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.

NHS Hospitals: Apheresis

Baroness Ludford Excerpts

Wednesday 9th October 2024 Lords Chamber

[Baroness Merron (Lab)]

NHS Blood and Transplant provides the biggest apheresis service in Europe. It has been growing by 10% to 20% year on year, and that includes the workforce and increasing provision to patients. I will be pleased to write to the noble Baroness with the most up-to-date waiting list figures. However, in addition to the existing units, satellite services have been set up in Plymouth, Cardiff, Birmingham and London. I am glad to say that, over the next six months, NHS Blood and Transplant will also open new services in East Anglia and the south-west, and it is aiming to provide over 2,000 additional collection slots per year within the next 12 months. I hope the noble Baroness will welcome that development, which we want to continue to really harness the benefits of life sciences.

[Baroness Ludford (LD)]

My Lords, does the government review that the Minster mentioned encompass sickle cell patients? As a member of the All-Party Group on Sickle Cell and Thalassaemia, I am aware that apheresis is one of the few treatment options for sickle cell patients. It is crucial in reducing the chances of sickle cell patients suffering a sickle crisis whereby oxygen is prevented from travelling around the body, resulting in intense pain and potentially life-threatening complications. However, the lack of adequate apheresis capacity means that many sickle cell patients are unable to access this essential care. A number of APPG reports have shown that they often get under-prioritised and bounced out by other patients. Is the department factoring in sickle cell patients?

[Baroness Merron (Lab)]

I assure the noble Baroness that we are more than factoring it in. We are totally committed to working to support those with sickle cell, and thalassaemia. There is ongoing work to provide the very best possible care, including boosting the number of blood donors, which is vital in improving clinical pathways and delivering treatments. There is a treatment, as I am sure the noble Baroness is aware, called Casgevy, which requires apheresis as part of the process. It is being evaluated by NICE for the treatment of thalassaemia and it is also being evaluated for sickle cell. I hope all those things will bring great benefits.

Care Homes: Guidance

Baroness Ludford Excerpts

Wednesday 21st April 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, there are two points of difference. One is that we can take certain measures to guide the behaviours of care home workers but we cannot mandate for every aspect of their lives. Secondly, care home workers wear PPE and that significantly reduces their infectiousness. We do not ask care home residents to wear PPE. Were we to do so, I think it would provoke suitable concern among residents and their families. As a result, we have to have these isolation protocols in place to avoid the spread of the virus.

[Baroness Ludford (LD) [V]]

My Lords, I am a member of the Joint Committee on Human Rights, which has been concerned about the treatment of care home residents over the past year. It is continuing its inquiry with an evidence session this afternoon. As colleagues have asked, are not the Government sabotaging the chance for care home residents to have a trip outside, especially given that staff are coming and going without quarantine? The Government’s guidance says that they “recognise how important” outside trips are

“for residents’ health and well-being”.

At the same time, and as the Minister has affirmed in his answers today, they recognise that their requirement for a 14-day isolation period

“is likely to mean that many residents will not wish to make a visit out of the home.”

This is insulting and treats care home residents and their families like children, not as responsible adults.

[Lord Bethell (Con)]

I completely sympathise with the noble Baroness’s point. She is right: this puts huge pressure on residents and their families. I am heartfelt when I say that I completely agree with her that this has an impact on the mental health and well-being of residents. However, their health, their safety and their actual lives take priority, I am afraid. We are at a moment where, even with the rollout of the vaccine, there is still a high infection rate in the country. If the virus gets into a home it has a potentially devasting effect, spreading very quickly within the confined spaces of the home among people who, typically, are highly vulnerable. That is why we have to put in place these serious protocols. This is done with huge regret and we review it constantly. It is my sincere hope that we can lift these protocols as soon as we possibly can, but until the day when the evidence is conclusive, we have to have them in place in order to protect lives.

Reciprocal and Cross-Border Healthcare (Amendment etc.) (EU Exit) Regulations 2020

Baroness Ludford Excerpts

Monday 16th November 2020 Lords Chamber

[Baroness Ludford (LD)]

My Lords, I thank the Minister for his introduction. The removal of free movement rights in the recent Immigration Act is a matter of great regret to millions of British people, who knew their value. It will also become a matter of regret to many more Brits once they realise that their dreams of working in Germany or retiring to Spain without hassle or paperwork have been torn from them. The triumphant tweet from the Home Secretary celebrating the end of freedom of movement was a tasteless mistake.

