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Amputation postcode lottery getting worse

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The postcode lottery of diabetes-related amputations in England is getting worse, according to new figures released today by Diabetes UK.

The new figures, based on NHS data, show that the overall diabetes-related amputation rate has not improved at all, with 2.6 per thousand people with diabetes per year having a lower limb amputation. And what is more unacceptable is that the gap between the worst and best performing areas has got bigger.

This means people with diabetes in the worst performing area (Fareham and Gosport) are now seven times more likely to have an amputation than people in the best performing area (Brent in London). The previous year, the rate in the worst-performing area was 5.4 times higher than in the best-performing area.

More than 100 amputations a week

Overall, people with diabetes are over 20 times more likely to have a lower limb amputation than people without the condition and there are more than 100 in the UK every week.  These amputations have a devastating impact, with half of those having them dying within two years.

Evidence shows that up to 80 per cent of diabetes-related amputations could be prevented but Diabetes UK is concerned that, while some hospitals and clinical commissioning groups (CCGs) have improved aspects of diabetes foot care in the last two years, there are still too many amputations happening because people are not getting the care they need. This includes:

  • Too many people with diabetes not getting a good quality annual foot check or not being informed about their risk status at the end of their check;
  • Some people with active foot disease not being referred to a team of specialists quickly enough, despite the fact that diabetes-related foot problems can deteriorate in a matter of hours.
  • Many people with diabetes not having their feet checked when they stay in hospital, even though the National Institute for Health and Care Excellence recommends every hospital inpatient with diabetes should get their foot checked during their stay.
  • Too many hospitals still do not having specialist foot care teams or, if these teams are in place, not referring patients with foot disease to them quickly enough.

Diabetes UK is calling for CCGs across the country to focus on improving foot care and for areas with above average amputation rates to put in place a plan urgently for reducing their rate. It is also urging the Government to set out its plans for reducing the national diabetes-related amputation rate, as Health Secretary Jeremy Hunt has personally committed to halving the amputation rate by the end of 2017 but has yet to make clear how this will happen.

Barbara Young, Chief Executive of Diabetes UK, said: “Given the appallingly high levels of preventable diabetes-related amputations, it is hugely disappointing that these latest figures have not shown a reduction in the rate. It means we are continuing to see thousands of people losing their feet when better healthcare could have prevented this from happening.

"Gap getting wider"

“It is also worrying that the gap between the best and the worst performing areas is getting wider. The postcode lottery around amputations is now so great that if you have diabetes then where you live is one of the single biggest predictors of whether you will end up having one.

“To be fair, some areas have made real improvements over the last couple of years by setting up teams of foot specialists in hospitals and making sure more people with diabetes get their feet checked if they are staying in hospital. It may also be the case that some of the improvements made at local level will have happened too late to have been reflected in these statistics.

“But despite the good work going on in some areas, these figures show that the NHS urgently needs to give much more focus to improving diabetes foot care, especially in those areas where the rate is higher than average. We also want the Government to set out how it intends to meet its commitment of halving the rate over the next four years, including its plans for holding to account those areas with especially high rates.

“Everyone agrees on the things that could help reduce the amputation rate. We need better education for people with diabetes, good quality foot checks both at GP practices and in hospitals, and for any problems to be acted on quickly. What we now need is action to make this happen.”

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