Report highlights wide regional variation in NHS prosthetics and orthotics funding

A new report from the British Association of Prosthetists and Orthotists (BAPO) has highlighted marked differences in how prosthetic and orthotic services are funded across the UK, raising questions about transparency, consistency, and equity within the current system.

The British Healthcare Trades Association (BHTA), through its Prosthetic and Orthotic Section, supported publication of the report following an external review for clarity and factual presentation. While BHTA did not author the report or direct its conclusions, it has welcomed the findings as a useful contribution to discussion about how prosthetic and orthotic services are commissioned, funded, and tracked across the NHS.

The findings are set out in the report ‘Funding Prosthetic and Orthotic Services Across the UK’.

Prosthetic and orthotic services play an important role in supporting mobility, independence, and quality of life for people with limb loss, neurological conditions, musculoskeletal conditions, and other long-term health needs. Transparent and sustainable funding for these services is important not only for the people who rely on them, but also for the wider health system. Against a backdrop of rising demand and growing pressure on NHS budgets, the report focuses on whether current funding arrangements are sufficiently visible, consistent, and aligned with patient need.

Key findings from the report

The report draws on a UK-wide Freedom of Information exercise carried out in 2025, examining funding data from NHS Trusts and Health Boards over the five financial years from 2020/21 to 2024/25.

Its headline finding is the scale of regional variation in spend. For orthotics, reported spending ranged from £8.87 per head to £0.20 per head, a difference of around 44 to 1. For prosthetics, reported spending ranged from £7.57 per head to £0.49 per head, a difference of around 15.5 to 1. The report says this level of variation raises important questions about how funding is allocated and whether patients in different parts of the UK are experiencing very different levels of provision.

The report also points to significant gaps in financial visibility. More than 60 percent of organisations providing prosthetic or orthotic services were unable to supply complete five-year financial data. Of the 124 Trusts and Health Boards identified as providing relevant services, only 47 were able to provide complete data for one or both services. The report says this makes funding harder to track and accountability harder to assess.

Among the service lines where detailed data was available, the report identifies a difference between funding reported as received and funding reported as allocated directly to services. Across 61 service lines, around £379.9 million was reported as received over five years, while around £333 million was reported as reaching prosthetic and orthotic services. That leaves a gap of £46.93 million, equivalent to 12.35 percent of the total funding in the dataset, which the report says was not allocated directly to frontline prosthetic and orthotic service budgets and was instead retained at organisational level without transparent accounting for its use.

The analysis also examines the effect of inflation on service budgets. While nominal funding rose in some years, the report concludes that these increases often did not keep pace with cost pressures. In 2022/23, funding passed to the 61 service lines increased by 4.87 percent, while average CPI inflation was 10.04 percent, resulting in what the report describes as a real-terms cut of 5.17 percent. Across the period from 2022/23 to 2024/25, it estimates a cumulative loss of purchasing power of around £9.65 million.

Taken together, the findings present a picture of funding arrangements that the report describes as fragmented and difficult to scrutinise. Its central argument is that without clearer reporting and more consistent oversight, it is harder to assess whether prosthetic and orthotic services are being funded fairly and effectively.

Supporting evidence-informed discussion

The report proposes a number of measures aimed at improving transparency and accountability, including mandatory annual reporting of prosthetic and orthotic funding, a national dashboard to improve visibility of funding flows, independent audit of block contract arrangements, and the development of a clearer funding formula linked to population need and outcomes.

For the prosthetics and orthotics sector, the report adds to the evidence base around how funding decisions affect service sustainability and patient access. It also reflects a wider shift towards viewing commissioning through an outcomes-led clinical lens, rather than a purely procurement-led one.

The BHTA has highlighted the value of the report in helping inform constructive dialogue between industry, clinicians, commissioners, policymakers, and patient organisations.

As Ben Taylor, Chair of the BHTA Prosthetic and Orthotic Section, notes in the report:

“BHTA’s Prosthetic & Orthotic Group welcomes this report from BAPO as a timely contribution to improving understanding of how prosthetic and orthotic services are funded and how that funding is allocated and tracked across the system. The report highlights recurring themes that matter to patients and the sector alike: the need for greater visibility and transparency of funding flows, more consistent reporting and accountability, and commissioning decisions that are increasingly viewed through an outcomes-led clinical lens rather than a purely procurement-led one.

“BHTA has not authored this report and does not direct its conclusions; our role has been limited to external review for clarity and factual presentation, and we support its publication to enable constructive, evidence-informed discussion with clinicians, commissioners, policymakers, and stakeholders on the changes needed to secure sustainable, equitable P&O provision.”

Looking ahead

For the BHTA, the report is a useful contribution to ongoing discussion about how prosthetic and orthotic funding is tracked, allocated, and evaluated across the system. The association will continue to work alongside BAPO and wider stakeholders to support constructive engagement on the changes needed to secure sustainable and equitable prosthetic and orthotic provision across the UK.