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A vision for better bone health in Wales

Dr Inderpal Singh is a consultant geriatrician at the Ysbyty Ystrad Fawr hospital in south-east Wales, responsible for the Caerphilly falls and bone health service. As the national clinical lead for falls and frailty, he shares his vision for improving bone health through closer working between the Welsh government, health boards and the third sector.

How did we get here?

Since 2011, I have been clinical lead for the falls and bone health service at the enhanced local general hospital in Caerphilly. We care for people who have broken bones or other injuries after falling over, and who may have lost their confidence as a result. We assess these people and check whether they are at risk of falling again and work with them to reduce their risk.

In 2013, I introduced systematic and structured training for falls assessments in the hospital. The training reduced not only the number of inpatient falls in the hospital but has shown a significant reduction of inpatient hip fractures. Added benefits include a reduction in hospital stay, discharge to usual place of residence and more importantly, a significant reduction in mortality. We won a 2017 NHS Wales award, and our good practice was soon adopted by all health boards in Wales and welcomed by the RCP, with the National Audit of Inpatient Falls (NAIF) publishing its first report in 2020. Finally, our virtual fracture liaison service (FLS) supports patients with a ‘bone health care plan’ including lifestyle advice, information on osteoporosis and drug treatment options. We recently expanded this service by appointing two bone health specialist nurses.

My research experience and clinical interest in the management of secondary fragility fracture led to my appointment as Welsh national clinical lead in 2020. Since then, I have been engaging with health boards and the third sector to ensure a standardised national approach and better access to bone health services for everyone in Wales. In 2021 we introduced an all-Wales inpatient falls network to share learning and good practice. This led to the introduction of common pathways for falls risk assessment in line with NICE guidelines and NAIF recommendations. 

‘Let the first fracture be the last’

In 2022, I introduced a national FLS development and quality assurance group to improve and support the delivery of care across Wales and reduce the chances of patients having subsequent fractures. The group uses National Institute for Health and Care Excellence (NICE) guidelines and Royal Osteoporosis Society (ROS) standards to manage and improve osteoporosis and fragility fracture care in the community, identifying and disseminating good practice and providing recommendations to the Welsh government and NHS Wales.

Post pandemic, staff are exhausted, both emotionally and physically  

We face several challenges ahead of us with limited resources, training and staff shortages, but we remain committed to reducing variation in bone health care, integration and partnership working, and raising awareness and improving education.

Shared learning, in person

On 20 October, the first fracture liaison service (FLS) conference in Wales was held to coincide with World Osteoporosis Day. We welcomed the minister for health and social services, Eluned Morgan MS to hear speakers including the NHS Wales chief executive, the ROS chief executive and the RCP vice president for Wales. Healthcare professionals came away with information and support to help improve bone health and secondary fracture care for the people of Wales.

What does the future hold for bone health in Wales?

My national work allows me to reflect on the learning from my routine clinical work and collaborate with other professionals, which is very stimulating. My aim is to develop a national strategic framework (NSF) for osteoporosis care in Wales, underpinned by quality planning, control and improvement. After all, Wales has an ageing population, and we must change how we care for older people to help them stay steady on their feet and live a full and independent life.

Dr Inderpal Singh
National clinical lead, falls and frailty
Consultant geriatrician, Aneurin Bevan University Health Board
Honorary senior lecturer, Cardiff University