Diabetes report identifies standardised care as key to better outcomes

By Editor
14th June 2022
Footcare, NHS Research

A report that looks at themes in compensation claims involving people with progressive diabetes-related lower-limb complications has been published.

Conducted by NHS Resolution, the report looks at 92 claims and of these, 55 individuals underwent a major lower limb amputation.

In the majority of cases a good standard of care is provided to people with diabetes by the NHS in England but more can be done to reduce harm with appropriate, timely care.

Standardised care and better education could prevent people with diabetes from undergoing amputations, preserve wellbeing and save the NHS money, an NHS Resolution report has found.

The report identifies themes in compensation claims involving individuals with progressive diabetes-related lower-limb complications that in the worst cases can lead to amputation.

Up to 85 per cent of amputations are avoidable. Both amputations and other harms can be reduced with appropriate, timely care.

Since 2013/14 there has been a steady growth in the volume and value of clinical negligence claims in people with diabetes with lower limb complications in England.

Globally, both the number of cases and the prevalence of diabetes have been steadily increasing over the past few decades.

It is important to recognise that in the majority of cases a good standard of care is provided to people with diabetes by the NHS in England.

Only claims that had been settled since 2018/19 and with an incident date after 2012/13 were included in the report.

The report identifies several key time points during the patient journey where intervention could improve care quality.

This includes ensuring standardised, evidence-based assessment techniques are used to diagnose promptly.

Once an individual has been diagnosed, the report highlights the importance of rapid access to a multi-disciplinary foot team (MDfT).

This team would provide oversight and management of the entire patient care pathway to ensure consistency, appropriate timely decision making and follow up.

Follow up includes education to empower people to self-manage and commence safe foot and lower limb care habits.

One of the issues highlighted in the report is that individuals often do not know that their condition is getting worse because they don’t feel pain, due to a condition called neuropathy, resulting from nerve damage. This means they often delay seeking help.

The reports also found that diabetic foot disease is a condition that is not always well recognised or taken seriously.

It highlights the need for a national focus on this issue, to ensure that both the clinicians and people with diabetes are better equipped with the right information to take preventative action early.

As well as impacting the person’s physical and mental wellbeing, delays in diagnosis and treatment have financial costs.

Managing the diabetic foot, coupled with the cost of associated lower limb amputations, costs the NHS up to £1 billion annually.

Co-developed with experts across the healthcare system, the report includes seven recommendations to improve the care of those with diabetes and lower limb complications.

Work with stakeholders will continue over the coming months to help implement the suggested recommendations.

Helen Vernon, Chief Executive, NHS Resolution said: “One of NHS Resolution’s aims is to learn from incidents of harm and share learning as widely as possible.

“We hope this report will contribute to reducing the number of people that suffer with severe diabetic lower limb complications.”

She added: “In most cases, the care of people with diabetes and lower limb complications is good, reflecting the commitment of groups of footcare clinicians and networks that work tirelessly to keep standards of care high.

“‘Time is tissue’ when it comes to diabetic foot disease. At every stage of the patient journey, acting with urgency is imperative.”

She concluded: “We hope the recommendations will help to identify and remove some of the barriers that potentially exist in implementing evidence-based and standardised care.”

Michael Edmonds, Professor of Diabetic Foot Medicine, Consultant Diabetologist, King’s College Hospital, who contributed to the report as part of the Clinical Advisory Group, said: “Major amputation is one of the most destructive complications of diabetes and regrettably the number of major lower limb amputations in diabetes continues to rise.

“This report should be compulsory reading for those who are involved with care of people with diabetes including healthcare professionals, commissioners and policy makers.”

He added: “There must be learning from the diabetes-related lower limb amputations analysed in this report and a thorough appreciation of why they occurred.

“The report makes recommendations to improve patient care and proposes certain standards which should be put into practice and regularly audited.

“As a result of this learning it is hoped that the preventable loss of limbs due to diabetes can be reduced.”

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