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1.48 pm
The Parliamentary Under-Secretary of State for Health (Mr. John Horam): I am grateful to my hon. Friend the Member for Billericay (Mrs. Gorman) for initiating a debate on osteoporosis in the middle of National Osteoporosis Week. She said during her speech that her jaws and teeth were in good condition; I can assure her that the House and, in particular, the
Government have never had any doubt about that. I believe that this is the second such week--the first World Osteoporosis Day was on Monday--the main initiative for which came from the National Osteoporosis Society.
I should also like to take this opportunity to pay tribute to the society and its achievements during the past 10 years in giving osteoporosis sufferers everywhere a voice. The NOS has also organised this week the fifth annual conference on osteoporosis and bone mineral measurement, in Bath, bringing together the leading experts in the field.
As my hon. Friend said, the debate can only help to raise the profile of a condition which has been described as the silent epidemic. Osteoporosis is undoubtedly a major public health problem. It has been estimated to affect as many as one woman in four in the United Kingdom. Each year in this country, there are about 60,000 hip, 50,000 wrist and 40,000 vertebral fractures which are due to osteoporosis. Most of these occur in older women, but about 20 per cent. of the hip fractures occur in men. I noted the comments about that by the hon. Member for Woolwich (Mr. Austin-Walker), the chairman of the all-party group. Almost half of all women will have experienced a fracture by the time they reach the age of 70.
In March 1993, my colleague Julia Cumberlege--I acknowledge the tributes paid to her work--decided to look at what we were doing in the whole field of women's health, for which she has particular ministerial responsibility, and to examine the outstanding issues. She concluded that, at that time, osteoporosis was the single most important women's health issue yet to be addressed by the Department: it had not been given the attention that it deserved. She resolved to put this right by setting up the advisory group on osteoporosis, or AGO.
The group's remit was
Since publication of the AGO report, progress has been made on a number of fronts in developing osteoporosis services. Two of the report's recommendations were directed at the NHS. Julia Cumberlege wrote to the chairmen of all NHS bodies about these on the day before the report was published, and has subsequently discussed them with regional chairmen.
The first of AGO's recommendations specifically for the NHS was that health authorities should facilitate improved co-ordination and communication between the various groups of professionals and specialists--general practitioners, nurses, gynaecologists, rheumatologists, radiologists, orthopaedic surgeons and others--involved with different aspects of osteoporosis. That may sound like a statement of the obvious, but we have made it clear to NHS chairmen that we think that it is worth taking a bit further--looking at whether having a lead clinician for osteoporosis in each locality would be cost-effective and desirable. Osteoporosis should be tackled with a "shared care" approach among all sectors of the NHS.
The advisory group's second recommendation for the NHS was that bone densitometry should be made available to assist clinical decision making with certain groups of patients identified as being at high risk.
The National Osteoporosis Society, the leading voluntary body, published in January the results of a survey it had carried out among health authorities of the services provided around the country for people with osteoporosis. My hon. Friend referred to this work. It is fair to say that the results of that survey clearly highlight the fact that the NHS has a lot of work to do before the recommendations of the advisory group can be considered to be successfully met. It is clear that some health authorities have a great deal of work to do in improving local osteoporosis services. I note the percentage of them that my hon. Friend mentioned. That said, it would be unrealistic to expect services to improve radically overnight, but there are many points that need to be improved on.
A number of the recommendations of the advisory group on osteoporosis were directed at the centre, and a great deal of work towards implementing the recommendations has already been done. For example, a group led by the Royal College of Physicians is working on clinical guidelines for osteoporosis. I also understand that the Clinical Standards Advisory Group will take the AGO report into account in its own report on community health care for elderly people, which is expected to be submitted to the Department later this year. Osteoporosis is now also specifically referred to in "The Health of the Nation" fact sheet on accidents.
There has been much debate about the role of bone density scans. In such debates, the findings of the "Effective Health Care Bulletin on Screening for Osteoporosis", produced by the York centre for reviews and dissemination, are often cited in defence of decisions not to increase the availability of bone scans, as recommended in the AGO report.
The "Effective Health Care Bulletin" considers the evidence for establishing a population screening programme for osteoporosis and concludes that, on current evidence, it would not be advisable to do so. The AGO report reaches the same conclusion. However, the latter goes on to say that, once someone at high risk of developing osteoporosis has been identified--usually by the GP asking a few key questions in the surgery--there is an important role for bone density measurements to confirm the diagnosis where the patient is reluctant to agree to treatment and to monitor the treatment to encourage the patient to continue with it.
This use of bone density measurement is not considered by the "Effective Health Care Bulletin"--which is why the AGO report recommended that it should be reviewed. AGO rightly concluded that the bulletin as it stands has misled health care purchasers into believing that there was no role for bone density measurement in local service provision. The NHS executive is in discussion with the York centre about updating this and other bulletins in the context of a new contract for further clinical effectiveness work.
Of course, bone density scans are not the solution to osteoporosis; but I believe that their availability, in the circumstances set out in the advisory group's report, is an important element in a good local osteoporosis service.
The Department of Health has considered the contribution that nutrition can make to maintaining bone health on several occasions. In 1991, the Government published updated dietary reference values for assessing the adequacy of dietary intakes of nutrients. The nutrients generally regarded to be most important in bone health are calcium and vitamin D, but many other nutrients have been implicated, including copper, fluoride, phosphorous, vitamin C and protein. In addition, the risk of fracture in old age is related to body composition--for once it seems to help to be a little bit plump. I make no reference to my hon. Friend the Member for Billericay in this context, of course.
I also noted with great interest what my hon. Friend said about HRT, and I know of her other concerns in that area. Much of what she said about it made great sense.
The report of the advisory group on osteoporosis also recommended better public and professional awareness of the condition. It also made recommendations in respect of the nursing professions; indeed, a key quotation from the section on the role of nurses said:
I am therefore delighted that, on Monday, at the fifth annual conference on osteoporosis and bone mineral measurement in Bath, Julia Cumberlege launched just such a resource pack on osteoporosis for nurses, midwives and health visitors. I have one with me; it is an excellent document, hot off the presses, and I can recommend it to nurses and to hon. Members. The resource pack was produced jointly by the Royal College of Nursing and the National Osteoporosis Society, and my Department gave a grant of £5,000 towards its production costs.
The resource pack takes the form of short fact sheets in an easy-to-use folder. The simplicity of its production belies the depth of the information which it contains. The subject matter is fully covered and I am sure that it will be an invaluable aid to the expansion of the nurse's role in this field. The pack is available, free of charge, to any nurse, midwife or health visitor and can be obtained from the NOS.
I hope that I have revealed the importance that the Department of Health attaches to osteoporosis, which is also reflected in the financial support which we give to charities in this field--not only to the National Osteoporosis Society but to Women's Health Concern and the Amarant Trust, of which my hon. Friend was a founder. We shall continue to work with them and with other interested parties, with the NHS and health service professionals, to increase awareness of osteoporosis and to improve its treatment.
"to establish what information about osteoporosis is available, what research is being conducted and what further work needs to be done, and to report to Ministers".
AGO submitted its report in November 1994 and, having accepted its recommendations, Julia Cumberlege published it in January 1995. The AGO report was widely distributed both within and outside the NHS, and we have reprinted it three times since then--a pointer to its popularity among health professionals and the public.
"with appropriate preparation this group is in a prime position to make a significant contribution to any programme for the prevention, early diagnosis and treatment of osteoporosis".
Nurses can do this only if they have a full understanding of the disease and its implications. Therefore, the next logical step was to build on the existing literature by producing a comprehensive and detailed resource pack for nurses.
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