The loss of the European health insurance card will be understood and felt immediately by any British person wanting to travel within the EEA next year. If the promise of the vaccines is borne out and travel opportunities open up, people will want to spread their wings. But they will get a nasty shock from the travel insurers, as the price of a policy will be whacked up to account for the loss of free emergency healthcare under the EHIC. In the other place, it was mentioned that some 30,000 people on dialysis can currently travel throughout Europe and receive their dialysis free of charge thanks to the EHIC. This is not covered by commercial travel insurers and in future it will cost them up to £1,000 a week. The Minister in the other place talked about a recently launched directory of specialist insurers covering serious medical conditions. Well, maybe—but the premiums are likely to be eye-watering.

Brits are also losing the ability to go to another EEA country for, say, an operation when the NHS waiting list is too long. Can the Minister tell me how many procedures have been done under the cross-border healthcare directive since it was implemented in 2013? It is perhaps appropriate that the amendment to domestic legislation entails deletion of references to “EU rights” because, very sadly, rights are being torn from British people in the healthcare sector as in so many others.

The only brighter news is that, thanks to the withdrawal agreement, some people will retain rights after the end of the transition period. First, UK nationals living and working in the EEA on 31 December 2020 will continue to be entitled to healthcare funded by their member state of residence and get an EHIC issued by that state. Can the Minster clarify whether that EHIC will grant that UK national free emergency healthcare wherever they travel in the EEA or only in their member state of residence? Will those British nationals get free NHS care when they visit here?

Secondly, British pensioners resident in the EEA on 31 December 2020 who hold a so-called S1 form will continue to be entitled to UK-funded healthcare, including a UK-issued EHIC. Will that EHIC be usable throughout the EEA, and will the S1 form mean they will get free NHS care in this country? EEA nationals resident in the UK on 31 December 2020 will continue to be entitled to access the NHS, which I assume means free of charge. They will also get a UK-issued EHIC, which will surely make their British friends very jealous indeed.

Lastly, a British national who has previously worked in an EEA country can get a UK-issued EHIC plus planned treatment in an EEA country under the S2 scheme. They can also apply for an S1 form—this debate has a horrible amount of jargon—issued by the UK once they reach state pension age, on the same terms as now. Is there a specified minimum length of time that they would need to have worked in an EEA country, or could it be for as little as, say, a week? Again, there will be some jealousy from their British friends that a British national, by virtue of having worked for I do not know how long in an EEA country, will be able to get a new EHIC.

I welcome the agreement with Ireland that the Minister referred to. I was not sure whether the agreement had been finalised, but it is of course good news.

As the clock ticks down to 31 December, we know that even if a deal is reached with the EU, it will be a skinny one. How confident is the Minister that it will include any provision to continue reciprocal healthcare, including the EHIC? Discussion about rules of origin or customs arrangements might seem arcane to many people, but losing access to free healthcare if ill on holiday will hit home to most Brits. The Minister said that no impact assessment has been done because the instrument makes only “technical” amendments. British holidaymakers might disagree when they get their bill from their travel insurer. A Government celebrating “getting Brexit done” through gleeful tweets about the loss of rights might find themselves not so popular if they tweeted about the EHIC. They might think that the loss of free movement is popular, as many people have yet to discover that free movement is a two-way benefit, but the loss of the EHIC card will not go down well at all. I hope the Minister will be able to give us good news about continued arrangements.

Health Protection (Coronavirus, Restrictions) (No. 2) (England) (Amendment) (No. 2) Regulations 2020

Baroness Ludford Excerpts

Friday 18th September 2020 Lords Chamber

[Baroness Ludford (LD)]

My Lords, getting the (Amendment) (No. 2) and (Amendment) (No. 3) regulations is somewhat academic, since the (Amendment) (No. 4) regulations came into force at one minute past midnight last Monday morning. There are various illogicalities and serious constraints on human rights in all these regulations and I look forward to the fairly imminent report from the Joint Committee on Human Rights, of which I am a member.

Our Secondary Legislation Scrutiny Committee commented in its 19th and 24th reports on the problems caused by regulations being laid less than 12 hours before they came into effect. In the case of the (Amendment) (No. 4) regulations, they were published only about 12 minutes before they came into effect—at, as I say, one minute past midnight. Can the Minister confirm my understanding that they were laid only after they came into effect?

