Ed Humpherson to Ruth Wakeman: Fracture Liaison Services
Dear Ruth
Coverage of Fracture Liaison Services in England
Thank you for contacting the Office for Statistics Regulation (OSR) about your concern, which relates to how the government is reporting progress towards its commitment to expand the coverage of Fracture Liaison Services (FLS) in England.
We have considered the information you have provided and have also contacted the Department of Health and Social Care (DHSC) to better understand the origin of the statistics and whether their use has been misleading.
We understand that the original commitment was first made formally in May 2024 in the House of Commons by the then Secretary of State for Health and Social Care, Victoria Atkins, who said:
“…today I want to confirm that this Government have the ambition to expand the use of fracture liaison services to every integrated care board in England and achieve 100% coverage by 2030.”
This Government first addressed the commitment in Parliament on 23 July 2024, when Andrew Gwynne who was Parliamentary Under-Secretary at the Department of Health and Social Care at the time, responded to a question on the provision of FLS in all hospitals, stating:
“I am pleased to reiterate the Government’s commitment to expanding access to fracture liaison services.”
While the commitment made in May 2024 references integrated care boards (ICBs), we agree that reporting on progress towards the commitment has not been consistent. Government ministers have drawn on several different statistics during subsequent public discourse on this topic, including the number of FLS, the number and percentage of individual Trusts with an FLS, and the number and percentage of ICBs with FLS. We consider this could confuse members of the public about the specific nature of the commitment and about how progress towards it is being measured and made. Specifically, we note the percentage of trusts with a FLS is currently considerably lower than the percentage of ICBs with at least one FLS.
As the regulator for official statistics, it is not within our remit to comment on which measure is the most appropriate to represent progress towards a government commitment. Therefore, we have presented our position with regards to the Code of Practice for Statistics, which contains the Standards for the Public Use of Statistics, Data and Wider Analysis. These standards speak specifically to how statistics should be used publicly by government, to support public confidence in statistics and the decisions that are influenced by them.
We have written to the DHSC to set out our findings, along with our recommendations for steps the department could take to improve the availability and clarity of data relating to this commitment, to better support public understanding of the intended outcome and progress against it. For transparency, we have set out our view and these steps in more detail here as well:
Equality of access
Although figures relating to FLS coverage and the FLS commitment are drawn on periodically in public discourse, statistics on this topic are not routinely published by the government. While we understand that data on the number of FLS and their locations are publicly available and therefore that individuals and organisations can calculate statistics about FLS coverage themselves, given the ongoing commitment and sustained public interest in this topic, we consider it would be better to have a single government source of statistics that can be drawn on by all, which clearly explain how the statistics presented relate to the commitment for 100% coverage. Accordingly, we have advised DHSC to consider publishing consistent and timely official statistics or management information related to this commitment, for as long as it remains a government commitment.
Supporting understanding
To support the understanding of any statistics used in future public discourse, we consider that published statistics and those communicating them should set out more clearly what is meant by “coverage” and the end goal of the commitment. This could include confirming whether “100% coverage” relates to the presence of FLS within ICBs or Trusts. This could help avoid any confusion about FLS availability and the levels of service provision.
Decision making and leadership
To further support the appropriate and clear use of statistics in public discourse, we have agreed with DHSC analysts the need for any statistics included in ministerial briefings to be accompanied by relevant supporting information, including any contextual information and limitations or uncertainty within the statistics. This would include, for example, any changes in percentage coverage that arise from changes in the number of ICBs or changes to how ICBs are clustered, rather than the number of FLS.
Thank you again for raising this concern with us. We hope our response provides assurance that we have considered the issues you have raised and that we have highlighted the relevant points for improvement with DHSC. My team would be happy to discuss any part of this response with you, if helpful.
Yours sincerely,
Ed Humpherson
Director General for OSR