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Petition Number: P-06-1293 Petition title: Provide funding for universal access to Fracture Liaison Services. Text of petition: The Welsh Government should commit to 100% coverage of quality-assured Fracture Liaison Services (FLS). FLS is the world-standard for treating osteoporosis and preventing fractures, yet access is a postcode lottery. This means thousands of people living on the wrong side of a catchment line will suffer life-changing spinal and hip fractures. The Welsh Government can transform the picture through a clear strategic direction from the top, backed with modest funding for FLS and sensible incentives.
Fractures (broken bones) caused by osteoporosis are one of the most serious threats to living well in later life. Left untreated, osteoporosis threatens our freedom, dignity, quality of life and independence. With an early diagnosis and the right treatment, people with osteoporosis can live well, thanks to safe, effective, medication that is highly affordable for the NHS. But missed opportunities for diagnosis and early intervention mean that thousands of people across Wales are missing out on the bone-strengthening medication they need. In a recent FOI request, the Royal Osteoporosis Society (ROS) found that only 4 out of 7 Health Boards could confirm they had a FLS (and not all of these cover the whole population). The ROS estimates that scaling up FLS provision for the whole of Wales would cost around £2 million per year. Over the next five years, this would save the NHS and social care around £25 million, prevent over 1,200 hip fractures, and release over 34,000 acute bed days.
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The Royal Osteoporosis Society (ROS) statesthat osteoporosis affects men and women and leads to fragile bones, which can then lead to ‘fragility fractures’. These broken bones occur after low trauma, such as a minor bump or fall that would not normally cause a bone to break. These fractures are the consequence of low bone density and structural deterioration of bone tissue.
The ROS also statesthat many fragility fractures could be prevented by timely interventions to reduce fracture risk. A Fracture Liaison Service (FLS) systematically identifies, treats and refers to appropriate services all eligible patients aged over 50 within a local population who have suffered a fragility fracture, with the aim of reducing their risk of subsequent fractures.
An FLS is centred around a dedicated co-ordinator (often a Clinical Nurse Specialist) who works to pre-agreed protocols to case-find and then assess patients who have had a fracture. The service may be based in any healthcare setting, either in hospital or out of hospital, and requires support from a medically qualified practitioner (typically a hospital doctor or a GP with expertise in osteoporosis and fragility fracture prevention).
In a letter to the Petitions Committee on 2 September 2022, the Minister for Health and Social Services states that the Welsh Government recognises the valuable role that FLS have in providing early intervention, easy access to osteoporosis care and in reducing the risk of further fractures.
The Minister notes that Dr Inder Singh, the National Clinical Lead for Falls and Frailty for Wales, has prioritised this work within the National Falls and Frailty Fracture Audit Programme Strategic Group. Following the Fracture Liaison Service Database Annual Report, undertaken by the Royal College of Physicians and published in January 2022, Dr Singh initiated a review of FLS across Wales and identified a FLS audit lead within each health board. The review provided a clear understanding of current services across Wales and helped to outline the variation in access and range of services provided that the petitioner refers to.
To support this area of work, a new national FLS Development & Quality Assurance Group has been established, consisting of a wide range of key stakeholders including the FLS audit leads. The inaugural meeting was held on 20 July 2022 and focused on the results of the national audit, improving and supporting the delivery of care across Wales and reducing the risk of subsequent fractures for patients with a recent fragility fracture. The Welsh Government is said to be working closely with the ROS and obtaining patient voices to ensure it is clear on the impact these services, or the lack of equitable access to these services, can have on the population.
The Minister confirms that the Welsh Government is in the process of organising a national conference to celebrate World Osteoporosis Day and ensure health boards in Wales are committed to driving forward FLS across Wales.
The Minister goes on to say that the Welsh Government is committed to supporting the effectiveness in osteoporosis care delivery in its existing services and working to develop those areas which do not currently have services in place.
Health boards are responsible for providing services for their population and the Minister highlights that it is appropriate that funding is made available via their resources. It is noted that the Welsh Government will work with health boards to increase the importance of FLS within their services and will continue to pay close attention to progress made.
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