Artificial Limbs: Audit Commission Report (Hansard, 21 June 2000)

§ The Parliamentary Under-Secretary of State, Department of Health (Lord Hunt of Kings Heath)
My Lords, we welcome the report and are already taking action to improve standards. We are also considering currently all of the recommendations and hope to make further announcements soon.

Lord Campbell of Croy
My Lords, I am grateful to the noble Lord for his reply. Does it mean that he agrees with the report that urgent reorganisation is required in the supply of orthotic equipment such as callipers and surgical appliances because the quality of what has been described as fragmented services is, in many places, unacceptable?

§ Lord Hunt of Kings Heath
My Lords, alongside many of the other recommendations, the Government are considering with careful interest the suggestion to which the noble Lord refers, in particular that units should be large enough and throughput sufficient enough to make for quality and cost effectiveness. Part of the process of improving the quality of services at local level is to remind health authorities and local authorities of their responsibilities in that area. Where changes need to be made to improve the organisation, I am sure that that will occur.

§ Lord Ashley of Stoke
My Lords, is the Minister aware that his constructive response to a recent debate on the subject was warmly appreciated? The urgent requirement now is a clear timetable. In the debate, the Minister was not enthusiastic about that need. However, without specific targets, dates and outputs we shall get nowhere. Will my noble friend think again?

§ Lord Hunt of Kings Heath
My Lords, I am not in a position today to give an explicit timetable. I assure my noble friend that my honourable friend Mr John Hutton is considering urgently the recommendations in the Audit Commission's report and what the Government's response should be. The Government have taken action. They are promoting the value of integrated community services providing a single point of access for service users. The sum of £14 million is being provided recurrently for wheelchair developments. As my noble friend well knows, £4 million is being invested this year to modernise the NHS 250 hearing aid service. We agree that the deficiencies identified by the Audit Commission need to be addressed.

§ Lord Addington
My Lords, notwithstanding his previous answer, does the Minister agree that the report raises some points which could be dealt with easily? Recommendation 15 states: Service managers should review and eliminate the potential conflicts of interest that arise when commercial suppliers discharge the services of both clinician and salesman". That relates to the supply of orthotics and wheelchairs. Will the Minister draw his department's attention to this matter? Such a straightforward conflict of interest can surely be quickly dealt with.

§ Lord Hunt of Kings Heath
My Lords, the noble Lord raises the issue of whether the role of the orthotist as both clinician and salesman creates a conflict of interest. I understand that the matter has been addressed in Department of Health guidelines on orthotic services. Ultimately it is a matter for local management. We must ensure that the lessons of the Audit Commission report are fully considered at local level by health authorities and, where appropriate, local authorities. In order to have effective performance management of health authorities and performance assessment of local authorities the Government must ensure that account is taken of current guidelines and any future guidelines.

§ Baroness Masham of Ilton
My Lords, does the Minister agree that some materials used are heavy and old fashioned whereas others are light and more attractive? Will he consider how important it is for a young girl, for example, who has lost limbs through meningitis to have equipment which is usable and attractive?

§ Lord Hunt of Kings Heath
My Lords, I very much understand the noble Baroness's point. A working group has been set up to consider the introduction of silicone cosmeses coverings in artificial limb services. In addition, the NHS Purchasing and Supply Agency has set up a strategic commissioning group which brings together commissioners, providers, the industry and user representatives to inform future specification for artificial limb contracts. I hope that, as part of that process, we can take account of the point the noble Baroness raises.

§ Lord McColl of Dulwich
My Lords, is the Minister aware that the supply of artificial limbs in many places in developing countries in Africa is better and quicker than in this country? It is an urgent issue. What will the Government do?

§ Lord Hunt of Kings Heath
My Lords, I pay tribute to the noble Lord for his work over many years on this issue, in particular in relation to the artificial limb and appliance centres. We need to be careful not to suggest that everything is poor about current services. There are many examples of excellent services around the 251 country. The problem is that high standards are not universal. The Government are seized of the need to ensure that best practice is adopted throughout the country. In addition, through its local inspectors, the Audit Commission will monitor what will happen at local level. Although we should always consider the experience of other countries, we can also look to our own country for experience of best practice.

§ Lord Clement-Jones
My Lords, the Minister is aware of the problem when medical staff, in particular occupational therapists, are faced with widely differing standards from social services departments and health authorities about the equipment which can be provided for patients on discharge from hospital. The position as regards charges made and the type of equipment provided needs urgent consideration. Can the Minister say something on that?

§ Lord Hunt of Kings Heath
My Lords, I do not disagree with that point. We need to bear in mind that effective investment in appropriate equipment in the long term will ensure that many people make fewer demands on the services in the future. We need to bring home to the health service and local government the message that the more effective services they can develop in this area the better the spin- off for users of the services and the services themselves.
As regards community equipment services, the Government are keen to encourage health and local authorities to work together. As regards charges, the noble Lord will know that we intend to table amendments to ensure that we can issue statutory guidance.

Lord Campbell of Croy
My Lords, will the Minister recognise that, owing to our ageing population, demand for surgical appliances is increasing but that new materials and technologies, as referred to by the noble Baroness, Lady Masham, which are becoming available, could alleviate the situation?

§ Lord Hunt of Kings Heath
Yes, my Lords. Part of the effective delivery of high quality services in future is the need to ensure that those in NHS health services and local authorities who commission services relating to community equipment are keeping up to date with developments and ensuring that its quality and acceptability are of the highest order. We want to encourage that.