Two years ago, Health Secretary Wes Streeting promised people with osteoporosis life-saving early diagnosis clinics.1 He has repeated that commitment in Parliament and the media 63 times since the election – but nothing has yet changed. For every year that ministers delay, another 2,000 patients die needlessly.2
People with osteoporosis have been overlooked for decades, driven by the mistaken belief that broken bones are a normal part of ageing rather than a treatable medical condition. This disease silently weakens bones until they can break from coughs, sneezes or even a hug. For someone with osteoporosis, a fall from standing height can be enough to break a hip. Half of women over 50 will experience fractures due to the condition, alongside one in five men.3
I meet grandmothers too afraid to lift a newborn baby for fear their bones could shatter, and women in early menopause told by GPs they have the bones of an 80-year-old. Yet effective treatments exist, often costing as little as £1 a week. The problem is not medical – it’s about NHS performance.
Today, two-thirds of the 3.5 million people living with osteoporosis are not receiving medication, not because treatments do not exist, but because the system is failing to deliver them.4 Too often, patients are fixed up and forgotten, left exposed to further fractures that could have been prevented.
The reason is a postcode lottery. Half of NHS Trusts still lack Fracture Liaison Services (FLS) – specialist services that identify patients after a fracture and ensure they are assessed and treated to prevent the next, often more serious, fracture.5 Without them, the consequences are stark. A broken hip is frequently the start of a rapid decline, with more than a quarter of patients dying within a year.
During the 2024 general election campaign, there was rare cross-party consensus on the need to roll out FLS to every area by 2030. All three main political parties made this their policy, with the Greens and Reform adding support in the months since. Streeting went further than his counterparts, pledging that the rollout plan for nationwide FLS would be one of his first acts in post.
Since then, that commitment has been reiterated dozens of times, but no progress has been made.
Around 60 NHS Trusts in England still lack these services. A national rollout takes time and requires steady, year-by-year progress. On any credible trajectory to 2030, services would already need to be expanding at pace. By now, we would expect around 24 Trusts to have been brought into coverage. Instead, none have. No national delivery plan has been published, and there are no clear milestones, funding mechanisms or implementation timelines in place.
This absence of clarity is now affecting behaviour on the ground. In some areas, plans for new services have been paused in anticipation of a national rollout that has yet to materialise. Systems are waiting for direction, but without a clear framework, progress is stalling and fracture prevention has been paralysed.
Delay carries both human and financial costs. Around 2,000 people die each year following hip fractures that FLS could help prevent. In the time since the election, the NHS has spent an estimated £150m treating fractures that could have been avoided, which is around double what it would have cost to have pump-primed FLS across the whole country.6
Elsewhere, progress is tangible. New Zealand has rolled out FLS to cover almost its entire population, while Japan has rapidly expanded provision in recent years. Within the UK, Wales has made FLS a national priority and set world-leading expectations for coverage and performance. England risks falling further behind.
Ministers have rightly emphasised a shift from sickness to prevention. Osteoporosis is a clear test of whether that ambition translates into delivery. The evidence is established, the model is proven, the commitment has been made 63 times by ministers, and the economics are compelling. If we can’t realise prevention here, what does it say about the future of the NHS?
What is needed now is not further commitment, but an implementation plan: one that sets out how rollout will begin, how it will be funded, and how progress will be tracked. A phased, funded approach – backed by clear national expectations – would provide systems with the certainty needed to act and invest.
Clinicians and system leaders are not asking for perfection. They understand the pressures on public spending and the realities of delivery. But without a clear starting point and trajectory, the 2030 target becomes harder to sustain with each passing month.
We stand ready to work with the government to achieve the outcome set out. But progress starts with a clear and credible implementation plan.
Without it, a widely supported prevention policy risks becoming one that the NHS cannot deliver, with grave consequences for trust and confidence.
For more information, visit theros.org.uk/StillNoPlan
References
- Mikhailova, A. (2024) Wes Streeting’s personal vow to tackle bone scan postcode lottery crisis in NHS. Daily Mail. Available at: https://www.dailymail.co.uk/news/article-13484645/Wes-Streeting-personal-vow-tackle-bone-scan-postcode-lottery-crisis-NHS.html (Accessed: 14 April 2026).
- Royal Osteoporosis Society analysis. Available upon request.
- Van Staa TP, Dennison EM, Leufkens HGM, Cooper C, Epidemiology of Fractures in England and Wales.
- Professor Kassim Javaid, oral evidence, APPG on Osteoporosis Inquiry (2021).
- ROS Freedom of Information request, analysis of responses (2021).
- Royal Osteoporosis Society analysis. Available upon request.