I welcome the fact that, finally, the guidance and the law coincide. I believe that the Government’s language in the last six months has created a lot of confusion, including for the police. They have used the term “must” about both law and advice. I imagine this was because Mr Johnson was coy about the “nanny state”, but the obfuscation was very unhelpful. It would have been much better to say, “This is what you must do, because it is enforceable law, and this is what you should do, because it is your civic responsibility to show respect and care for your fellow citizens.”

It is my belief that the overwhelming majority of people would respond to such clarity by following both law and guidance if they diverge. Better, though, to bring the two together, which I believe the (Amendment) (No. 4) regulations finally do. Why has it taken six months for the Government to do that?

Lastly, I observe that, on the Tube in the last couple of weeks, I have observed almost 100% observance of the requirement for a face covering. I attribute this to the clarity of the requirement and to the fact that Londoners are law-abiding and care about their city. As internationalists and majority remainers, they were once labelled “citizens of nowhere” by a former Prime Minister. I am glad to say that Londoners have demonstrated that they are very much citizens of somewhere.

Covid-19: Response

Baroness Ludford Excerpts

Tuesday 19th May 2020 Lords Chamber

[Baroness Ludford (LD)]

When the Health Secretary told the other place yesterday that he was preparing to roll out his contact-tracing app, he rejected the plea from my colleague, Daisy Cooper MP, for a law providing for specific, rigorous safeguards. When does the Minister expect to get the response from the Information Commissioner on the data protection impact assessment for the app, which has been judged by privacy experts to be confusing and misleading?

[Lord Bethell]

The noble Baroness raised the data protection impact statement, which I have read. I did not find it confusing; I thought it was extremely straightforward and it has been welcomed by a large number of the privacy groups I have spoken to.

Coronavirus Bill

Baroness Ludford Excerpts

2nd reading & 2nd reading (Hansard) & 2nd reading (Hansard): House of Lords
Tuesday 24th March 2020 Lords Chamber

[Baroness Ludford (LD)]

My Lords, the only bright spot in this crisis is that experts are being listened to; long may that continue.

Obviously, the overarching concern is that the powers in the Bill should last no longer than is strictly necessary, should not overreach and should not set unwelcome precedents—one thinks, for example, of the reduction to one doctor for the exercise of Mental Health Act powers and the problems around care assessments. Moreover, the powers should not impact unfairly on disadvantaged minorities or marginalised groups, and should not go further than can be truly justified. It is not entirely clear why the Civil Contingencies Act or the Public Health Acts were insufficient in various areas.

In Schedule 21, there is a test of necessity and proportionality which is strangely absent from Schedule 20—the one that affects directions to people. From these Benches, we will therefore table an amendment to require that all the powers in the Bill should be exercised in accordance with the principle of necessity, proportionality and non-discrimination, respecting the European Convention on Human Rights and other human rights instruments. We also want the Government to keep the powers under frequent review and to publish reasons and explanations for any measures introduced under the Bill.

Although the right to life—Article 2 of the ECHR—underpins the response to this pandemic, human rights issues under several articles of the convention are engaged: Article 5 on the right to liberty; Article 8 on the right to family life, as relating to isolation, quarantining and restriction of family visits; Article 11 on freedom of assembly and association, relating to the prohibition of public meetings and gatherings. These are just some of the examples. I am glad that the Joint Committee on Human Rights, chaired by the right honourable Harriet Harman—I declare an interest as a member—is conducting an inquiry into the human rights implications of the response to Covid-19.

There have been shocking cases of victimisation and blaming of certain people due to their perceived ethnic or national origin, particularly those of Chinese and other east Asian appearance. The power for local authorities not to meet some assessed care needs and to avoid the duty to conduct a care needs assessment will impact on the vulnerable. The Government should, at a minimum, notify the Council of Europe and the United Nations, as stewards of the ECHR and international human rights instruments respectively, that the UK is enduring a national emergency, and of the measures being taken. Do they in fact need to formally derogate? Perhaps the Minister could tell us.

People need to be able to assess, scrutinise and, if necessary, question and challenge the Government. It is not helpful to have a Minister on Twitter call someone by a rather vulgar term because they had the temerity to raise questions about the Government’s approach, as happened yesterday. Apparently, there have been no advertisements on social media. I am on only Twitter so I do not see Facebook, Instagram or any of the others but, considering that a lot of money was spent on Brexit no-deal ads on social media, this omission seems anomalous.

