NHS Resolution report reveals inadequacies in diabetic foot care leading to preventable amputations - what support is available

NHS Resolution recently published a report highlighting shortcomings in diabetic foot care in England. Following a review of a select group of diabetic patients, the report has made recommendations to improve diabetic patient care and minimise amputations, which are avoidable in up to 85 per cent of cases.

From 2017 to 2020, there were reportedly 7,957 diabetic lower limb amputations in England. A lower limb amputation can have an insurmountable effect on a patient’s mobility, independence and quality of life and it is therefore of paramount importance that diabetic patients receive adequate foot care to ensure amputation remains a last resort.

Report Findings

NHS Resolution considered and reviewed 92 claims involving diabetic patients who had suffered diabetic foot disease and consequently required a lower limb amputation. 

The findings note that there was a variation in the foot care the patients received and the services provided to patients. In particular, there were notable inconsistencies in the diagnosis of diabetic foot disease and the assessments used to reach a diagnosis, as well as different diagnoses being reached despite having the same pathology.

The review also highlighted that in most cases the severity of the initial injury and the subsequent deterioration were not recognised and met with appropriate and timely care, thus patients experienced a delay in obtaining specialist footcare treatment. 

In particular, many patients were not identified as high-risk and therefore there was a lack of preventative measures in place.

Key Stats

Some of the key findings from the report include:

• All of the patients reviewed, did not have a diabetic foot assessment performed at every occasion where it was indicated.
• 68 per cent of patients reviewed experienced a delay in being referred to a specialist footcare team.
• 52 per cent of patients reviewed received no multidisciplinary diabetes foot care team (MDFT) input at all.
• 36 per cent of patients reviewed with a diabetic foot ulcer had no debridement performed until surgery. Debridement is a method of treatment used to clean a wound of infected skin tissue to promote healing.
• 58 per cent of patients reviewed with a diabetic foot ulcer had no offloading interventions performed. Offloading and pressure relief interventions should be used to relieve pressure from a diabetic ulcer to promote a quicker healing process.
• Due to their moderate or high-risk status, all of the patients reviewed should have been under the care of a community podiatry team already prior to the development of pathology and should have been receiving ongoing review, care and education.

Recommendations

As a result of its findings, which demonstrated an evident need for reforms in the care provided to diabetic patients, NHS Resolution has made the following recommendations:

• Education and training – to instill an awareness of the importance of footcare prior to the onset of diabetic pathology, an understanding of diabetic foot disease, and the way in which it can be managed by clinicians.
• Pathways and the provision of consistent services – to ensure pathways facilitate early intervention and consistent care
• Biomechanics and offloading (pressure relief) – for these essential interventions to be provided alongside a holistic and evidence-based management plan
• Commissioning of services – aim to reduce the variation of services patients receive by identifying a governing team to have responsibility for, monitor and appropriately review the patient pathway.
• Public health campaign – a national campaign to raise awareness and understanding of diabetic foot disease and preventative measures amongst clinicians, patients and the general public.
• Leadership and workforce – to review current workforce levels and ensure those in leadership positions take accountability to improve service provision
• Participation in the National Diabetes Footcare Audit and local service audits – accurate recording and auditing of the diabetic footcare services to continue to identify and rectify shortcomings in care.

Available Support

Unfortunately, the shortcomings identified in NHS Resolution’s report do not come as a surprise to us as clinical negligence specialists. All too often we've seen patients experience negligent diabetic foot care at the hands of medical professionals which has consequently led to preventable and avoidable lower limb amputations.

Leslie, an insulin dependent diabetic, attended his GP practice 21 times in a three-week period to have a burn to his foot dressed, during which nurses failed to consider his history of diabetes and failed to refer him for specialist foot care. 

Leslie later developed an infection in his foot and required a life-changing below the knee amputation. 

Irwin Mitchell worked with Leslie to bring a medical negligence claim and obtained a settlement to help fund Leslie’s ongoing rehabilitation, prosthetics and home adaptations he now required as a new amputee.

You can find out more about Irwin Mitchell's expertise in supporting people affected by amputations at our dedicated amputation claims section.