Prosthetics for Amputees

Baroness Ludford Excerpts

Thursday 1st May 2025 Grand Committee

[Baroness Ludford (LD)]

My Lords, I am very grateful to the noble Lord, Lord Mackinlay, for introducing this debate. When I first introduced myself to him as someone interested in continuing to be involved in the All-Party Parliamentary Group on Sepsis, because of my late husband’s experience in losing a leg to sepsis, his response was, “Is that all? Only one?” The fact that he could make such a quip to me is a tribute to his wit and humour—by the way, I did check with him before quoting that exchange in this debate. His experience puts my late husband’s in perspective, and his speech was extremely interesting, as were those of other noble Lords. Not only do I not have first-hand experience—that was my husband’s, and I was only an anxious observer and supporter—but it was a decade ago, and I am glad to hear that the development of prosthetics has moved on considerably, although whether they are supplied in the NHS is another issue.

We never knew exactly how and why my husband developed sepsis, which led, after a series of operations—to me they were, and are still, a bit of a haze—to the amputation of his leg above the knee. The surgeons tried to save the knee, but they could not do that if they were going to save his life, which they did by the skin of their teeth. I pay tribute to those excellent surgeons and all the other medical staff. The second bit of slightly dark humour I associate with this topic is that my husband was, at the time, the chairman of the Whittington Health trust at Archway in north London, and we managed to joke—at least once it was clear that he was going to survive—that it would not have been a good advert for them or the hospital to lose the chairman under the knife in their own operating theatre. You sometimes have to find humour in very difficult circumstances and, of course, strength and resilience. My husband was not always the easiest person to live with, and he would say the same about me, I am sure, but learning to use a very heavy prosthetic leg from the hip in his late 60s took every ounce of his considerable grit and determination. The noble Lords, Lord Mackinlay and Lord Shinkwin, have that in spades.

Of course, every person who needs a prosthetic is different—we learned that almost 60,000 are attending clinics—and has specific needs. Steve’s physio and training at the Royal Orthopaedic Hospital in Stanmore took place alongside service personnel who had lost limbs, usually one or both legs and usually to an IED or mine in Iraq or Afghanistan. They were, of course, much younger and fitter than him, though they had gone through a horrible situation. It would have been easy for him to get discouraged, and he tried not to, but—one thing was mentioned about the stump—he had a lot of sores on his stump, I suppose because it was not fitting or just from the situation.

I noted from the briefing that the Library kindly produced for us that there is also a veteran’s prosthetics panel, through which people whose limb loss followed from their military service can access high-quality prosthetics. Of course, service veterans absolutely deserve that, including those 80,000, as the noble Lord said, in Ukraine. But if non-military patients do not also receive the best prosthetics going, they are likely to cost the NHS more as they develop other medical problems—maybe joint, muscular or other problems. This is my first example of where I think the NHS is not doing proper cost-benefit assessments.

I shall come back to sepsis, but I want to say something about diabetes. My husband had been a type 1 diabetic since he was 21, and because type 1 damages organs and the immune system, all this was no doubt a contributory factor in his acquiring sepsis. His blood sugar control was pretty good by 2015, but it was a big fight for him to get access to the then latest technology, which would make keeping his blood sugar as level as possible a bit easier and less hit and miss than the old reliance on pinprick tests. The point is not just about the personal welfare of diabetics—though a severe hypo is horrible for the person suffering it and as a spouse, it can be pretty terrifying to deal with—but for these purposes I want to highlight the long-term costs for the NHS of not investing in the latest technology for patients. Because poor sugar control contributes to long-term complications of diabetes, and many diabetics face limb amputation as well as other devastating conditions, such as kidney failure, I have always found it puzzling that the NHS does not pursue a policy of up-front investment to stop even higher costs down the line. It may be something to do with the siloing of budgets between the GP, the hospital and specialist diabetes services.

The same applies to sepsis, from which a shocking 48,000 people die every year. The NHS ombudsman issued major reports on sepsis care in 2013 and 2023, but last September, the current one, Rebecca Hilsenrath, said she not seen the health service do enough to improve staff’s awareness of the condition and the imperative to diagnose it quickly. The noble Lord, Lord Mackinlay, rightly mentioned the threat of antimicrobial resistance, which is putting another challenge on the fight against sepsis. Dr Ron Daniels, an NHS doctor and the founder and joint chief executive of the UK Sepsis Trust, was quoted in the Guardian as saying

“Ministers need to ensure that the NHS starts giving sepsis the same priority as other big killers such as heart attacks and strokes”.


Obviously the biggest tragedy is those who die, but for those who survive—and we hope that more may do so as care improves—the care and provision of prosthetics is vital. I should say that in a Guardian article I read, the noble Lord, Lord Mackinlay, was referenced, as bionic man, as helping to raise the profile of both sepsis and prosthetics. I pay tribute to him not only for coping with his personal circumstances but making it a campaign issue for the benefit of all.

All noble Lords who spoke before me highlighted that the biggest challenge is staff. I am glad to read that bionic prosthetics, or whatever they are called nowadays, which respond to the body’s electrical signals, have been available from the NHS since 2022; that is what we learn from the briefing. I do not know whether that is general and everyone is getting what they need, and I have no idea whether that could have helped my husband’s mobility, but the more that people who have lost a limb can do, including possibly work, the less help and expense they will need, so here too the NHS needs to invest upfront. Time and again, the NHS does not join up the dots in this respect.

The last thing I want to say is about people with poor mobility trying to get around safely in the public sphere. For my husband, even the consistent provision of railings on steps could have helped. In many places, there are, quite rightly, ramps for wheelchairs, and he was in a wheelchair for a few months before he had his prosthetic fitted, but those ramps made life more difficult for him because, without an ankle joint—the leg was rigid—he could not go up or down a slope. Every person with disabilities has different needs, but just having a rail in public spaces would have helped enormously.

I conclude with what is, I am afraid, a constant preoccupation of mine with e-bikes, e-scooters, bikes and scooters. Steve found that even then, a decade ago, it was scary trying to dodge the proliferation of bikes and scooters on pavements because, if he fell, without a knee, he could not get up on his own. To me, this is another reason to stop this menace on pavements. Of course, he did not like asking for help; it could be humiliating and he was a very self-sufficient sort of chap. If noble Lords will allow me that personal anecdote, it was a reminder to me of the huge difficulties that people needing prosthetics face.

I am hugely grateful to the noble Lord, Lord Mackinlay, and the other contributors to what I think is a very important if relatively short debate.