---

12 Oct 2004 : Column 25WH—continued

Osteoporosis (Dorset)

11 am

Mr. Robert Syms (Poole) (Con): This is an important debate, particularly for the 3 million people affected by osteoporosis, for many of my constituents in Poole and for other people in Dorset, where we have a high age profile. It is a major problem in the area.

Osteoporosis affects one in three women and between one in 12 and one in eight men over the age of 50. Over the next 50 years, it is predicted that the level of osteoporosis will double, mainly because of the ageing population.

Osteoporosis is often passed off as a normal facet of ageing, rather than a serious condition that requires treatment. However, without treatment, osteoporosis can be painful and debilitating. Every two minutes, someone has a fracture due to osteoporosis, resulting in more than 200,000 fractures a year. Sometimes, those are a major factor in mortality. Nearly one in five people who suffer a fracture die within a year. The cost to the national health service and the wider economy is between £1.7 billion and £1.8 billion a year.

As well as causing considerable pain, osteoporosis has major implications for NHS resources. More than 800,000 hospital bed nights each year are accounted for by patients with hip fractures in England alone. Patients with spinal fractures visit their GP an additional 14 times in a year following a fracture. Osteoporosis will have a major and growing impact on the NHS.

Apart from the overall situation, osteoporosis has a tremendous impact on individuals. Broken bones due to osteoporosis can result in pain, deformity, depression, anxiety, social isolation and death. Up to one in three hip fracture patients die within a year, and some surveys show that 80 per cent. of elderly women at high risk of hip fracture would rather die than have a bad hip fracture and lose their independence. Fear of falling and breaking bones can prevent women from enjoying a normal retirement, and osteoporosis can prevent patients from doing many ordinary daily activities.

Osteoporosis is a preventable condition. Strong bones can continue to be built up to the age of 35. Therefore, the earlier in life that a healthy lifestyle is adopted, the greater the benefits. Key risk factors include lack of physical activity, smoking, excessive alcohol, and low calcium and vitamin D intake.

The difficulty nationally with osteoporosis is that it tends to form part of lots of other strategies. The Government have a preventing falls strategy and there is a national service framework for older people. Osteoporosis is a part of both. However, it is sometimes not the focus, and remains under-prioritised. That is one of the reasons why I want to raise the issue in the House of Commons, and I am glad to see the Minister of State here today.

My interest was increased by a visit to the offices of Osteoporosis Dorset, a local charity partly funded by the Dorset and Somerset strategic health authority, which funds the osteoporosis prevention officer, Mrs. Carol Jones. I met the chairman, Group Captain John Rees. They went through some of the things that they do. I intend to point out what can be done, because prevention and work in the community are important in dealing with the problem.
 
12 Oct 2004 : Column 26WH
 

Osteoporosis Dorset was established in 1992 to reduce the incidence of fractures in the county. From its inception, it has received support from the Dorset health authority. Its scientific advisory group developed a clear strategy built around the rubric "Prevention through education", using a high-risk-group approach. The groups were defined as women with early menopause before 45 years; men and women on long-term corticosteroids; patients presenting with low-trauma fractures; residential care home residents, for whom Osteoporosis Dorset has been instrumental in introducing hip protectors; and elderly people living at home, the strategies for whom have included falls templates, calcium and vitamin D, and hip protectors.

Much work and money was dedicated to piloting the ideas and developing protocols for the management of those groups of individuals at high risk of osteoporosis. In addition, the charity formed a nurse network known as the Bone Alliance, which trained practice nurses—at no cost to the individual or practice—in how to support their patients. That local organisation does a lot of excellent work in advising GPs. One point that has been raised with me is that, because osteoporosis is not part of the GP contract, GPs do not necessarily pay it adequate attention. In Poole, the organisation helps to make up for that by providing information and expertise. It has also developed a network of osteoporosis patient peer support groups, as well as securing funding from the Department of Health to become one of eight national pre-retirement health check pilot sites, details of which it is working on. We benefit greatly from the work of the charity and its local organisation.

One of the major benefits of Osteoporosis Dorset is that, early in its existence, it came across hip protectors, which were developed in Denmark and are widely used on the continent. They are useful devices. I shall show how and try to explain for Hansard. They give protection to people who are at risk of fracturing their hips, help to absorb the shock if they fall over, and provide additional protection during recovery if they have to have hip surgery. They cost only £32 plus VAT each, and Poole primary care trust is very good in that it provides them for people living in homes in the Poole area. I understand that some neighbouring primary care trusts do not provide them.

Let me demonstrate. Essentially, they are pants with pads on either side—not the most stylish items in the world, but very practical. They do an excellent job in providing protection for those in homes whose hips are at risk from falls. This practical idea could be rather more widely used in order to save people the agony that results from falling and breaking their hips.

