Standardised care and better education could prevent amputations, NHS Resolution report finds

Foot experts have said “there must be learning” following the publication of a NHS Resolution report into compensation claims involving people with progressive diabetes-related lower-limb complications.

The report examined the themes of 92 claims, which included 55 people who underwent a major lower limb amputation.

It highlights that while a good standard of care is provided in the majority of cases, more can be done to reduce harm to people with diabetes through standardised care and better education.

Michael Edmonds, Professor of Diabetic Foot Medicine and Consultant Diabetologist at King’s College Hospital, said: “There must be learning from the diabetes-related lower limb amputations analysed in this report and a thorough appreciation of why they occurred.

“The report makes recommendations to improve patient care and proposes certain standards which should be put into practice and regularly audited.

“As a result of this learning it is hoped that the preventable loss of limbs due to diabetes can be reduced.”

Up to 85 per cent of amputations are avoidable. Both amputations and other harms can be reduced with appropriate, timely care. There has been a steady increase in the number and value of clinical negligence claims in people with diabetes with lower limb complications in England since 2013/14.

The report surmises: “Preventative care improves patient outcomes and reduces costs to the NHS. The majority of patients in the claims were not receiving any preventative input prior to the onset of pathology.

“Very few patients were correctly identified as high risk or were being seen by a foot protection service.”

Several key time points during the patient journey where intervention could improve care quality are highlighted in the report, including using evidence-based assessment techniques for a prompt diagnosis.

The report also highlights how crucial it is for people to be given rapid access to a multi-disciplinary foot team.

Educating individuals to self-manage and develop safe foot and lower limb care habits is also important, the report says.

One of the key messages is that diabetic foot disease is a condition that is not always well recognised or taken seriously.

The cost to the NHS of managing the diabetic foot and associated lower limb amputations, is up to £1 billion every year.

Implementing the recommendations from the report will get under way in the coming months.

Helen Vernon, Chief Executive of NHS Resolution, said: “One of NHS Resolution’s aims is to learn from incidents of harm and share learning as widely as possible.

“We hope this report will contribute to reducing the number of people that suffer with severe diabetic lower limb complications.

“In most cases, the care of people with diabetes and lower limb complications is good, reflecting the commitment of groups of footcare clinicians and networks that work tirelessly to keep standards of care high.

“‘Time is tissue’ when it comes to diabetic foot disease. At every stage of the patient journey, acting with urgency is imperative.

“We hope the recommendations will help to identify and remove some of the barriers that potentially exist in implementing evidence-based and standardised care.”

Professor Edmonds added: “Major amputation is one of the most destructive complications of diabetes and regrettably the number of major lower limb amputations in diabetes continues to rise.

“This report should be compulsory reading for those who are involved with care of people with diabetes including healthcare professionals, commissioners and policy makers.”

The report, Diabetes and lower limb complications: A thematic review of clinical negligence claims, can be viewed here.

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