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NHS failing over diabetes linked foot amputations

Slow treatment results in thousands of amputations

Adrian O'Dowd

Monday, 25 February 2013

Every year around 6,000 people in England have to undergo a diabetes-related foot amputation because their foot ulcer was not treated quickly enough, claims a new report.

However, as many as 80% of these amputations could be prevented if people received treatment quickly enough, said the Diabetes UK report Fast Track For A Foot Attack: Reducing Amputations.

Around the country, there are too many places that do not have systems in place to ensure foot ulcers and foot infections in people with diabetes are treated within 24 hours, warned the report’s authors.

The number of diabetes-related amputations a year increased from 5,700 in 2009-10 to more than 6,000 in 2010-11 and is predicted to rise to 7,000 by 2015.

In April and May of last year, the authors carried out a root cause analysis of every amputation across 13 London hospitals and examined 27 patient datasets.

The results suggested a lack of integration of the pathway across primary and secondary care – only 54% of those having amputations were known to footcare services.

The report, which Diabetes UK has produced with the Society for Chiropodists and Podiatrists and NHS Diabetes, makes recommendations aimed at reducing diabetes-related amputation rates and to end the current situation where people with the condition are more than 20 times more likely to have an amputation than the rest of the population.

For the report, an event was held in October of last year at which people with diabetes, GPs, vascular surgeons, podiatrists, diabetologists, commissioners, researchers and policy advisers, and a health economist came together to discuss the issue and share their expertise and experience.

All present agreed that rapid access to specialist assessment and treatment for all those with a foot problem would be essential in achieving the goal of reducing amputations by 50% over the next five years.

Action needs to be taken by the NHS Commissioning Board, CCGs and health and wellbeing boards, said the authors.

They recommend that all hospitals should have a multi-disciplinary footcare team (MDT), which brings together different healthcare professionals to ensure good quality care for foot problems in people with diabetes (NICE recommends that these teams should be in place, but only 40% of hospitals have them).

Other recommendations are that:

  • every hospital should guarantee that people with urgent foot problems can be assessed by an MDT within 24 hours
  • every area should have a system for identifying and regularly reviewing people at high risk of foot ulcers and infections, including annual foot checks and foot protection teams in the community.

Barbara Young, chief executive of Diabetes UK, said: “It is unacceptable that every single week people with diabetes who have treatable foot problems are having feet or toes amputated because they are not being treated quickly enough.

“If every hospital had a multi-disciplinary footcare team and ensured access to that team within 24 hours, then that would make a huge difference to the amputation rates. We also need to make sure people with diabetes are getting a thorough annual foot check and then those at high risk of amputation are given the help they need to prevent them.”

How would qualify the communication between primary and secondary care services? (See OnMedica News 20/04)

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