There are many other ways in which we could tackle osteoporosis. There is no formal national screening programme for it, which means that, apart from certain groups such as those taking corticosteroids, and thus receiving regular screening, most patients are unaware that they have osteoporosis and are diagnosed only when they suffer fractures. One million women in the UK are identified for possible treatment, most commonly at the time of fracture.

A screening programme ought to be considered. That would be a way of identifying those who are prone to osteoporosis. A range of treatments can be used: bisphosphonates, non-hormonal drugs that help to
 
12 Oct 2004 : Column 27WH
 
maintain bone density and reduce fracture rates; calcium and vitamin D supplements, which can reduce the risk of hip fractures; hormone replacement therapy for women; and selective estrogen receptor modulators, drugs that act on the bone in a similar way to oestrogen and help to maintain bone density.

There have been developments. I noticed an article in the Daily Mail on 5 October about a drug called Bonviva, a bisphosphonate that is being developed by Roche, and which would have to be taken monthly by those with osteoporosis. One problem is that, although some 650,000 women currently receive drug treatment for the condition, there is evidence that not all of them take the drug as often as they should. It would be beneficial if there were a pill that could be taken once a month and slowly released the drug into the blood stream.

I would be interested to hear the Minister's comments on drug treatment for the condition. There could be substantial savings in having a range of drugs; I have pointed out the cost of some of the treatments for osteoporosis. It is a preventable condition that has not received the attention that it needs in order to be given priority by the relevant parts of the national health service. It forms part of the preventing falls strategy and the national service framework for older people, but has not received the focus that it ought to have. I know that the National Osteoporosis Society does very good work, and Osteoporosis Dorset also does good work, but the matter requires a greater focus from the Government. We ought to consider whether to carry out more screening and put more investment into prevention, so that we not only save considerable sums of money, but avoid the tying up of substantial numbers of hospital beds as a result of people going in with fractures.

As we have heard, people with one fracture often get further fractures, which can cause problems. We ought to revisit the GP contract on this matter, and GPs ought to regard osteoporosis as a greater priority. The topic is important. Fractures impact greatly on the lives of older people. If we are serious about saving money and improving the quality of life of some of our elder citizens, the condition should be treated as a higher priority by the Government and the NHS. If it were and we invested more in prevention, we could reduce the number of cases of osteoporosis substantially.

Mr. Roger Gale (in the Chair): Before we proceed, I would like to place one matter on the record. The hon. Gentleman produced an exhibit and described it articulately, tastefully and with care for the record. I would not wish it to be thought that the fact that I allowed him to do so should be regarded as a precedent in any way.

11.11 am

The Minister of State, Department of Health (Ms Rosie Winterton) : I congratulate the hon. Member for Poole (Mr. Syms) on securing the debate. I know that many of the issues that he raised are of great importance to his constituents and to him. He set out clearly many of the facts and figures relating to osteoporosis. I share his concern that we should do everything we can to
 
12 Oct 2004 : Column 28WH
 
reduce the suffering caused by the condition. I hope that I shall be able to reassure him that the Department of Health, the national health service and other key stakeholders have put in place a programme to do just that. I hope that I can illustrate that we are making the matter a priority and will continue to do so.

The hon. Gentleman mentioned screening. In 2000, the NHS plan announced an initiative to identify five pilot sites in England to provide advice and health checks for people entering retirement. That was managed by the Health Development Agency and ran from 2001 to 2003. As he is aware, South and East Dorset primary care trust, in collaboration with Osteoporosis Dorset, a well respected charitable trust, were involved in one of the five national pre-retirement health check pilots for women aged between 56 and 65.

The aim of the pilots was to identify risk factors and to implement strategies to reduce the risk of osteoporosis fractures, heart attacks, stroke and diabetes. Following the pilots, a major implementation programme has been put in place at the Health Development Agency, using the evidence from the pilot phase, so that practitioners and policy makers can focus services on those particular age groups.

My Department and the Welsh Assembly Government have asked the National Institute for Clinical Excellence to develop clinical guidelines and technology appraisals on what is effective in the prevention and treatment of osteoporosis, the assessment of fracture risk and the prevention of fractures in individuals at high risk—the hon. Gentleman highlighted the preventive aspect—and the assessment and prevention of falls in older people.

The technology appraisals of prevention and treatment of osteoporosis include consideration of five osteoporosis drugs, which the hon. Gentleman mentioned. The appraisal is split into two parts: primary and secondary prevention. The primary prevention part is due to be published in September 2005, after which the second part will be published, although we do not yet have a date for that. The appraisals are designed to give doctors the latest evidence-based information on the most effective treatments for osteoporosis. However, it is also important to patients and carers to have access to clear, authoritative advice on both the sort of care that might be best for them, and the standards of care they can expect from the NHS.