Assessing Schedules 20 and 21 is a bit difficult, as we do not yet know how the Government will give effect to the measures heralded in the Prime Minister’s announcement last night. I imagine that is still being worked through. Schedule 20 does raise a lot of concerns. Where are people to be directed or detained? Is a police station envisaged or just home? What screening is to take place, especially given the lack of current testing capacity? Will there be any judicial authorisation of detention or any provision for appeals? What about people who, for one reason or another, do not have a home to go to—the street homeless, sofa surfers, victims of domestic abuse, some immigrants and refugees, who get little or no support? Surely imposing isolation and quarantining restrictions on people living in abusive or dangerous environments would place them in an impossible situation. As concerns Schedule 21, are the closure of premises regulations issued just last Saturday under the public health Act—they were mentioned by my noble friend Lord Newby—to be revoked in the same way as the February regulations on direction and detention of persons are repealed by this Act in Schedule 20?

I want briefly to mention one or two other things. I entirely agree with the noble Lord, Lord Falconer, and the right reverend Prelate the Bishop of Rochester, who raised issues about funerals and religious beliefs as concerns the need for burial and not cremation. As someone who organised my late husband’s funeral just five months ago, and a memorial service four months ago, this is very important to me. I will perhaps have more chance tomorrow to raise concerns about immigration powers as they affect people in immigration detention as well as in prison. Also, the fear of data sharing with the Home Office could deter people from seeking health treatment. Will the Home Office undertake to suspend that data sharing?

There are also some concerns about video hearings in court. Much as one accepts that they are necessary in the circumstances, various safeguards would be required. There are also concerns about changes to the Investigatory Powers Act and the extension to 12 days for a warrant. From experience, we know that there is a ratchet effect of expansion of state powers, as terrorism legislation has shown. We will need to be vigilant to prevent spillover.

Covid-19 Update

Baroness Ludford Excerpts

Monday 16th March 2020 Lords Chamber

[Lord Bethell]

On government priorities I will be really simple and clear. The Government’s priorities are to save lives and to support the NHS. That is our objective and that is what we are throwing our energies into. In terms of sick pay and support for the self-employed, provisions for those have yet to be published, but when they are I look forward to them being discussed.

[Baroness Ludford (LD)]

My noble friends Lady Brinton and Lady Hamwee have tried to get an answer from the Minister on this question of enabling businesses to claim on their insurance. If they are just advised to close, as I understand it, most of them would not be able to do so, but now we hear from my noble friend Lady Hamwee that DCMS has actually instructed theatres to close—but only theatres. What about restaurants, bars, clubs and everybody else? It does not seem to be a very coherent situation and for the Minister just to say that it is not within his purview to answer this question is frankly not good enough. Could he please give a clear answer as to whether not only theatres but other businesses will be instructed by the Government to close, so as to enable them to claim on their insurance policies?

[Lord Bethell]

As the noble Baroness will be aware, this is a fast-changing situation. I cannot come to this House, in all honesty, and give an account for every single element of the strategy since we have turned around some of these decisions in very quick time. Our focus is on health and on our clinical decisions. When I am able to deliver an answer to that question, I will do it. As soon as I can, I will be glad to write to the noble Baroness.

Brexit: Food Standards Regulations

Baroness Ludford Excerpts

Tuesday 4th September 2018 Lords Chamber

[Lord O'Shaughnessy]

My understanding is that they will be laid, subject to clearance, before the end of the year.

[Baroness Ludford (LD)]

My Lords, the Government are refusing to agree with Brussels on maintenance of the system of geographical indications which protects the name and quality of local and regional products. Are the Government throwing Cornish pasties and West Country cheddar to the wolves in proposing to accept fake American versions of these products?

[Lord O'Shaughnessy]

I do not know whether wolves like cheddar, but that is more a question for my colleagues in Defra which I would not seek to answer. What I can say is that we want to provide protection for everything that the UK produces that is internationally recognised and special.

Long-term Plan for the NHS

Baroness Ludford Excerpts

Tuesday 19th June 2018 Lords Chamber

[Lord McColl of Dulwich (Con)]

My Lords—

[Baroness Ludford (LD)]

My Lords—

[Baroness Manzoor]

My Lords, we have plenty of time. It is the turn of the Lib Dem Benches.

[Baroness Ludford]

My Lords, further to the question from the noble Lord, Lord Davies, is it not true that the OBR forecast budget deficit is twice our net EU contribution? We will also be making continuing payments for participation in EU programmes and agencies, let alone the £39 billion divorce Bill. Is not the Brexit dividend claim on the No. 10 website—which is a government website, not a Tory Party website—a breach of the Government’s duty to ethics, truth and accuracy?

[Lord O'Shaughnessy]

No.