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Footcare audit urges introduction of NICE-backed structures

By Editor
10th May 2019
Audits, Footcare

Commissioners have been urged to implement NICE-recommended diabetic footcare structures following a nationwide audit.

The recommendation was made in the fourth National Diabetes Foot Care Audit Fourth Annual Report, which found 2.7% of people with diabetes with severe ulcers underwent a major amputation (above the ankle) within six months, four times more than those with less severe ulcers.

Of these, 14 per cent had died within one year, which was twice as many as for those with less severe ulcers, according to the publication released by NHS Digital on Thursday, May 9, 2019.

In response, the report issued a series of recommendations, including:

Audience Call to action
Commissioners
Providers
  • Should promptly refer people with diabetic foot ulcers for early specialist assessment.
People with diabetes
  • If you have poor circulation or loss of feeling in your feet, seek advice about how to prevent foot ulcers.
Healthcare professionals
  • Participate in the audit to take part in this nationwide drive to improve outcomes for diabetic foot disease.

The audit measures care structures, patient management and care outcomes for people with diabetic foot ulcers.

Being ‘alive and ulcer-free’ at 12 weeks is associated with either a Foot Protection Service (FPS) pathway, a referral for assessment pathway or a step-down care between the Multi-Disciplinary Foot Care Team and the FPS. The findings indicated 31 per cent of providers had all six of the care structures audited.

The latest report, covering 2017-18, collected data on 27,700 people with diabetes, who had a total of 33,155 new ulcer episodes, from 221 specialist footcare services. The number of ulcer episodes submitted to the audit increased by 57 per cent from 2016-17.

Writing in the report, Professor William Jeffcoate, the audit’s Clinical Lead, said: “The findings in the last 12 months have reinforced those of earlier years in confirming that ulcers undergoing expert assessment within two weeks are less likely to be severe, more likely to heal by 12 weeks, and less likely to lead to hospital admission and to amputation.

“There are, however, quite large differences in clinical outcome in different areas and there is now increasing evidence to link this variation with the structure of the local care pathway.

For the first time this year the total number registered has also allowed modelling to identify those risk factors which link most closely to different clinical outcomes. In the future this will allow the routine use of case-mix adjustment in comparing performance of different services. By identifying aspects of the care pathway which link to variation between localities and services, the aim is to improve clinical outcome for all people across England and Wales.”

To access the full report, click here.

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