An investigation of the NHS Service provision of prosthetic limbs

This thesis explores the NHS Service provision of prosthetic limbs from a patient centred perspective. Amputation is the removal of a limb either for medical reasons or through trauma. The amputated limb can be replaced with a manufactured device to help the patient regain movement and as much function as possible. This device is known as a prosthesis and is given to the patient by the NHS at a Disablement Services Centre (DSC). There has been increasing negative media coverage of the NHS and the service it provides with specific reference to the Postcode lottery which has allegedly become apparent. This research aims to ascertain whether the service being provided at DSCs across the UK is satisfactory to patients and how this service can be improved. The literature surrounding amputation rehabilitation and care pathways is reviewed (Chapter 2). Research philosophies and approaches are discussed (Chapter 3). A countrywide study of NHS Disablement Services Centres was conducted to ascertain how the centres functioned and the differences in service between centres (Chapter 4). The data collected from this study were used to create a questionnaire for amputees to ascertain their opinions on the service they received at their centre (Chapter 5). The data revealed that patients had many problems with the service they received, very few of which could readily be acted upon due to budget restrictions. An investigation into patient s opinions on information provision was conducted as information provision was a problem highlighted by patients that could be influenced by further research (Chapter 6). Data gathered from all three studies were used to produce a proposed clinical pathway for Disablement Services Centres to follow with a new patient (Chapter 7). The proposed pathway was critically evaluated by prosthetists at a clinical conference and improvements to the proposed pathway were made using their suggestions (Chapter 7). The benefits, drawbacks and threats to the use of the proposed pathway were discussed both from the patient and clinical perspective (Chapter 8). The work was completed by overall conclusions and a discussion of further work (Chapter 9).