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National Osteoporosis Society

Osteoporosis helpline

0845 450 0230

9am - 5pm Mon-Fri

Fighting for Fracture Liaison Services campaign

The National Osteoporosis Society would like as many people as possible in England, Northern Ireland and Wales to write a letter to their local politician or health authority to ask them to improve osteoporosis and fracture services in their community.

It couldn’t be easier to do this - we’ve written out template letters for you to send, depending on the country in which you live. Just click on the links below to download a letter:

Don’t forget to type your local politician’s name and your own name and address in the letter – the places to do this are marked in bold italics. You can save the template to use on your own computer, or copy it out by hand. You may even wish to print out several copies so that your friends, family or members of your local Support Group can all send letters.

You can also write directly to the Chief Executive of your local health authority. Again, we’ve written template letters to help you. Just click on the links below to access them:

If you don’t know the name of your local health authority, don’t worry. The frequently asked questions section below shows you how to find out.

Sending a letter will make a huge difference to those with or at risk of fragility fractures in your local area. Thank you for your support!

Frequently asked questions

What is a Fracture Liaison Service?
Are there any Fracture Liaison Services already in place in the UK?
Is there a Fracture Liaison Service in my area?
Are FLSs expensive?
Is anybody else calling for FLSs to be put in place?

How can I find out who my local politician is?
Why are there different letters for England, Northern Ireland, Scotland and Wales?
What will happen after I send the letter?
I would prefer to speak to someone at the charity before I send a letter - who should I talk to?
What happens if I don’t hear anything back from my local politician?
What should I do if I’m not satisfied with my response?

What should I do if the reply I get tells me that there is no FLS in my local area, with no plans to put one in place?

Where can I find contact details for my local health authority?
I can’t find the name of my local health authority’s Chief Executive. What should I do?
I know someone who would love to write a letter, but isn’t connected to the Internet - can they still get involved?
These letters only help people who have already had a fracture - surely we should be trying to prevent them happening in the first place?
I thought that campaigning for a DXA scanner for our local area was the most important thing to do - is that still the case?
What else is the National Osteoporosis Society doing to improve falls and fracture services in my area?

What is a Fracture Liaison Service?

When someone breaks a bone as a result of a fall from a standing height or less, they are said to have suffered a fragility fracture.

A fragility fracture is often the first sign that an individual has osteoporosis and is at a higher risk of sustaining more serious broken bones in future. These could include hip fractures, which are painful, debilitating and, in many cases, life threatening. Studies show that half of all hip fracture patients have had at least one previous fragility fracture during their lives.

Fracture Liaison Services (which are also known as ‘FLSs’) are systems of care usually provided by a dedicated nurse specialist, which guarantee that every person over the age of 50 who suffers a fragility fracture is identified, either at hospital or the GP surgery, recorded and given an assessment for their future fracture risk. The nurse then helps to ensure that patients are prescribed bone protecting treatments where appropriate, reducing their chances of suffering serious fractures later on in life. The nurse can also discuss and advise patients on any problems they may have in taking their medication in the months following their fracture.

A comprehensive FLS will also ensure that patients receive high standards of post-fracture care, co-ordinating the complex range of health and social care services that they need, including falls services.

Are there any Fracture Liaison Services already in place in the UK?

Yes - areas such as Glasgow, Ipswich, Newcastle, Aberystwyth and Belfast already have good examples of FLSs. Published research has shown that the Glasgow FLS has been particularly successful at identifying people with fragility fractures who would otherwise have been missed in other systems of care.

Unfortunately, the majority of fracture patients in the UK do not have access to FLSs. A recent audit has shown that just 38% of health trusts in England, Wales, Northern Ireland and the islands ensure that the further assessment and management of fracture patients is co-ordinated by a Fracture Liaison Nurse or similarly designated person.

In Scotland, where provision is much better, a recent study has shown that 22% of the population still do not have access to an FLS.

Is there a Fracture Liaison Service in my area?

You can find out by clicking here.

Are FLSs expensive?

