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Diabetic foot ulcer care needs to improve

Audit reveals need for more referrals to experts in under two weeks

Mark Gould

Thursday, 31 March 2016

A new audit of patients with diabetic foot ulcers found that around half (2,302) were ulcer-free 12 weeks after their first expert assessment by a specialist foot care service. But it also found that when two weeks or more elapse between initial presentation and expert assessment, a patient is significantly less likely to be ulcer-free 12 weeks on.

The National Diabetes Foot Care Audit (NDFA), a new national clinical audit, presents initial findings about the treatment and outcomes of more than 5,000 patients presenting with a diabetic foot ulcer in England and Wales between July 2014 and April 2015. The majority of these patients were referred to specialist services (3,699) by a GP or other health service, while the remainder (1,516) self–presented to the service without a referral.

Around 10 per cent of people with diabetes will have a diabetic foot ulcer at some point in their lives, at an estimated cost of £650 million to the NHS; equivalent to £1 in every £150 spent.

Considering those patients who had a 12 week ulcer status recorded:

  • Of the 2,029 patients seen within two weeks or less, 50 per cent (1,010) were ulcer-free 12 weeks on from assessment.
  • Of the 911 patients seen between two weeks and two months, 43 per cent (394) were ulcer free 12 weeks on from assessment.
  • Of the 359 patients seen after more than two months, 34 per cent (123) were ulcer free 12 weeks on from assessment.

The audit also included a survey of the local structures for the care of diabetic foot disease provided by clinical commissioning groups (CCGs) and local health boards (LHBs) during October and November 2015. Approximately 60 per cent (82) of providers responded to all the questions asked in the survey. Of these, 45 per cent (37) did not have all three basic NICE recommended systems for preventing and managing diabetic foot care disease.

The NDFA is part of the National Diabetes Audit which is managed by the Health and Social Care Information Centre (HSCIC) in partnership with Diabetes UK and is commissioned by the Healthcare Quality Improvement Partnership (HQIP) as part of the National Clinical Audit Programme.

Dr William Jeffcoate, the clinical lead for the audit, said: “This first report from the National Diabetes Foot Care Audit highlights the importance of early expert assessment of all people presenting with a new foot ulcer in diabetes. The results show that when the time to expert assessment exceeds two weeks, the condition of the ulcer is on average more severe.

“Whilst future audits will no doubt provide further insight, this report will make a valuable contribution towards improving services, and is an important first step in measuring the quality of care provided for diabetic foot disease in England and Wales.”

Chris Askew, chief executive of Diabetes UK, said the audit highlights how critical early expert assessment is for people with diabetes who have a diabetic foot ulcer to ensure they do not suffer further, avoidable, complications. “With around 10 per cent of people with diabetes having a diabetic foot ulcer at some point in their life, a good-quality foot care service, which meets NICE guidelines, and well-trained staff are essential. People with diabetes must be provided with information on how to look after their feet, and those who are at increased risk of foot ulcers must be given information about the care and treatment they need and how to access it quickly. Left untreated or poorly managed, diabetic foot ulcers can cause much suffering for individuals, and ultimately pose the threat of an amputation that could have been avoided.

“Beyond the clear human cost, failure to provide much-needed good-quality foot care services also serves a blow to the NHS budget; foot ulcers currently account for an estimated cost of £650 million.

“We strongly urge more clinical commissioning groups (CCGs), local health boards (LHBs) and foot care services to take part in future audits with it being an important resource that informs us of what services are currently offered and how they can be improved."

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