Department of Health and Social Security: Working Party on Artificial Limb and Appliance...

Artificial Limb and Appliances Centres (ALACs) in England and Wales were directly administered by the Department of Health and Social Security (DHSS) and the Welsh Office respectively. The services undertaken by the ALACs included the provision of artificial limbs and appurtenances; provision and fitting of artificial eyes; provision and administration of invalid vehicles for the disabled; and certain services for war pensioners, including surgical appliances, hearing aids, and home nursing equipment.

Upon creation of the National Health Service (NHS) in 1948, the Ministry of Pensions supplied limbs, vehicles and appliances to NHS patients (it had previously supplied such services to the war disabled). In 1953, following the abolition of the Ministry of Pensions, such services were transferred to the Ministry of Health. At that time, it was intended to bring the artificial limb fitting service (but not other disablement services) within the NHS to closely associate clinicians and surgeons responsible for investigation, assessment, treatment and management of amputees with those responsible for prosthetic care, to improve the service to the patient.

It was not until 1984 that the first independent review of ALAC services since 1953 was carried out. A working party was set up, under the chairmanship of Professor Ian McColl to:

"review and report on the adequacy, quality and management of the various services received by patients in the Artificial Limb and Appliance Centres in England and on the respective roles of the staff of the Centres, the NHS and manufacturers, having regard to the need to promote efficiency and cost effectiveness."

Artificial Limb and Appliance Centre Services included artificial limbs, wheelchairs, surgical appliances (for war pensioners only), supply of vehicles and artificial eyes. The working party considered all these services separately, and produced its final report in January 1986.

Members of the working party included Sir Austin Bunch, Miss Elizabeth Griffiths, Professor B Griffiths, Mr Marmaduke Hussey, Mr P Janes and Dr C B Wynn-Parry. In response to public invitation by the working party, consultant surgeons, NHS administrators, hospital and health authority representatives, occupational therapists and physiotherapists, remedial gymnasts, interested companies and manufacturers of limbs, appliances and related products, associations concerned with the disabled and users of the ALAC services made submissions which were considered by the working party, and represented in its report. The annexes of the final report contain summaries of the principal evidence given, and details those giving evidence.

The main recommendations made by the working party were the need for change in organisation and management; the need to improve contracting arrangements; and the importance of co-ordinating the various services that ALAC users required for effective rehabilitation. To achieve these improvements to the service, the McColl report recommended the establishment of an independent management board to run the ALAC service.

The government accepted the main recommendations of the report. A new board was created as the Disablement Services Authority on 1 July 1986, as an interim measure, with the aim of integrating the service with the Health Authority's management by 1 April 1991. The ALAC service's budget was guaranteed until 1993 to ensure that the service was fully integrated and acclimatised to its new context before full competition for funding opened up, with safeguards to maintain the continuity of the service.