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NHS Atlas of Variation — highlights hot spots and sore points

More integrated diabetes footcare services need to be in place across the NHS to put a stop to the amputation postcode lottery highlighted in the recently published NHS Atlas of Variation.

That’s the message from NHS Diabetes Director Anna Morton, who is making the call to action after it was revealed some people with diabetes are six times more likely to have a major lower limb amputation (defined as above the ankle) because of where they live.

NHS Diabetes Director Anna Morton comments, “The amputation rate is high, and often avoidable, but what is even more unacceptable is that the chances of having this life-changing surgery can come down to your postcode. To stop this, we are calling for integrated footcare services across primary and secondary care, including footcare protection teams in the community and specialist multi-disciplinary teams in hospitals. Examples from Ipswich and Middlesbrough hospitals have shown such teams can reduce amputations by up to 75 per cent, which saves costs and, more importantly, people’s limbs.”

NHS Diabetes has a national footcare network of clinicians and commissioners to promote improvements in diabetic footcare through communication and shared learning. As an organisation, we are continuing to develop tools and guidance to improve footcare services.

NICE has recently published guidance on footcare in hospitals which should be followed and NHS Diabetes has also issued guidance called Putting Feet First.

The NHS Atlas of Variation, published by the Department of Health and supported by the National Diabetes Information Service (NDIS), found that over 4,600 people with diabetes, included in the National Diabetes Audit, had had a major amputation in the previous five years.  This represents 0.24 per cent of the people included in the audit and has remained static since 2008/09.

The report, which covered Primary Care Trusts in England, found that the percentage of people with diabetes having major lower limb amputations ranged from 0.1 per cent to 0.5 per cent (a 6-fold variation).

The NHS Atlas of Variation has been published through the Department of Health’s national QIPP programme and can be found on the NHS Right Care website at http://www.rightcare.nhs.uk/index.php/atlas/atlas-of-variation-2011/.

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