. The cost to the rest of us is less visible but no smaller: one in fourteen hospital beds is occupied by someone with a fracture caused by osteoporosis. These cost the NHS £2.5bn a year; add social care and the bill is £4.5bn. When we talk about the “frail elderly” taking up beds, this is very often who we mean – and, shockingly, we talk more about the beds than about the people in them.
Here is the sad part. Much of this is preventable. Osteoporosis is a very treatable. The medicines are cheap, well understood, and cut the risk of fracturing quickly – enough to stop a wrist fracture at 65 becoming a hip fracture at 75. Yet two thirds of those with osteoporosis don’t get the treatment they need.
A fracture prevention service is cheap, proven, keeps people on their medication – and pays for itself in empty beds and operations saved. Shockingly only about half of NHS trusts provide this service, so whether your first fracture is also your last depends on your postcode. That is why Labour’s commitment to universal coverage mattered, and why campaigners called it the greatest victory for people with osteoporosis in a generation. They saw what a Labour government could do.
Sadly, since the election, progress has stalled. The number of patients identified by a fracture prevention service in England rose by just three per cent last year. In contrast, Wales, which made the same commitment in 2023, saw patient numbers nearly double in the same period. Same promise, same medicines, same model of care – but Wales’s Labour government delivered.
Ministers have repeated the 2030 commitment a hundred times, and I’m sure they mean it, but have failed to produce a plan for getting there. That leaves doctors and nurses desperate to launch a service which would save lives and money, yet waiting for a direction from the centre that has not come.
Goodwill, a paragraph in a policy document, a hundred assurances from the Despatch Box – none of these are a rollout. A rollout is a plan with dates and somebody responsible for its delivery.
Unsurprisingly, I have tabled an amendment to the Health Bill requiring the government to publish that plan. This was not what I wanted to do – like the Royal Osteoporosis Society and others, I would prefer a plan from the department, with dates and a responsible name. That’s better than an Amendment and an argument in the Chamber.
But without the plan, I will press it. We can’t neglect this aspect of women’s health just because it’s about older women. A promise was made and we look to Yvette Cooper to make it a reality. Winter is coming, pavements are icy. Let’s not tell a woman who breaks her hip it was simply bad luck. Let’s look after her bones and keep her up and about and looking forward to Christmas.
Baroness Hayter is a Labour (Co-op) peer
