National Rehabilitation Hospital

NRH Prosthetic Service and Strategic Partnership

The National Rehabilitation Hospital delivers the only consultant-led interdisciplinary prosthetic rehabilitation service in Ireland.  The service is provided in conjunction with a strategic partner, Ability Matters, as part of a Service Level Agreement with the HSE.  Ability Matters was selected as the Strategic Partner following international tender.

Patients who require rehabilitation services must be referred by their consultant or general practitioner to the Consultant in Rehabilitation Medicine at the NRH.  Following a multidisciplinary assessment process involving rehabilitation consultant, physiotherapy, occupational therapy, specialist nursing and prosthetist, a clinical decision is taken as to whether the services delivered at the NRH are suitable based on the patient’s clinical need.

All prosthetists from Ability Matters work under the clinical governance of a Consultant in Rehabilitation Medicine supported by a multidisciplinary team.  All team members, including Ability Matters prosthetists, are involved in the decision as to the most appropriate prescription of a custom made prosthesis (which is a medical device regulated by the Health Products Regulatory Authority – HPRA) to meet the patient’s physical, medical and cognitive needs.

Prosthetic rehabilitation requires ongoing adjustments of the custom made prosthesis (medical device) to optimise patient function as the patient progresses.  Working under the Strategic Partnership (NRH and Ability Matters) ensures that all changes recommended by the physiotherapist, occupational therapist and consultant are followed through and in a timely manner. We cannot have clinical governance over this process without a partnership agreement. Under the current system (in the absence of a national procurement tender for prosthetic services) if the NRH were to adjust, repair or modify a prosthesis supplied by a company other than our Strategic Partner, then the NRH would have the responsibility and liability for that prosthesis without having full traceability for the medical device.

The NRH commits to providing and maintaining a high standard of prosthetic devices. A close and stable partnership with the manufacturer is of major importance in ensuring highest quality for custom made prostheses.

In summary, in the current Irish health system context where no governance structures for prosthetic provision and rehabilitation are in place, the NRH can only safely provide rehabilitation services to patients referred, assessed and provided with a prosthesis manufactured by the strategic partner Ability Matters for all reasons stated above. The National Rehabilitation Hospital does however provide medical consultant care to all amputee patients referred to the service regardless of the provider of the limb.