Last week the Chancellor announced £10 billion further health spending over the next 5 years, with £6 billion frontloaded to 2016. However, the health service’s money troubles are far from over; the spending review also reiterated the £22 billion in efficiency savings the NHS would need to make by 2021.
NHS bosses need to find a way of controlling skyrocketing hospital admissions, whilst improving variable patient care and translating the money given to them to do those things into twice the amount of savings; Happy Christmas or not that is one tough New Year’s resolution.
The good news is that, although Black Friday and Cyber Monday may now be over, there are still deals waiting to be snatched up. The new FLS Benefits Calculator, launched by the National Osteoporosis Society, shows hundreds of millions of pounds are there to be saved across England; roughly speaking for every £1 spent on a Fracture Liaison Service (or FLS), the local health service can save £2 in prevented broken bones.
Osteoporosis is the fragile bone disease that puts millions of people across the UK at risk of breaking bones from everyday activities, from reaching to put the star on top of the tree to hugging a grandchild.
The fragility fractures it causes costs the UK an estimated £4.4 billion each year. Hip fractures alone cost English hospitals 69,000 emergency admissions, 1.3 million bed days and £1.5 billion every year.
The cost to people’s lives is much greater still. Hip fractures are notorious for robbing older people of their mobility and independence. 1 in 4 people who suffer a hip fracture die within a year; a statistic that is even more troubling knowing estimates that up to a quarter of hip fractures could be prevented with widespread FLS coverage… Vertebral fractures put people in long-term pain; pain which 1 in 3 describe as severe or unbearable. Fractures from osteoporosis affect people’s work, their relationships and body image; last year a women told the National Osteoporosis Society she couldn’t understand how anyone could love her “looking like this”.
One tragedy of osteoporosis is just how often it is ignored. The silent condition (named so because fractures are often the first obvious symptom) is quiet in more ways than one. The National Osteoporosis Society’s Life with Osteoporosis survey last year showed that 39% of people diagnosed with the condition had to prompt (and often fight tooth and nail for) their own bone health assessment. With research suggesting as few as 1 in 4 of us are aware of osteoporosis, you can imagine how many people are not pushing their diagnosis and being missed.
The consequence: fractures. More fractures, more hospital admissions, more pain, more disability. Tragically it came as no surprise when one woman told us “my GP told me at 57 I was too young to have osteoporosis. 4 months later I was in hospital with six spinal compression [fractures]”. Both of us have examples from family, personal and other experience where women in middle age have suffered severe broken bones that were not linked to osteoporosis until much later. Another women’s experience sums up the situation for many: “if it had not been for a chance meeting with the consultant concerned or I had not worked for the NHS, I would never have been diagnosed”.
Osteoporosis is treatable and many of the 300,000 fractures it causes each year could be prevented. Fracture Liaison Services ensure that people with clear indications of osteoporosis are identified after their first fracture, tested for the condition, offered treatment and followed up. The FLS model has proven to be clinically and cost efficient and is recognised by NHS England as best practice.
Fortunately things are happening; although only 35% of England currently has some sort of FLS, the National Osteoporosis Society are working with 105 sites across the country to either set up services or develop existing ones. Alongside a host of other resources from the Charity, the aforementioned online FLS Benefits Calculator combines a decade’s worth of evidence with local population data to model the potential savings an FLS could bring to each Clinical Commissioning Group. Even erring on the cautious side, the calculator suggests the NHS in England could save an estimated £350 million over 5 years with full FLS coverage.
The momentum in this area is building across many fronts. The All-Party Parliamentary Osteoporosis Group (which we are proud to chair) has championed FLS for a few years. Last week the group saw MPs and Peers from across the political spectrum stop by the Not Forgotten, Not Alone reception to show their support and learn about the services in their constituencies. In 2016 the Fracture Liaison Services Database – a new publically funded national audit ran by the Royal College of Physicians – will begin reporting on the quality of services and care across England.
FLS is a clear win where, for a tiny fraction of the new funding available to the NHS, we could revolutionise patient care and see hundreds of millions more pounds in efficiency savings flow back into the health system. The case for national and local decision makers is now clearer than ever: look at the evidence, use the wealth of free resources available and grab your area a bargain!