No - the Department of Health’s Prevention Package for Older People, published in July 2009, shows that FLSs actually save money. The Package states that in a typical English Primary Care Trust (PCT) area with a population of 320,000 people, the total savings as a result of an FLS are £290,708 over five years, with the majority of savings made in the first three years. These are achieved as a result of fewer fractures taking place. Revenue costs of £234,181 need to be spent to set up an FLS during the first year of its operation. This means that FLSs make net cost-savings over a five year period.

An FLS will prevent 33 fragility fractures, including 18 hip fractures, from occurring in a PCT area over a five year period. Given that 30% of patients die within one year of a hip fracture, FLSs have the potential to save lives which would otherwise be lost following serious fractures.

In Scotland, the annual national cost of ensuring universal, automatic post-fracture assessment for treatment for osteoporosis and secondary fracture prevention for all women and men over the age of 50 has been estimated to be £747,000. This is in addition to initial set-up costs of £140,000.

Is anybody else calling for FLSs to be put in place?

Yes – a number of official strategies for the different nations of the UK recommend that all fracture patients should be able to access a local FLS. These include the Department of Health’s Prevention Package for Older People, the Welsh Assembly Government’s National Service Framework for Older People and the Northern Ireland Fragility Fracture Working Group’s The Prevention and Management of Fragility Fractures in Northern Ireland.

FLSs are recommended for Scotland by NHS Quality Improvement Scotland and support the findings of the Scottish Government’s Falls Working Group.

Organisations including the International Osteoporosis Foundation, the British Orthopaedic Association, the British Geriatrics Society, the National Hip Fracture Database Executive and Age UK all support the universal implementation of FLSs across the UK.

How can I find out who my local politician is?

To find out who your local politician is:

• if you live in England, click here or phone 020 7219 4272
• in Northern Ireland, click here or phone 028 9052 1333
• in Wales, click here or phone 0845 010 5500

Why are there different letters for England, Wales and Northern Ireland?

Health and social care policy in the UK has been devolved since 1999 - as a result, four different health and social care systems now operate across the UK. The Department of Health is still responsible for falls and fracture services in England. In Scotland, however, responsibility rests with the Scottish Government. The same applies for the Welsh Assembly Government in Wales and the Department for Health, Social Services and Personal Safety in Northern Ireland.

What will happen after I send the letter?

Your local politician will receive the letter. They should then, as your representative, write to your local health authority to ask what plans it has to establish a comprehensive Fracture Liaison Service and to review its current falls and fracture services. They should also write back to you to acknowledge the receipt of your letter.

I would prefer to speak to someone at the charity before I send a letter - who should I talk to?

Please contact our General Enquires in the usual way on 0845 130 3076/01761 471771 or email info@nos.org.uk. We will put you through to someone who can help.

What happens if I don’t hear anything back from my local politician?

Don’t be afraid to call their office to see what steps have been taken as a result of your card - remember, they are there to represent you and to work on your behalf.

If you’re not sure how to call your local politician’s office, you can telephone the numbers listed above for the UK Parliament, National Assembly for Wales and Northern Ireland Assembly. Each will tell you how to get in touch.

What should I do if I’m not happy with my response?

If you don’t feel that you’ve got the response you deserve from your local politician, or they haven’t followed up the matter with your local health authority, don’t be afraid to write back again.

What should I do if the reply I get tells me that there is no FLS in my local area, with no plans to put one in place?

Write back to your local politician, letting them know that an FLS will prevent fractures and save money for your local area. You should also ask them to continue to press for a local FLS to be put in place. You could even ask to meet with them at one of their regular constituency surgeries (call their office for more details of these).

You may also wish to write directly to your local health authority to make the same points.

Where can I find contact details for my local health authority?

• England: Find your local Primary Care Trust (PCT), its address and the name of its Chief Executive.

• Northern Ireland: Find the address of your local Health and Social Care (HSC) Trust from the list below:

o Belfast HSC Trust
o Northern HSC Trust
o Southern HSC Trust
o South Eastern HSC Trust
o Western HSC Trust

• Wales: Find the address of your Local Health Board (LHB)

I can’t find the name of my local health authority’s Chief Executive. What should I do?