The fracture risk guideline, which is due to be completed in June 2005, will look at all groups recognised to be at high risk of osteoporotic fracture. It will examine the interventions that can be used to prevent fractures and cover primary care, secondary NHS health care and the professionals who have direct contact with and make decisions about the care of high-risk individuals. The guideline will also look at areas where collaboration is needed between primary and secondary NHS services. Fracture risk would apply because of the very issues that the hon. Gentleman highlighted about the need to provide ongoing preventive care and to ensure that primary and secondary care services work closely together.

The falls guideline is due to be completed in November this year. It will provide recommendations for good practice that, again, are based on the best available evidence of clinical and cost-effectiveness.
 
12 Oct 2004 : Column 29WH
 

The hon. Gentleman mentioned the national service framework for older people. I hope that we might consider the appraisals and the guidelines as building on the work on standard six of the NSF, rather than think of them as separate. That is certainly one of the key policy drivers on osteoporosis. The framework sets clear milestones for the planning and development of integrated falls services and requires that such services should be established across all health and social care systems by April 2005.

Good progress is being made across the country in implementing that, but the decisions are sometimes local, in line with "Shifting the Balance of Power". However, the Department will monitor the April 2005 milestone through the strategic health authorities. We are also collecting information from a sample of health and social care communities on all the NSF standards to enable us to assess progress on implementation. That information will feed into the Healthcare Commission's in-depth review of progress on the framework. That is what we are doing to ensure that we can drive through the proposals and have a consistent service across the country.

I congratulate and pay tribute to all the staff and stakeholders in the Dorset health economy for their commitment to delivering and improving osteoporosis services for local people. As the hon. Gentleman said, osteoporosis services in Dorset are co-ordinated through a partnership between the Dorset health community and Osteoporosis Dorset. The Dorset and Somerset strategic health authority has assured me that that model of service provision is working extremely well and has resulted in the county being perceived as one of the lead areas in developing innovative, evidence-based approaches to fracture reduction. I am sure that he and his constituents are proud of that long-term arrangement, which has been operating in Dorset since 1992.

I have been assured that the details necessary to maintain an ongoing arrangement are at present being agreed by the Bournemouth Teaching primary care trust, which is the NHS organisation leading the relationship with Osteoporosis Dorset, on behalf of all primary care trusts in Dorset. I am also assured that all the primary care trusts in the Dorset and Somerset strategic health authority area are committed to delivering on this high-priority national service framework milestone and are developing integrated osteoporosis strategies as part of their overall falls strategy. I am informed that plans are being implemented to ensure that the integrated falls service, which was developed by primary care trusts in line with local partners, is in place by March 2005.

I have been illustrating some of the ways in which, nationally, we are setting the milestones and, locally, there is implementation. The hon. Gentleman asked about GP contracts. It is true that in a sense osteoporosis did not make it into the quality and outcomes framework, perhaps because there was not
 
12 Oct 2004 : Column 30WH
 
enough evidence-based information to make that possible. I have reviewed some of the issues around that. We are trying to build that information consistently by reviewing the pilot studies, the NICE guidelines and how we implement national service frameworks, and an independent review group is considering the GP contract and how new indicators can be included from April 2006 if new evidence emerges in those areas.

I draw the hon. Gentleman's attention to the fact that the increase in spending in the NHS overall—particularly the amount of money that is allocated at local level through devolved decision making—is allowing the development of extra services and ensuring that we can fund many of them. That is not to say that we are in any way complacent about what needs to be done.

I note the hon. Gentleman's comments about, and vivid illustration of, hip protectors—I now completely know what they look like—for people with osteoporosis, and I understand his desire for more consistency in how they are funded and provided locally. Current NICE draft guidelines on prevention and treatment of falls consider the use of hip protectors, but conclude that the evidence is not strong enough to support a firm recommendation for their use as an effective preventative measure for all people with osteoporosis. However, that appraisal is still in progress. Hip protectors are available free if they are provided by the NHS following an individual assessment of clinical need. I know that all NHS organisations in Dorset continue to make provision for that as necessary.

I reiterate that I do not underestimate the enormous burden of this debilitating disease. As the hon. Gentleman said, about 310,000 osteoporotic fractures occur each year. There is absolutely no doubt that, because of the ageing UK population, that number is set to increase. He was right to point to work that still needs to be done regarding preventive measures such as diet. The issue of how we can use diet more effectively to prevent some of the conditions that arise from poor diet is being considered in the public health White Paper.

It is only by collective and collaborative work across sectors and professions and, of course, by properly engaging with older people that we will be able to make a difference to people's lives. We need to work at a national level, build on the best practice that has been illustrated so vividly and excellently in Dorset, and consider what further measures can be taken, not least by examining relevant public health issues.

I hope that my comments have given the hon. Gentleman some assurance that we take this issue seriously and that we are working towards the clear goal of doing everything we can to reduce the effects of osteoporosis and to prevent it from occurring in the first place.

11.27 am

Sitting suspended till Two o'clock.
 
12 Oct 2004 : Column 29WH
 

 
12 Oct 2004 : Column 31WH
 

---