Skip to main content

Amputees: Limb Fitting

Volume 797: debated on Thursday 2 May 2019


Asked by

To ask Her Majesty’s Government what plans they have, if any, to introduce a national system of recording (1) the number of, (2) the treatment received by, and (3) the dates of treatments for, new amputees attending limb fitting centres in England.

My Lords, I pay tribute to my noble friend for his continuing interest in wanting to improve services in this important area. As an ex-surgeon he has significant expertise and insight. From 1 April this year, NHS England’s specialised commissioning has required all limb centres delivering amputee services to complete a data reporting template which will collect the information described. The data is not expected to be published as a national statistic but is collected to support the commissioning process.

My Lords, I thank the Minister for her usual helpful reply. She has done so well in stimulating the Department of Health, because in November last year the department told us that it did not collect this information centrally—so I am very glad that she has had success. Will the information be collated?

My Lords, the data collection is not expected to be published routinely but is submitted by the provider to the relevant commissioning hub as a contractual requirement under schedule 6 of the NHS contract information reporting requirements. But I hope that my noble friend will be pleased to hear that we will be considering making available a summary of this data in due course once we have established that it has been collected and reported appropriately.

My Lords, being fitted with a new knee can completely change a person’s life. Can the Minister tell the House what advice is given to clinical commissioning groups about commissioning knee replacements? Living in Cornwall, I would be treated sooner than if I lived on the Isle of Wight. When does the Minister expect the wait on the Isle of Wight to be the same as in Cornwall?

My Lords, I hope that any variation in any service is dealt with and reduced as much as possible. As the noble Baroness will be aware, NHS England commissions the prostheses centrally and has a service specification. It has a duty to reduce inequalities in access to health services and in the health outcomes achieved, as enshrined in the Health and Social Care Act 2012. Certainly the principle is to reduce inequalities.

My Lords, is my noble friend aware that three weeks ago I was the recipient of a new knee—and what a wonderful job the National Health Service does in Stoke-on-Trent?

I thank my noble friend for his support for the NHS. I hope that his new knee continues to work effectively and properly for a very long time.

My Lords, I have two questions for the Minister. First, many people face an amputation as a result of diabetes. What progress is the national prevention programme making in reducing the number of amputations? Secondly, the Minister will know that NHS England organised a patient survey last year. It reported that one of the biggest issues for people was getting a comfortable and timely socket fit. People expressed frustration that it was not always a get it right first time situation. That is vital, so my second question is about quality control as well as collecting data.

I thank the noble Baroness. NHS England invested more than £9 million of transformation funding in 2017-18 to further reduce amputation rates in people with diabetes by putting in place new and expanded multidisciplinary footcare teams. Overall, the incidence of major amputations in England is now one of the lowest internationally because of this investment. As the noble Baroness correctly said, a review was undertaken. Clinicians will look at the outcomes of that review and take the appropriate action in due course to ensure that some of the complaints made have been addressed adequately.

My Lords, is it proposed that amputees from the Armed Forces, whether serving or retired, will be included as a subgroup, bearing in mind the importance of maintaining the military covenant?

My Lords, the military provide dedicated and important service and it is right and fundamental that we support them in their time of need. The Veterans’ Prosthetics Panel supports members of the Armed Forces community who require prosthetics and ensures that they receive the latest prosthetics, including with next-generation microprocessors. More than 97% of claims were approved in 2016-17 and more than £1.5 million was spent on prosthetic centres.

Will the statistics include amputations as a result of sepsis? I declare an interest as having a family member who was affected by this. Perhaps that would be a motivation and inspiration to encourage an increased awareness of sepsis.

I am very sorry to hear of the experience that the noble Baroness’s family has faced. Sepsis is an important issue, and we are dealing effectively with ensuring that we bring it under control. All amputations as a result of whatever issue are taken very seriously and we are offering the same kind of service so that we cut down the variations in the system. The current review will take into consideration all issues that patients have raised.

My Lords, following on from the question asked by the noble Baroness, Lady Thornton, about the relationship between amputations and type 1 diabetes, the worrying aspect is the great variation in amputation rates across England. Does the Minister agree that areas that have high rates of amputation should be asked to look at how they can follow the guidelines issued by NICE to reduce the rates?

I agree that it is important that we reduce the variations and that NICE guidelines are followed. NHS England’s service specifications include a duty to reduce inequalities. They set out a number of issues to ensure that there is improved access, including flexible appointments, rehabilitation and reablement—but the noble Lord is quite right that we must address the variations.

Does the Minister agree that the way to reduce the number of amputations is to reduce the causes of them, one of which is the obesity epidemic? If a person’s waist measurement is more than half their height, it means that they are eating too much of the gross national product.

My Lords, absolutely. As someone who has had a problem with her weight all her life, I do agree. Losing weight is not as easy to do it as it is to say, but obesity plays a key role in diabetes and we need to get it under control.