The audit collected data on 11 000 individuals with acute diabetic foot ulcers. Only 54% of commissioners in England and Wales provided information regarding the structure of foot care services in their area. Of these, only 43% had all three of the nationally recommended care structures (training for routine diabetic foot examinations, a foot protection service pathway and a pathway for assessment within 24 hours if necessary) in place.
Two-fifths (40%) of the ulcer episodes referred by a healthcare professional had an interval of 2 weeks or more before their first expert assessment, and almost one third of ulcer episodes were self-referred (30%). Self-referring patients were less likely to have severe ulcers (34%). Patients not seen for 2 months or more were most likely to have severe ulcers (58%). One third of people still had ulcers 24 weeks after assessment, and almost one in 20 had died.
The audit makes the following recommendations for healthcare providers:
- Petition Clinical Commissioning Groups and NHS Trust/Local Health Board executives to provide diabetes specialist foot care teams if not established.
- Participate in the NDFA to collaborate in this nationwide drive to improve the outcomes for diabetic foot disease.
- Create simple and rapid referral pathways.
For commissioners, the audit makes the following recommendations:
- Ensure that your local diabetes specialist foot care services participate in the NDFA to help improve the disabling, lethal and costly consequences of diabetic foot disease.
- Ensure your local services have an easily accessible diabetes specialist foot care team.
- Appoint a lead to work with local providers to review services and local care pathways, and ensure that pathways meet NICE guidelines, using audit findings for the local area.
The report findings can be accessed at: http://www.content.digital.nhs.uk/catalogue/PUB23525
