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Leading foot health experts call for an end to avoidable amputations

Leading foot health experts call for an end to avoidable amputations

Thursday 30/11/2017

The College of Podiatry is calling on healthcare commissioners to prioritise diabetic foot care and end avoidable amputations that can have a devastating impact on the lives of patients and their families and cost the NHS millions.

Complications from diabetic foot disease are costing the NHS in England more than a billion pounds a year.

Today, and every day, 23 people with diabetes in England will have a toe, foot or leg amputated.

A third of these are major amputations, meaning that the patient loses their whole foot above the ankle or even more of their leg. Many of these amputations are preceded by diabetes related foot ulcers, caused by a combination of impaired circulation and nerve damage – common problems experienced by people with diabetes.

Experts believe that by improving the way diabetic foot health is commissioned and delivered, around half of these life-shattering surgeries could be avoided.

The College of Podiatry is today (30 November 2017) launching an online commissioners’ guide, www.improvingdiabeticfootcare.com, that exposes - in detail - the comparative rates of amputations across England and is calling on commissioners to take action and help end the postcode lottery of avoidable amputations.

Dr Paul Chadwick, Consultant Podiatrist and Clinical Director of The College of Podiatry, is a leader in the field of diabetic foot care and was instrumental in developing the toolkit resource. 

Dr Chadwick said: “The findings of this new commissioning resource shine a spotlight on the stark differences there are in amputation rates between regions – differences that signify a deep human cost for patients and their families as well as a huge cost burden for our already stretched NHS foot services.

“It is time for commissioners to increase investment in foot protection, to make sure we reduce these unnecessary and appalling personal and financial costs for patients and the NHS.” 

There are an estimated 4.6 million people with diabetes in the UK. It is the most common cause of lower limb amputations and a person with the condition is around 23 times more likely to have an amputation compared to the general population. Both lower limb amputation and foot ulceration are associated with high mortality. Only around 50% of patients survive for 2 years after major amputation in diabetes and the 5-year survival rate after a diabetic foot ulcer is only 58%; similar to that for colorectal cancer, and lower than for breast or prostate cancer.

The average Clinical Commissioning Group (CCG) spends around £5.7 million a year on diabetic foot problems; more than the combined cost of the three most common cancers. Reducing the prevalence of severe ulcers by one third would reduce the cost of ulcer care by around £1 million a year per CCG.

The online toolkit resource will support CCGs in England to commission improved services for diabetic foot disease. It provides information on:

  • the impact of diabetic foot ulcers and amputations on patients' lives and on NHS costs

  • the potential for improved care to transform lives and reduce NHS expenditure

  • what good care looks like and how to restructure services and pathways


Examples of good practice do already exist across the country: 

In London and the South East, Brent CCG and London North West Healthcare NHS Trust reshaped their diabetic foot care pathway back in in 2004, spending an additional £101,000 a year to establish a Foot Protection Service and multi-disciplinary foot team. Brent CCG now has one of the lowest diabetes amputation rates in England and the estimated annual savings from averted amputations and bed days for diabetic foot disease are £633,000. 

In 2012, the South West had some of the highest amputation rates in England. A team of local clinicians worked with CCGs to review their services and recommend changes. Those that implemented these measures saw significant reductions in the number of major amputations carried out between 2013 and 2016. Somerset CCG established eight community podiatry clinics, appointments within 24 hours for people with active foot disease and direct referral to the Multidisciplinary Foot Service (MDFS) where necessary. Community podiatrists received specialist training and became members of the MDFS, with regular rotation into the hospital-based diabetic foot services. Somerset’s major amputation rate is now below the England average and bed days for diabetic foot care have been significantly reduced, reducing costs each year by £959,000 - six times the annual cost of the service improvement. 

Beverley Harden, Allied Health Professions Lead, at Health Education England which funded the resource commented:

“Getting diabetic foot care right for people and their families is an essential part of improving lives and preventing avoidable limb loss.  People not only lose limbs, they can lose their livelihoods, their independence and sometimes also their life. By working with the College of Podiatry, we want to support the workforce to ensure a positive change in the landscape of diabetes foot care right across England.”

Marion Kerr, Senior Health Economist at Insight Health, led the development of the online toolkit and commented:

“One pound in every hundred pounds spent by the NHS in England is for diabetic foot care - more than a billion pounds a year. Yet in many parts of the country patients don’t get the care they need, when they need it. Delays in access to specialist foot care can lead to ulcers that don’t heal, and sometimes to amputation. Long-term ulcers and amputations not only devastate lives; they also increase costs. There's a big opportunity here for the NHS to transform the lives of tens of thousands of people with diabetes, and at the same time to reduce NHS costs.”

For further media information, please contact:

Claire McLoughlin
Senior Media Officer
The College of Podiatry  
020 7234 8648 or email: cm@scpod.org


Simon Colvan/Kathryn Race/Taryn Glenister
Ceres PR on 01189 475956 
or email: collegeofpodiatry@ceres-pr.co.uk  

For out-of-hours media enquiries call: 01189 475956


Notes to Editors

  1. The College of Podiatry is the academic authority for podiatry in the UK, and an independent charity dedicated to foot health research, education and public awareness. The College is the public facing and academic arm of the Society of Chiropodists and Podiatrists – the professional body for the UK’s registered podiatrists. Podiatry is the field of medicine that specialises in diagnosing and treating diseases and disorders of the foot and lower limb. 

  2. Marion Kerr is a senior health economist and director of Insight Health Improvement Ltd. Marion has a special interest in diabetic foot care. She has published papers on the NHS costs of ulcers and amputations in diabetes, and has advised government, NHS organisations, and international bodies on diabetic foot care. More generally, her work focuses on measurement of the quality of healthcare, on the identification of opportunities for improvements in quality and productivity, and on the creation of incentives for the delivery of those improvements. 

  3. HEE was established on 28 June 2012, working as a shadow Special Health Authority from 1 October 2012. It took on its full operational responsibilities from1 April 2013. It has five national functions:

    • providing national leadership on planning and developing the healthcare and public health workforce

    • promoting high quality education and training that is responsive to the changing needs of patients and local communities, including responsibility for ensuring the effective delivery of important national functions such as medical trainee recruitment

    • ensuring security of supply of the health and public health workforce

    • appointing and supporting the development of LETBs

    • allocating and accounting for NHS education and training resources and the outcomes achieved