My Lords, I have declarations to make. These are TASKA hands, and they are on long-term loan from Steeper Group. Similar, Steeper Group paid for me to attend a prosthetics conference in France just a couple of weeks ago. As ever, we owe thanks to our library facilities—both the House of Commons Library and, this time, the House of Lords Library, which provided some data for this debate.
Some 55,000 to 60,000 people attending UK clinics have some form of limb loss. We are not entirely sure of the figure. The NHS is a great organisation for collecting a lot of data, but it has not quite managed to collect the data on why people have lost their limbs, which is a little remarkable. There are a number of reasons why people may not be fully limbed or may have suffered limb loss after they were born. There are congenital reasons, obviously: people may not have fully functioning limbs. Indeed, not having limbs at all can be a feature. The examples of limb loss that we are more familiar with, of course, are those caused by trauma, such as car accidents or injuries at work.
I always ask why Leeds seem to be a centre for the whole prosthetic and limb loss industry, if there is such a thing. Leeds hospital is at the forefront of hand transplants. Of course, that is because of the industrial past of that part of the world; we may have a greater population in the south-east, but we do not have those types of industrial accident at quite the same level.
Of course, we see a huge expansion in limb loss during wartime. We saw that during the Afghan and Iraqi wars, with IEDs and mines, which are certainly good at one thing: taking limbs off very effectively. The Ukraine war, though, has come up with some new reasons for limb loss. Some 80,000 soldiers in Ukraine have lost limbs—one can only guess that, in Russia, it is a similar amount—but there is a new dynamic of antimicrobial resistance. If you get a limb injury, it should not kill you; it should just pass. However, because we have an increased amount of resistance, that can lead to limb damage and loss. Then there is the use of field tourniquets, where the urgent decision of saving life, not limbs, is taken; the limbs then die and have to be taken off.
The classic cause is diabetes; it is one of the main reasons for limb loss. When I was in my clinic, the amputee rehabilitation unit just over the river in Kennington, the classic example was that of older men who had lost limbs to diabetes—not living as well as they should, shall we say. You can also lose limbs with cancer.
However, the cause that is of great interest to me is sepsis. The trouble with sepsis is that you often lose limbs in pairs. You do not lose just one: both go at once, whether that is two legs or two arms. If you are really lucky and get the quad, you lose all four, like me. The provision of legs is somewhat easier. I am very lucky in that mine were lost below the knee, so I have knees; that makes life incredibly different. The NHS has been good at bringing forward microprocessor-controlled prosthetic knees, which are known as MPKs. They have been widely provided for some years, and people get on well with them. They have become standard kit.
So NHS provision, particularly on legs, is okay once it is on track. However, it is one of extreme delay. I can tell you the story of the legs that I am on. They are private legs. Thankfully, I have been able to get them. I am 10 months on from a cast and still have not got a leg that fits on the NHS. If I had not been able to get these privately, I would have been in a wheelchair for the last 10 months, with mental health issues, unable to go to work and probably suffering severe muscle wasting.
We have a problem in our clinics. The age profile is poor; it is old. It is not an industry that youngsters feel enthused to enter. The pay is not great, and although it may not be much more, if any more, in the private sector, that sector is growing and there is a feeling there of greater reward, greater ability to do your craft and better morale.
We have university provision for prosthetics. The two primary ones are those in Salford and Strathclyde. Within clinics that I have been to there has often been someone shadowing from their university course. However, the drop-out rates are appalling. We can look even further to the technicians, who make the sockets. It is all very well having a great prosthetist for the mould, but you need a technician. The drop-out rate there is even worse and the pay truly dire—often little better than minimum wage. As a country, we concern ourselves with how NHS provision is, particularly regarding our nurses. We have done a lot to try to improve nurse morale and nurse pay, but we have not had that same focus on the problems facing prosthetists and technicians.
This country used to have transferrable old skills. I come from north Kent and the Medway towns. I attend the Medway NHS clinic. In days of old, you would have had those transferrable skills from, say, the dockyard, which closed in 1983. In fact, they would have been greater skills of knocking stuff up in fibreglass, wood and whatever else. This would have also been true in parts of the country with car industries that have, perhaps, now gone. Those craft industries were very good at providing technicians for making prosthetics, but those days are gone.
Noble Lords can imagine my frustration that we still use those old ways, which work, of a plaster cast that is prised off and manufactured manually by a skilled artisan, yet we are short of those skilled artisans. Staff are the limitation. I hear all the time, “We’re short of staff”. There are new CAD techniques to direct 3D printing. I talk to various private companies that do NHS provision, such as Steeper Group, which I mentioned, and which is supporting me. Opcare is another. Those companies are still using those old techniques. I am trying to encourage them, if they have a shortage of people, to take people out of the system as far as they can.
If you lose one arm, you might get away with it. However, you could call losing two something of a catastrophe. I am a quadruple amputee. My worry is that we will see more people like me. My sepsis was very severe, and I was lucky to live, but years ago, if you had severe sepsis, you would simply have died. Now, with a greater understanding, greater knowledge and better drugs, you will get survivors, in states such as mine or that are even worse, yet the system is not preparing itself for keeping people alive. If you are going to keep people alive, let us try to get them on a pathway to recovery.
My experience of upper limbs is really poor. In the brief time I have, I will tell the Committee the story. One is that I was given a pair of what I can only call William the Conqueror-designed arms, with a rubber end. If you have one arm, you might get away with it, but being given two of those was the lowest part of my rehabilitation. You are then told, “Within a few months we might think about body-powered hooks”, which are straps around your shoulders—I would not be able to put them on by myself, of course, as I have two limbs missing—and you use your shoulder to open and close them. They are circa 1790. You then progress to a 1950s-style myoelectric. You have to use that for a year before you can be considered for what I have now, which people with two arms missing need at the earliest possible stage.
We have to go through those hoops. Those early hoops are paid for by the local NHS trust; my hands are paid for by NHS England. My experience was to attempt to make a discretionary appeal, as my condition is as bad as it is, to NHS England. It said, “After 10 months of trials, surely we can just get going with NHS-provided multifunctional hands”. The answer from NHS England was no, so I am very pleased to see the end of NHS England because we have to do better.
I have a final few words. If you go into A&E with a wound on your arm, the staff do not reach for a 1920s hot bread poultice; they give you up-to-date drugs, topical solutions and antibiotics. So please stop giving out pre-Victorian prosthetics.