Why Wales is leading the way?

Collaboration between the Welsh Government, Welsh Health, Limb Centre leads, and Blesma is yielding significant benefits in offering improved services to injured military personnel.

Health services around the UK are strained, but the provision of prosthetics across Wales highlights how collaboration and cohesion can create high-quality services.

In Wales, prosthetics services operate from three Limb Centres: Cardiff, Swansea, and Wrexham. The Cardiff and Swansea centres, in particular, are unique services within their hospital areas, and with staff being mainly full-time, they exemplify what can be achieved with the multidisciplinary expertise of clinical staff, including physiotherapy, psychology, occupational health, and prosthetics. This also includes the behind-the-scenes work of technicians.

These crucial multidisciplinary teams and centres work precisely because of the unique environments and exclusive expertise provided to amputees and those with amputation-related conditions. Being based within a small environment of readily available and dedicated professionals, they have the space and time to treat traumatically injured veterans.

"This is a perfect example of how partnerships can work with a foundation of flexibility and transparency," says Wales and West Support Officer Tom Hall, who works with Outreach Officer Jason Suller to respond to a wide range of member needs, managing their expectations effectively when required.

"This is based on the current Welsh Health prosthetics policies, which cater to war veterans and the general amputee population through the respective Prosthetic and Amputee Rehabilitation Service policies. Blesma adds its voice to the formulation of these policies, which are constantly being improved by the NHS service in Wales."

Members with service-attributable injuries benefit from the latest technology and advances, but their feedback on new equipment is critical to improving the range and quality of help available to the rest of the amputee community. Limb Centres are constantly improving their services and can now provide psychological support, thanks in large part to the need identified by some Blesma members.

"It is a constantly evolving environment, and members play a big and positive role in shaping the service for themselves, for fellow members, and for the public," adds Tom, who currently supports 310 members in his region.

Member Steve Fisher, who was injured in the Falklands War and had his right leg amputated below the knee as a result, attends the Swansea Limb Centre.

"The fantastic thing is that all the experts I need to see are in the same place," says Steve. "I've got access to a prosthetist, physiotherapist, psychologist, in-house doctor, and nurses. And I am supported by the office staff, who are all very caring and helpful. They are like a family, and I call them my A-Team!"

"When I go in, I can get help from anyone, and that makes it a lot easier to get the help I need quickly. I've recently been helped by the psychologist after I fell into a deep depression, and I've had an operation for a neuroma and was given pads and cream when my stump became inflamed."

Addressing Areas of Concern

The Welsh Government has carried out a series of exercises to better understand the physical and psychological pressures on military veterans and is exploring measures to support veterans in the community and tackle loneliness and isolation—key areas of concern that have already been identified and continue to be addressed by the Association.

Meanwhile, a government representative attends the quarterly forum meetings alongside Blesma and senior Limb Centre staff to work through issues in the service, with member feedback being a powerful element in shaping provision.

"I am extremely proud of the excellent partnership work in Wales to support our forces community," says Eluned Morgan, Cabinet Secretary for Health and Social Care. "As in so many areas, this approach has delivered real outcomes for veterans. We have an amazing team of allied health professionals and others in our ALAS services, delivering excellent service and improved outcomes for those who need them. We value our positive relationship with Blesma, who are part of our Armed Forces Expert Group, and we will continue to work with Tom Hall to listen to veterans across Wales who access high-quality prosthetics services."

Limb Centres are bustling hospital environments with industrious behind-the-scenes units of highly skilled prosthetists and technicians, keeping pace with advancing technology and techniques. Ian Massey, clinical lead prosthetist at the Cardiff Limb Centre, joined the industry in 1975 and has seen significant advances in the technology available and the attitude toward veterans over his career.

The feedback from military veterans is essential to our delivery because they have that certain mindset.

"We now have some fantastic technology and techniques that we can use, and the Military Covenant changed veterans’ policy for the better so that they could access the best components," he says.

"The result has been that a lot of people are more mobile for a lot longer, and because of the trailblazing work of veterans who were the first to try out microprocessor knees, we now offer them to non-service-attributable veterans and the public. We have the components and the skills to tailor everything to our patients, who range from WWII veterans to those injured in more recent conflicts. We are fortunate to have good relations with our commissioners, who fund the service, the Welsh Government, and Blesma, which helps the service run smoothly."

"The feedback from military veterans is essential to our delivery as many have a mindset of driving through barriers and attaining goals. They are very active and push the prosthetics to their limits, which helps us understand more and develop an even better service."

Peter McCarthy, clinical lead prosthetist at Swansea Limb Centre, echoes this view: "Blesma members play a vital role in testing out new equipment and technology, which then feeds into the general patient population maybe five years later," he says. "Their feedback leads to improvements that everyone benefits from, and it is a role that they are keen to fulfill. One such benefit is the provision of psychological support, which was a clear need for some service-attributable veterans and is now available to all through a psychologist based at the department."

Pushing the Boundaries

Member Grant Jenkins, a Royal Artillery veteran, pushes himself and his prosthetic to the limits. The 56-year-old, who needed a right leg below-knee amputation after a car accident in 2007, has been attending the Cardiff Limb Centre to have a cast for a new fitting following stump revision surgery. Fitness has been his salvation since fighting depression and weight gain as he endured 15 operations.

"It is great to have this service and to be able to pursue my fitness," he says. "I like routine, which the training gives me. It has been really tough to have to put that on hold for the stump revision, but that was needed, and I’m looking forward to getting back to cycling and training."

Philip Watchorn, a 74-year-old former Royal Lancers Signaller who was struck by a car while on a night exercise in Osnabruck, Germany, at the start of his Army career, has volunteered for Blesma since leaving the Forces. "It is easy to visit the centre, and the staff are very friendly, knowledgeable, and professional," he says. "The centre is always there for me, and Blesma has always been there for me."

The previous Minister responsible for veterans in Wales, Hannah Blythyn MS, visited the Limb Centre in Wrexham, and the new Veterans’ Commissioner in Wales, James Phillips, has visited the Swansea Limb Centre with Blesma. He also attends the Prosthetics Forum to listen to views and offer his own expertise in making a difference for veterans.

Elsewhere, Blesma has also helped to forge collaboration between Wales and England, including with the Salisbury Hospital War Injuries Clinic. This has enhanced the options available to those service-attributable members in Wales who sometimes need cross-over care.

"The collaboration between Welsh Government, Welsh Health, the Limb Centre leads, and Blesma has been a game-changer in not only ensuring that members receive the best and most appropriate provision, but also in ensuring that any gaps in service are identified quickly and that communication is carried out in the right way," says Tom. "A professional, transparent, and trusting relationship has been established in Wales, and this can only be positive for our members and their families in the future."