Artificial limbs that are useless — because NHS hi-tech is edging out skilled craftsmen

W ORKING in a pub, Victoria Marks was used to pain and discomfort in her legs after a long shift spent on her feet. But the twinges she first blamed on the long hours were in fact the beginning of a terrifying condition that led to the amputation of both legs above the knee in 2006.

Victoria has Buerger’s disease, an incurable condition where the immune system attacks the blood vessels in the arms and legs, causing them to become inflamed and reducing blood flow. As a result the tissue can rot and the only option is amputation to stop it spreading.

Since her diagnosis, the mother-of-four has been determined to lead as normal a life as possible.

But the prosthetics she’s had have brought Victoria, 44, from Cornwall, nothing but problems, she says. She has been fitted with ‘dozens’ of man-made replacements, each costing around £5,000.

‘But each one has been useless and I’ve had to send them all back as they didn’t fit,’ says Victoria, who is married to Scott, 45. ‘They would rub my skin so much it would be raw and bleeding.’ After ten years of pain and distress, she is now permanently in a wheelchair.

Charities and support groups say her story is all too common due to what many see as serious failings in the NHS provision of prosthetics.

Growing numbers of patients in the UK are undergoing amputations, mainly due to complications from diabetes. In England, a record 7,000 diabetes-related amputations a year are performed, according to Public Health England.

Other reasons for amputation include peripheral arterial disease (where blood supply to leg muscles is restricted) and bone cancer.

Critics argue the quality of care amputees receive on the NHS has declined, leaving many of the country’s 65,000 amputees struggling.

One problem is the production and fitting of the sockets that join the man-made parts to a remaining limb. The socket, usually made from a plastic or carbon fibre material, is placed over a silicone liner that sits over the leg stump, and clipped on to the prosthetic limb.

It is crucial as it transmits forces from the prosthetic limb to the patient’s body when the limb hits the ground. How the socket sits on the stump largely determines how well the prosthetic ‘fits’ the patient, so it must be a perfect match.

But that fit can be affected by everything from slight weight changes to shrinkage in surrounding tissue after a limb is removed.

The sockets are produced by prosthetists working for the NHS. In recent years there has been a Distress: Victoria Marks is now forced to use a wheelchair shortage of technicians with the expertise to make sockets properly, says Gordon McFadden, from the charity United Amputees.

He says that as hundreds of ageing but highly skilled prosthetists retire, they are being replaced by less experienced graduates who lack the expertise needed.

The traditional technique is to make a plaster cast of the limb and tailor-make a socket to fit snugly. Gordon says technicians used to scrutinise how the limb performed bearing the patient’s weight and fine-tuned the fit to allow for that. BUT,

he says, modern methods using a laser require less hands- on skill and today’s prosthetists also lack the techniques to make adjustments: this leads to ill-fitting sockets that can leave patients in pain.

After numerous failed adjustments, many resort to wheelchairs, he suggests. Gordon speaks from personal experience.

Now 55, he lost his right leg below the knee when he was 18 months old due to a congenital deformity. For 40 years, he’s worn artificial legs made from wood, then metal, and now lighter plastic and carbon fibre. ‘For most of that time, I wore a wooden leg attached to braces that slipped over my shoulder. I never got pain. For years I could work full-time as a carpenter,’ he says.

‘Eight years ago, I had to switch to a more modern composite limb as there were no prosthetists left with the skills to maintain wooden ones. I’ve had problems ever since.

‘Now, I often have to dose up on painkillers to get through the day. I often struggle to get from the car to the front door due to the agony.

‘I know of a nurse who has been unable to work for the past four years because the NHS no longer has the skills to keep her moving.’

The lack of expertise is a concern, agrees the Limbless Association, which says it receives at least two calls a day from amputees unhappy with their NHS prosthetics — especially the standard of sockets.

‘It’s the biggest issue for civilian amputees,’ says chairman Stuart Holt. ‘The socket must fit perfectly and it can take time to get it right.

‘Modern techniques using lasers are OK, but a lot depends on the prosthetist’s skill. A lot of young prosthetists come out of university with the right degree, but lack the experience of the older generation. That is why there are complaints.’

Lynne Rowley, chairwoman of the British Association of Prosthetists and Orthotists, which oversees the specialty, insists the quality of the UK’s undergraduate training is ‘among the highest in the world’.

But she admits standards have been hit by a wave of retirement among experienced technicians. ‘We would welcome a review into NHS services. There is a need.’

What also causes resentment is that the NHS prosthetics budget is £60 million a year — or £923 for each of the country’s civilian amputees. But the Department of Health ringfenced £6 million of this for injured ex-servicemen and women.

This works out at £15,000 each, so injured veterans have access to more high-tech prosthetics and often several for different uses, compared to the single limb issued to civilians.

‘This has led to disparity in the service,’ says Lynne Rowley.

There has been some progress on this. In December, NHS England announced it will fund microprocessor-controlled knees — like those available to injured ex-servicemen and women — for civilians living with above-knee amputations.

These ease pain by measuring the walking pattern and terrain with tiny sensors in the knee and making adjustments in load. But Gordon McFadden insists: ‘ It doesn’t matter if it costs £10 or £1 million, if it doesn’t fit then it’s no use.’