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Lord Rowallan: My Lords, I thank the noble Lord for giving way. Will he confirm that that low demand is possibly because people are not told of the existence of the private service? In fact, people are being positively denied the knowledge that there is such a thing as a silicone-coated limb available from the private service.

Lord Hunt of Kings Heath: My Lords, it is difficult to speculate whether lack of knowledge is responsible for the relatively low take-up in the private sector. All that I can say is that it is important that as much information as possible is available to users of all NHS services. I am sure that all noble Lords would agree with that.

The point that I am trying to get across is that at the moment, if given a voucher, patients would have very limited options for exercising choice. More importantly--this point was made by the noble Baroness, Lady Masham--there are potential disadvantages in separating the limb supply from the clinical prescription, multi-disciplinary care and long-term support given to the patient.

I have every reason to believe that the vast majority of patients receiving artificial limbs within the NHS are satisfied by the quality of care that they receive. However, I was concerned when the noble Lord, Lord Rowallan, suggested that 50 per cent of limbs do not fit. We have no evidence of that, but if the noble Lord has any such evidence, we shall of course consider it. I am aware that some patients do not find their limbs comfortable, that achieving a good fit takes repeated visits to their disablement services centre, or that the appearance or functional performance of their limb is not what they would wish. Noble Lords have spoken in similar vein this evening.

That brings me to some of the questions that I have been asked about, in particular, the possibility of introducing a national service framework for disablement services. All that I can say at the moment is that the Government have already announced the

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first four frameworks. They will deal with mental health, coronary heart disease, older people and diabetes. It is expected that there will be one new framework per year. I cannot say any more on that, but the Government must take a number of factors and priorities into account. The views expressed tonight by noble Lords will be passed into that decision-making process.

In relation to the suggestion about a new disablement services authority, I should report to the House that my honourable friend Mr John Hutton has already given the matter some careful consideration. He has advised the charity consortium, emPOWER, that the establishment of a new disablement services authority does not fit with our model of service development. However, we understand why that has been proposed, and particularly the need for greater consistency in the provision of services for disabled people across the country.

Our preferred direction is very much through improving the quality of services, as we laid out in our White Paper, A First Class Service. The noble Baroness, Lady Masham, referred to the work of the National Institute for Clinical Excellence and of the Commission for Health Improvement. It is early days to go into details about the way in which NICE, in particular, will carry out its work. However, I very much take on board the point raised by the noble Baroness about ensuring that it develops a comprehensive approach to services. I believe that it will be a very powerful mechanism for producing authoritative guidance on clinical effectiveness and, together with CHIMP, for investigating poor services and improving quality across the board. That in itself is bound to lead to greater consistency throughout the National Health Service. I also feel confident that if there are sustained problems within the artificial limbs services, the Government would wish to bring the resources of CHIMP and NICE to bear on those issues.

Baroness Masham of Ilton: My Lords, does the Minister agree that the biggest waste to the National Health Service is the suing of bad practice by patients?

Lord Hunt of Kings Heath: My Lords, I could not agree more. The noble Baroness makes a very powerful point. As a former representative of health authorities and trusts, I am only too well aware of the cost to the NHS and its patients of malpractice suits.

Time is pressing on and I am conscious that I have not answered all the points put to me. However, I wish to comment on the question of getting people involved, because the noble Lord, Lord Rowallan, raised that important matter. We are keen to ensure this. It is part of the development of a proper partnership between the NHS and its patients. The regular meetings between emPOWER and my honourable friend Mr. John Hutton is a visible sign of wishing to do that. I am also glad to be able to

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tell the House that the supplies group mentioned by the noble Lord, Lord Clement-Jones, which is helping the NHS supplies authority to make the tendering process for artificial limb contractor services more effective and bringing together manufacturing and contractors and the staff of artificial limbs services, involves users of the service in those meetings. That is a real opportunity to bring the voice of the users right to the heart of the decision-making process in those areas. I take the point raised by the noble Lord about the potential of NHS supplies and in particular the procurement group. That should help us improve the quality of services.

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I am conscious that I have not touched on all the issues noble Lords raised, but I hope that it will be recognised that the Government very much take to heart the need to ensure that the undoubted improvements which have taken place in these services during the past few years continue; and that the mechanisms, particularly the use of CHIMP and NICE, should assist us in ensuring a greater consistency in the future. I do not believe that we should underestimate the achievements of the people working in those services at present, nor the courage of those who use the services.

        House adjourned at seven minutes past ten o'clock.

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