A House of Lords debate on 1 May 2025 laid bare the serious challenges facing amputees in England, particularly with regard to access to prosthetic care through the NHS.
The House of Lords debated the following question in Parliament: “Lord Mackinlay of Richborough (Conservative) to ask His Majesty’s Government what steps they are taking to ensure that amputees receive appropriate prosthetics at an appropriate time.”
The discussion highlighted widespread delays, outdated prosthetics technology, workforce shortages, and regional inequalities in accessing NHS prosthetic services that continue to undermine patient outcomes.
Lord Mackinlay, a quadruple amputee, opened the debate with a critique of current NHS prosthetic services. He described a system marked by “pre-Victorian” practices and frustrating delays. Though lower-limb devices like microprocessor-controlled knees are more common, access remains slow and inconsistent. Sharing his own experience, he explained how he waited 10 months for NHS-provided legs that ultimately did not fit. He was only able to stay mobile through privately obtained alternatives.
Upper-limb prosthetics fare even worse, with patients forced through a regressive pathway – starting with basic rubber arms and body-powered hooks – before being considered for modern multifunctional prosthetics. Even in severe cases like his, NHS England has refused to expedite access. Lord Mackinlay criticised this process as archaic and medically unjustifiable.
He also drew attention to the NHS’ staffing crisis. Low pay, limited career progression, and poor morale are deterring new recruits. Technicians, particularly those responsible for making sockets, are in short supply. Many centres still use outdated methods like plaster casting due to a lack of skilled staff and slow adoption of innovations like 3D printing.
Lord Mackinlay warned that conditions such as sepsis are increasing the number of high-needs amputees, yet the NHS is not adapting fast enough. He called for a responsive, modern system that offers timely access to life-changing prosthetics rather than making patients wait months or years.
Several peers backed Lord Mackinlay’s call for change. Lord Shinkwin, a lifelong orthotics user, praised the NHS for its acute care but criticised the lack of effective, timely rehabilitation services. He argued that delayed prosthetics provision undermines the investment made in emergency care, failing to support long-term recovery and independence.
He placed the blame not on frontline clinicians but on systemic issues: workforce shortages, low morale, and underfunding. Highlighting regional disparities and the slow rollout of new technologies, Lord Shinkwin called for urgent reforms in workforce training, funding allocation, and innovation. He proposed three priorities: developing the workforce, ensuring equitable commissioning, and investing in research partnerships.
Lord McColl of Dulwich echoed these concerns and noted that prosthetic provision in the UK has remained poor for decades.
Baroness Ludford contributed a personal account, describing her late husband’s challenges after a sepsis-related amputation. She praised specialist rehabilitation centres but raised concerns about ill-fitting devices and the long-term physical harm they can cause. She argued that prosthetics users should have access to the same quality of care provided to veterans and warned of the false economy of short-term cost-cutting.
Baroness Ludford also criticised the slow progress in NHS sepsis care and the lack of preventative measures for conditions such as diabetes, which often lead to amputations.
Lord Kamall added his support, framing prosthetics access as a matter of dignity, fairness, and independence. Reflecting on personal experiences with friends and family affected by limb loss, he emphasised the life-altering consequences of inadequate prosthetic care. He identified workforce shortages and unequal access as major barriers, calling for more training programmes and a strategy to attract engineering talent into prosthetics.
He also challenged the NHS’ bureaucratic and staged process for accessing top-tier prosthetics, suggesting that faster access might not only improve outcomes but also save money. He questioned why veterans benefit from more comprehensive support than non-veteran prosthetic users and asked what steps the government is taking to eliminate the so-called “postcode lottery.”
Responding for the government, Baroness Merron, Parliamentary Under-Secretary of State for Health and Social Care, acknowledged that the current state of prosthetics provision is inadequate.
“The current service is not where it needs to be and we have some way to go.”
Baroness Merron confirmed that Health Secretary Wes Streeting had met with Lord Mackinlay and other affected individuals to understand the extent of service gaps and regional disparities. She emphasised that prosthetics must be delivered based on individual need, rather than through one-size-fits-all policies.
She explained that prosthetics are provided through 35 regional specialist centres in England, supported by multidisciplinary teams. However, she admitted that local variations in care are contributing to unequal outcomes. She recognised the significant emotional and practical toll faced by patients when devices are delayed, ill-fitting, or inadequate.
In response to concerns about long wait times, Baroness Merron stated that while recovery from surgery can necessitate some delay, many patients still experience unnecessary waiting. To address this, NHS England is reviewing its clinical commissioning policy for multi-grip upper limb prostheses. The results of an audit currently underway are expected by summer 2025 and are intended to inform new guidance aimed at reducing delays and improving outcomes.
She also announced that updated national standards for prosthetic services would be released within the month. These will pay particular attention to improving care for children, young people, and individuals with congenital limb loss.
Workforce issues were a major focus of her response. Baroness Merron acknowledged that prosthetists and orthotists are the smallest of the 14 allied health professions in the NHS, with just 43 graduates annually – only a quarter of whom go into prosthetics.
To address this, a new degree programme has been launched at Keele University, complementing existing courses at Derby, Strathclyde, and Salford. She also pointed to a refreshed long-term workforce plan, which includes non-repayable grants of at least £6,000 annually for students training in this field.
On the topic of innovation, she expressed support for embracing cutting-edge technology, including research grants and private sector partnerships, to improve prosthetics care. She stressed the need to make the profession more attractive to graduates, particularly from engineering and technical backgrounds.
Concluding her remarks, Baroness Merron described the debate as “moving” and “practical,” and committed to turning the issues raised into actionable policy changes.
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