iDEAL Group calls for clearer footcare signposting
A group of diabetes specialists say clearer signposting is urgently needed to speed up rapid access to multidisciplinary footcare teams to reduce preventable amputations.
The Insights for Diabetes Excellence, Access and Learning (iDEAL) Group has published a research paper entitled ‘Diabetes and Foot Care Assessment and Referral‘.
It calls for more awareness to increase better footcare health outcomes and to improve education for all those living with diabetes and those who care for them.
As well as amputation being a personal life-changing event, the financial burden of diabetes foot care is immense
Professor Michael Edmonds
Lead author Professor Michael Edmonds, professor of Diabetic Foot Medicine at King’s College London, and consultant physician at King’s College Hospital, said: “Our paper recommends the need for a clearer signposting of the system and processes of care, which would allow for rapid access to multidisciplinary footcare teams and ultimately the end of preventable amputations.
“During their lifetime, one in three people living with diabetes may develop foot ulcers. These are highly susceptible to infection which can spread rapidly causing overwhelming tissue destruction or gangrene necessitating major amputation.
“We know that there were 7,545 major amputations in people with diabetes in England between 2015 to 2018. As well as amputation being a personal life-changing event, the financial burden of diabetes foot care is immense. The cost of health care for ulceration and amputation in diabetes in 2014–2015 was estimated at between £837 million and £962 million.
“We want to reduce the stigma often experienced by people living with diabetes in regard to complications, removing any blame or shame associated with diabetes complications. This includes not using the terms ‘Diabetic Foot or Diabetic Ulcer’ as these add to the stigma. These changes can be created through encouraging and enabling an environment of education, knowledge and trust using language that enables and not disadvantages people with diabetes.”
Uniquely Chris Aldred, also known as The Grumpy Pumper, was asked to contribute to the paper. His online persona, where he talks openly about living with type 1 diabetes for 25 years, has attracted more than 9,000 Twitter followers and helped make him known within the diabetes community.
Together, with Professor Anne Phillips, John Grumitt, Charles Odiase, Dr Patrick Holmes, Helen Halloum, Anita Beckwith and Dr Yvonne Doherty they have written a series of recommendations, which they believe will significantly improve footcare among people with diabetes.
- Increased awareness of the risks to all people living with diabetes (PLwD) to promote foot health and avoid delays in seeking help when facing any difficulties.
- Establish a national education programme with practical information in an illustrated practical handout for all PLwD about foot self-care and checks from diagnosis onwards.
- Increased access to education in foot assessment and urgent referral for ALL Health Care Professionals (HCPs) working with PLwD.
- Adoption of the ‘ACT NOW’ acronym, detailed at the end of this paper, in urgent foot care referrals for every PLwD by all HCPs.
- Clarity of referral pathways is essential for all HCPs to avoid unnecessary delays and LEAN thinking techniques to facilitate and enable clarity of pathways for easy referral.
- For all NHS Trusts to enable PLwD to self-refer as required to Multidisciplinary FootCare Teams (MDFT) to avoid unnecessary delays.
- NHS Standardisation of evidence based provision of MDFT in all NHS Trusts and referral criteria to reduce postcode lottery and fragmented services across the NHS and to comply with the guidance from The International Working Group of the Diabetic Foot (IWGDF) (2019).
- Regular audit to assess the impact on services and demonstrate the need to increase access to MDFT.
- Call upon professional bodies to review the annual data from NHS England and the National Diabetes Audits to assess the training and support needs for HCPs to have the necessary capabilities to address prioritised unmet needs.
- All Clinical Commissioning Groups and Primary Care Networks provide all three care structures of care for PLwD with diabetes and foot disease, as recommended by NICE Guideline, NG19 (2019).
- Training for healthcare staff to carry out routine foot examinations
- A clear pathway for assessment if someone has new, worsening or re-occurring foot ulcers (within 24 hours if needed)
- A clear pathway for referral into a specialist foot protection service if someone is assessed as being at increased risk of developing foot ulcers
To read the paper in full, click here.