The 2025 Guidance on amputation and limb difference in England, highlighting the needs of 60,000 individuals, including enhanced pediatric prosthetic services.
On 6 May 2025 NHS England released the first updated guidance (the 2025 Guidance) as to amputee rehabilitation and prosthetics services since 2016 with the aim being improved patient care and service delivery.
This 2025 Guidance notes the prevalence of amputation or limb difference in England as between 55,000 to 60,000 people of which around 2,500 children or young people. 45% of these people have suffered limb loss through vascular disease or diabetes, with trauma being responsible for between 9% and 14% - so up to 8400 people. Overall, the average age of amputees is lowering due to earlier onset diabetes and obesity.
NHS England provides prosthetics services to around 25,000 of these people both on a new and recurring basis.
The 2025 Guidance distinguishes between adult and paediatric service provision and notes upper limb, complex prosthetic rehabilitation and military veteran care specific requirements separately. The latter in receipt of enhanced facilities.
Additional prostheses such as water or spare limbs, are still subject to consideration by a multidisciplinary team (MDT), eligibility criteria and an unspecified prioritisation process.
Children’s activity and sports limbs are now included within the core provision of paediatric prosthetics which will be a welcome change. Overall, the 2025 Guidance provides a greater emphasis on the needs of children and young people and the importance of age appropriate settings. This approach follows concerns raised in parliamentary discussions about the varying needs of patients, including those of children with sudden limb loss compared to an adult with limb loss following illness.
Hansard records, on 1 May 2025, quadruple amputee Lord Mackinlay (sometimes referred to as the “bionic Lord”) asking what steps the government were taking to ensure amputees received appropriate prosthetics at the appropriate time - Prosthetics for Amputees - Hansard - UK Parliament. He has repeatedly raised concerns about NHS prosthetic provision saying that they “do not do mental health any good”. Lord Mackinlay said that the arms provided to him by the NHS after a quadruple amputation following sepsis were effectively “William the Conqueror-designed arms, with a rubber end”. He was told that he would receive a multifunctional arm four years after amputation which, not surprisingly, he said was too slow.
Lord Mackinlay stressed the importance of early functional prosthetics and although bionic arms have been part of the NHS offering since 2022, the clinical criteria are limited.
Following British paralympic success, there has been a greater spotlight on sports and high-performance prosthetics being made available via the NHS and, in the 2025 Guidance, NHS England still defers to the national governing bodies of sport, private arrangements and funding streams for these. Unfortunately, it looks like this aspect has not been addressed save for when an MDT considers that the service user is “fit to engage in the activity and would benefit from the activity, demonstrate some interest or history participation and that the prosthesis is likely to be of continuing use”. I suspect that provision of high-performance prosthetics will still be rare as with the more expensive prosthetics, such as microprocessor knees where the clinical commissioning policy is static as of 2016/2017.
My take is that the focus of the 2025 Guidance appears to be engagement with broader rehabilitation services and specific direction to MDT, which should improve patient outcomes. It also attempts to ensure consistency of provision across England with a coordinated “whole system” approach rather than a postcode lottery.
The children’s activity and sports limb programme will be welcomed by many albeit there is still the caveat that this does not include access to elite sports prostheses.
There will always be cost constraints with NHS amputee rehabilitation and prosthetics provision but especially in relation to children and young people the 2025 Guidance is a step forwards with the MDT approach and an emphasis on flexibility – including finer points like appointment times to accommodate work and school. It should bring about a more positive and effective framework for those with limb loss in England.
From an amputation claims perspective, especially where insurers do not have the opportunity to support early private rehabilitation and prosthetics funding, this improved MDT rehabilitation via the NHS should create an environment where more amputees are on track to faster recovery and better functional outcomes. We know how early rehabilitation and prosthetics provision can lead to improved mobility, independence and quality of life. Time will tell whether NHS England can deliver these recommended services and make a real difference.
