Prosthetics for Amputees

Lord Shinkwin Excerpts

Thursday 1st May 2025 Grand Committee

[Lord Shinkwin (Con)]

My Lords, it is an honour to follow my noble friend Lord Mackinlay of Richborough. I thank him for securing this important debate and draw courage from the example that he sets, as someone who also lives with a disability.

As he may know, non-disabled people often use the term “inspirational” to express their admiration of disabled people. Unwittingly, they thereby place us on a pedestal. The inadvertent implication—subliminal message, even—is that they could never countenance being disabled or, indeed, think of anything worse. Apart from the fact that being placed on a pedestal, however well intentioned, can compound the sense of isolation caused by living with a disability, surely my noble friend’s experience demonstrates that disability—in his case, specifically limb loss as a result of sepsis, as he explained—can affect any of us without warning.

Being placed on a pedestal does not lessen the daily grind of living with a disability, particularly the reliance on prosthetics or, as in my case, orthotics, which I have had to wear on my legs since I was a child. As my noble friend rightly argues, that challenge should not be exacerbated by the system, yet, as he highlighted so graphically, it unfortunately often is.

This seems to be an endemic, even cultural, problem in the NHS, which, to be fair, excels at acute care, as my noble friend and I know from direct experience. The quality of acute care in wonderful NHS hospitals such as St Thomas’, where both of us have been treated, is phenomenal. Yet the failure to follow through with what my noble friend euphemistically termed in his Question “appropriate” care—in his case, prosthetics—at “an appropriate time” perversely undermines the sometimes huge investment made in one individual by inadequate and delayed follow-up care. I hate to think of how much I have cost the NHS over the years. My noble friend is more diplomatic than I am in his use of the term “inappropriate”; what a multitude of sins that word covers.

I should make clear that I do not mean to imply that our highly skilled and dedicated NHS rehabilitation teams, incorporating both prosthetists and orthotists among other relevant healthcare professionals, are at fault—on the contrary. I can speak only as someone who has benefited from the care provided by orthotists, another branch of that rehabilitation family, but I am immensely grateful for the crucial part that they have played in enabling me to keep the show on the road. By that, I mean that, after every fracture—I have had countless fractures—it has only been because of them and the callipers I wear, which they have tailored to support the very broken body in which I live, that I am here today, on my feet, speaking in your Lordships’ Committee.

So I am delighted to have this opportunity to put on the record my sincere thanks to Chris Cody and his brilliant team at the Guy’s and St Thomas’s regional specialist rehabilitation centre for their professionalism, compassion and empathy as I pick myself up, dust myself down and damn well get on with it. I am sure that the same can be said by my noble friend in terms of the pivotal role that NHS prosthetists have played in enabling him to continue both to live a full life and to perform his crucial role as a Member of your Lordships’ House.

In advance of today’s debate, I consulted a few people on the front line of the NHS rehabilitation sector. First, I will give the good news. Technological advancements such as microprocessor knees, which my noble friend mentioned, and the integration of 3D printing are making a difference, although the latter is in its infancy. Such innovations are undoubtedly welcome but—it is a big “but”—they are overshadowed, again, as my noble friend said, by workforce shortages. Indeed, one of the rehabilitation experts said:

“We are a profession at risk”,


such are the workforce constraints. Coupled with funding constraints, which have led to disparities in access to and quality of care, this is a really worrying situation for anyone who cares about value for money in the NHS. As my noble friend explained, demand is outstripping supply. There are not enough prosthetists or orthotists, which has an inevitable effect on waiting times and—quite apart from the low pay for technicians, as has been mentioned, and for prosthetists and orthotists—their morale.

So I would welcome any reassurance the Minister can give that the refreshed NHS long-term workforce plan, which I think is due in the summer, will address the critical shortage of qualified prosthetic and orthotic professionals. In case the Minister assumes that I am asking for the NHS pot as a whole to be increased, let me say that I am not. This is a question not necessarily of increasing the NHS budget as a whole so much as one of reprioritising existing resources to safeguard the cost-effectiveness of the NHS’s investment in people like my noble friend and me, precisely in order to get bigger bangs for bucks.

In conclusion, I go back to the positives and front-line suggestions on improving patient outcomes. As we know, this means greater independence, fewer hospital admissions, better mental health—my noble friend mentioned this—and more disabled people in employment and thus paying into the system. I have three suggestions. First, strengthen workforce development by investing in education and training programmes. Expanding apprenticeship opportunities and providing financial incentives offer exciting potential to attract new talent to the profession.

Secondly, enhance funding and commissioning. For example, a standardised approach to commissioning prosthetic and orthotic services could potentially mitigate regional disparities and promote consistent access to high-quality care. There are lots of amazing products and components out there, but access is limited by financial constraints.

Thirdly, we must embrace technological innovations. This is where investment in research and development and the adoption of emerging technologies are so important. If that means greater collaboration with private sector firms such as the ones that my noble friend mentioned, in the interests of patient outcomes and consistent with NHS values, that is fine.

In closing, I hope that the Minister has found or will find this discussion useful in deepening her appreciation of just how important prosthetic, orthotic and other rehabilitation services are. Neither my noble friend nor I would be here without them; they need to be nurtured, and that requires a shift in priorities. I would love to think that my noble friend might be asked to help effect that change to the culture and priority that the NHS attaches to what are, sadly, Cinderella services.

Fracture Liaison Services

Lord Shinkwin Excerpts

Wednesday 4th December 2024 Lords Chamber

[Lord Shinkwin (Con)]

My Lords, earlier on today, I googled the meaning of the phrase, “It’s a no brainer”. Apparently, it applies to a question that is very easy to answer and, although it did not give an example, I suspect we could all think of one. As my noble friend Lord Black of Brentwood said, there is unanimity across your Lordships’ House on this.

As someone who lives with a bone condition, I am something of a reluctant expert on fractures, or at least on the excruciating pain they cause. The crunch as the bone fractures is immediately followed by the weird sensation of there being a void, because suddenly the broken bone cannot bear any weight. There is literally nothing there, and into that vacuum comes this all-consuming shockwave of pain. I make this point because some may assume that rollout is not urgent because, as my noble friend Lord Black of Brentwood mentioned with regard to hip fractures, it is not normally life-threatening. But this ignores the unnecessary human, as well as financial, cost.

I think of Stephen Robinson, a forklift truck operator, who suffered chronic, agonising back pain, dismissed for years as muscular by his GP. The doctor insisted that he should leave his manual job if he wanted his pain to improve. Eventually, the choice was taken away because the pain was so severe that Mr Robinson had to leave work altogether at 61. He remembers “living in the chair, drugged up to the eyeballs, counting the minutes until I could take the next painkiller”. My Lords, I have been there. It is not nice. A private DEXA scan is not easy to afford when you are unemployed, but it showed that Mr Robinson had 10 undiagnosed spinal fractures. An early assessment through a fracture liaison service would have given him back years of his life and saved him so much unnecessary pain.

In contrast, Alison Smith retired at 60, feeling fit, healthy and ready to embrace her new-found freedom. But nine months later a fall left her with fractured ribs and an alarming sense that something was wrong. Seen quickly by medics, she was referred to a fracture liaison service, which identified severe osteoporosis and started her on treatment. With the support of the fracture liaison service team, Alison received lifestyle advice and ongoing care, which prevented any further fractures happening and saved the NHS and the taxpayer money.

In conclusion, any further delay in the rollout of these vital services would represent an inexplicable, unjustifiable false economy, because it is actually costing money not to proceed with universal provision. I look forward to the noble Baroness the Minister giving us reason to hope.