Report highlights need for early intervention for diabetic foot ulcers

8 March 2017: A report published today finds that early intervention is important in the management of diabetic foot disease, with people who receive expert care most quickly having the best outcomes.

It also reports that the basic framework for effective prevention and management of diabetic foot disease in England and Wales is often missing.

It is estimated that between five and seven cent of people with diabetes will have a diabetic foot ulcer at some point in their lives, at an estimated cost of £935 million to the NHS.⁹

The National Diabetes Foot Care Audit (NDFA) 2014-2016, published today by NHS Digital and Diabetes UK, collected data on 11,000 individuals with acute diabetic foot ulcers. It is commissioned by the Healthcare Quality Improvement Partnership as part of the National Clinical Audit and Patient Outcomes Programme (NCAPOP).

Just over half (54 per cent) of commissioners⁶ in England and Wales were able to provide information regarding the structure of foot care services in their area. Of commissioners that responded, 43 per cent of commissioners confirmed that all three of the nationally recommended care structures were in place in their area - training for routine diabetic foot examinations, a foot protection service pathway and a pathway for assessment within 24 hours if necessary.

173 specialist foot care services in England and Wales took part in the 2014-2016 audit, covering more than 11,000 patients with 13,000 ulcer episodes between 14 July 2014 and 8 April 2016.

People who referred themselves directly to a specialist foot care service - probably because they had previously received treatment there - had the highest healing rates after 12 weeks (56 per cent) compared to between 32 per cent and 48 per cent in groups referred by a health professional.

Other findings from the audit include:

•  excluding self-referral, two fifths (40 per cent) of people with foot ulcers wait for two or more weeks before being seen for a referral by a specialist foot care service
•  people with ulcers⁷ that wait two or more months to be seen by the specialist foot care service are more likely to have severe ulcers when assessed (58 per cent of ulcers were severe compared to between 34 and 51 per cent in other groups)
•  half (49 per cent) of all people with ulcers⁷ were alive and ulcer-free at 12 weeks, and two-thirds (66 per cent) were alive and ulcer-free at 24 weeks

Professor William Jeffcoate, Consultant Diabetologist and Clinical Lead for the audit said:

"This report highlights inconsistencies in the services available to people with foot disease in diabetes. There is also wide variation in the time which elapses before people with new foot disease are assessed by a specialist service. We know that those who wait the longest have worse healing."

Read theNational Diabetes Foot Care Audit - 2014-2016

ENDS

1. NHS Digital is the national information and technology provider for the health and care system. Our team of information analysis, technology and project management experts create, deliver and manage the crucial digital systems, services, products and standards upon which health and care professionals depend. During the 2015/16 financial year, NHS Digital published 294 statistical reports. Our vision is to harness the power of information and technology to make health and care better. NHS Digital is the new trading name for the Health and Social Care Information Centre (HSCIC). We provide 'Information and Technology for better health and care'. Find out more about our role and remit at www.digital.nhs.uk

2. The National Diabetes Foot Care Audit (NDFA) is part of the National Diabetes Audit (NDA) programme. The NDA is commissioned by The Healthcare Quality Improvement Partnership (HQIP) as part of the National Clinical Audit programme (NCA). The NDA is managed by NHS Digital in partnership with Diabetes UK and is supported by Public Health England (PHE). Development and delivery of the NDA is guided by a multi-professional national group of diabetologists, GPs, consultants, public health physicians, and service user representatives. The NDA is chaired by Dr Bob Young, Consultant Diabetologist & CMIO, Clinical Lead NDA (National Diabetes Audit) & NCVIN (National Cardiovascular Intelligence Network). Data has been collected as part of the NDA since 2003-04

3. Diabetes UK is the leading UK charity that campaigns on behalf of all people affected by and at risk of diabetes. For more information on all aspects of diabetes and access to Diabetes UK activities and services, visit www.diabetes.org.uk

4. Provider level data is published alongside the report.

5. NDFA seeks to address three questions:

•  Are NICE recommended care structures for England and Wales in place for the management of diabetic foot disease?
•  Does treatment of diabetic foot disease comply with nationally recommended NICE guidelines NG19 for England and Wales?
•  Are the outcomes of diabetic foot disease as good as they could be?

6. Commissioners are Clinical Commissioning Groups in England and Local Health Boards in Wales.

7. In this context 'People with ulcers' refers to individual ulcer episodes. A single person may have multiple ulcer episodes.

8. Within this release, percentages are rounded to the nearest whole number.

9. Diabetic foot care in England: an economic study - Marion Kerr, Insight Health Economics, 2017

10. For media enquiries please contact [email protected]  or telephone 0300 30 33 888.