It’s time to invest in and improve diabetes footcare

By Catherine Gooday, Principal Podiatrist – Diabetes, Norfolk & Norwich University Hospitals NHS Trust

The diabetic foot has never received such high levels of publicity in national and local news headlines.

TheNational Diabetes Inpatient Audit (NaDIA) 2015analysis has shown some improvements in hospital based diabetic foot services over the last five years. However, there is still variation in access to services and the level of care provided across England and Wales. This variation in care could be one of the factors contributing to thereported variation in amputation rates. If we’re able to reduce this variation in care and ensure foot ulcers are referred early for treatment, ulcers will be less serious on presentation to footcare services and heal quicker as demonstrated in theNational Diabetic Foot Audit(NDFA) 2016.

Over the last few months there have been new and revised guidelines published to support commissioners and service providers in developing diabetic foot pathways (see below). Importantly, all of these guidelines have been developed by multidisciplinary groups of healthcare professionals and people with diabetes. The guidelines have also been endorsed by all professional bodies concerned with reducing amputations and improving diabetes footcare.

All of these new guidelines highlight the need for integrated pathways across primary, community and secondary care services; from screening, to the prevention and management of foot complications.

The challenge ahead is implementing these new recommendations into clinical practice to improve patient outcomes.

So, as commissioners and healthcare professionals, what can you do to support the implementation of these recommendations? As detailed in Diabetes UK’s(PDF, 55KB), there are six steps to follow:

1. Ensure that the full diabetes footcare pathway is being commissioned.
2. Use guidance and data to inform local footcare commissioning and performance.
3. Ensure all inpatients with diabetes receive foot checks and appropriate care.
4. Conduct a root cause analysis for all major amputations.
5. Ensure local participation in the National Diabetes Foot Care Audit.
6. Network and share learning with others.

All the new guidelines and audit results provide a strong case for further investment in diabetic foot services and the training of all staff involved in the management of the diabetic foot. Many footcare services are under resourced to manage the current demand, let alone the rising prevalence of diabetes.

Implementing the recommendations contained in the new guidelines is the first step towards reducing the number of patients developing diabetic foot complications. Following recommendations will also improve the outcomes for those who do develop foot ulceration. And importantly, any investment in services should translate into long term savings for the health economy as there will be fewer diabetic foot complications which are extremely costly to treat.

New and revised guidelines and resources

• Diabetic foot problems: prevention and management, NICE guidelines [NG19], August 2015

   Brings together and updates best practice recommendations for diabetes foot care. Brings together and updates best practice recommendations for diabetes foot care.

• Operational delivery of the multi-disciplinary care pathway for diabetic foot problems, Joint Specialty Recommendations

  Provides a framework for improving the delivery of hospital trust-based diabetic foot services to ensure equitable access to high quality care.Provides a framework for improving the delivery of hospital trust-based diabetic foot services to ensure equitable access to high quality care.

• Putting feet first risk stratification tool, Diabetes UK (June 2016) (PDF, 348KB)

  Updates the chart showing how to risk stratify and when and where to refer people with increased risk of diabetes related foot problems. Find out about the Putting Feet First campaign.Updates the chart showing how to risk stratify and when and where to refer people with increased risk of diabetes related foot problems.Find out about the Putting Feet First campaign.

• How to: use root cause analysis to reduce diabetes related amputations, Diabetes UK (July 2016) (PDF, 489KB)

  Practical, step-by-step guide on how to complete root cause analysis (RCA). It includes useful tools and templates. Practical, step-by-step guide on how to complete root cause analysis (RCA). It includes useful tools and templates. 

• Outlines the six steps CCGs can take to improve foot care and reduce amputations in their local area.Outlines the six steps CCGs can take to improve foot care and reduce amputations in their local area.