It’s usually possible to find the name of the Chief Executive of a health authority by checking the ‘About us’ or ‘Information about us’ sections of its website, or by contacting the health authority directly. If you are not able to do this, don’t worry - just address your letter to ‘The Chief Executive’.

Can anyone get involved? Can I ask my friends and family too?

Spread the word! The more people we can get to join in the campaign, the better.
Please ask friends, family or colleagues who live in the UK to get involved too.

I know someone who would love to write a letter, but isn’t connected to the Internet - can they still get involved?

Of course - just ask them to get in touch with us by phone (0845 130 3076/01761 471771) or by writing to us at:

Public Affairs and Policy Team
National Osteoporosis Society
Camerton
Bath
BA2 0PJ

We would be more than happy to post or fax a template letter through to them.

These letters only help people who have already had a fracture - surely we should be trying to prevent them happening in the first place?

Much of the National Osteoporosis Society’s work remains focussed upon trying to make sure that people take care of their bones throughout their lives. We communicate vital health messages to the general public through public health campaigns. We also consider working with young people to be vital for the prevention of osteoporosis in later life.

It is important that the health and social care services which we campaign for are proven to be successful at preventing fractures. They also need to be cost effective. For example, the pyramid below shows how the Department of Health has prioritised falls and fracture care for England. Objective 1 focuses on the care of hip fracture patients, who are represented by the red triangle at the top of the pyramid. While this covers a smaller population, action in this area is supported by the strongest evidence on clinical and cost effectiveness. As such, hip fractures are the Department’s top priority in falls and fracture care.

Equally, while older people who have not suffered a fracture represent a much greater population (represented by the blue section at the bottom of the pyramid), there is currently less evidence to show that interventions by NHS and social care providers to prevent falls and fractures amongst this group would be as successful or cost effective.

As a result, Primary Care Trusts and commissioning groups in England are currently being advised to target their resources from the top of the pyramid down.

It is important to note that the four objectives above are only in place for England. However, the principle of prioritised intervention also applies to our campaigning in Northern Ireland, Scotland and Wales.

I thought that campaigning for a DXA scanner for our local area was the most important thing to do - is that still the case?

The availability of DXA scanners in every local area in the UK remains important to us. However, comprehensive local falls and fracture services depend upon much more than a scanner. Although a DXA scan is the gold standard for assessing bone mineral density, it is not a perfect measure of bone strength or fragility.

In identifying those who are at the greatest risk of breaking bones, healthcare professionals have to take into account a range of risk factors such as family history or corticosteroid use. We encourage patients and health care professionals to use the online FRAX® fracture risk assessment tool, which takes these into account. DXA scans remain important, however, as in many cases NICE stipulates that a diagnosis of osteoporosis is necessary before bone-protecting treatments can be prescribed.

What else is the National Osteoporosis Society doing to improve falls and fracture services in my area?

Find out more about our national campaigning in the four UK countries here.

In England, we are pressing Strategic Health Authorities to ensure that PCTs in their regions commission falls and fracture services in line with the Prevention Package for Older People. This work is being done in partnership with the British Orthopaedic Association, the British Geriatrics Society, the National Hip Fracture Database Executive and Help the Aged. In Scotland, we are working with NHS Boards and Community Health Councils to help them implement combined falls and fracture strategies which include FLSs. In Wales, we are pressing Local Health Boards to implement the National Service Framework for Older People standard on falls and fractures. In Northern Ireland, we are pushing for the implementation of the recommendations made in the 2009 Health and Social Care Public Health Agency report entitled 'The prevention and management of fragility fractures in Northern Ireland'.

We would also like all health and social care trusts and local authorities in the UK to review the falls and fracture services they currently have in place. A good precedent for this is the detailed falls and fractures review which took place in the NHS South West region of England during the summer of 2009, which the charity has been involved in. Such reviews can help to spread best practice and bring about improvements in services.

The National Osteoporosis Society also provides training and advice for health professionals on delivering services.

 

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Lifestyle changes such as weight bearing exercise and eating a diet rich in calcium will help to build and keep your bones strong

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