Diabetic people 'having unnecessary amputations' Parliamentary group and charity Diabetes UK call attention to wide disparity in treatment of condition across UK
People with diabetes are having their legs and feet amputated unnecessarily, according to a group of MPs and peers who have highlighted stark differences in treatment of the condition across the NHS in England.
The all-party parliamentary group on vascular disease said amputations are twice as likely for adults with diabetes in the south-west compared with London. It calls for reductions in the "stubbornly high" numbers of patients losing limbs, feet or toes.
NHS commissioners and hospitals must ensure a more consistent approach to treating conditions such as peripheral arterial disease, which affects the blood supply to muscles, and "diabetic foot" and ensure they have appropriate multi-disciplinary health teams, the report said. Its demands were backed by a senior surgeon, who warned that unnecessary amputations were being carried out because of the lack of national standards, and by the charity Diabetes UK which called present variations in treatment "unacceptable".
It has complained existing best practice guidance for the NHS on PAD is often not followed.
Neil Carmichael, Conservative MP for Stroud, who chairs the parliamentary group, said:"Too many patients aren't getting the treatment they need to avoid losing their legs. The figures for parts of the south-west of England are particularly alarming, and this needs to be tackled."
Reducing lower limb-loss must be a priority, given the country's ageing population, he said.
In the south-west there were on average 3.88 amputations per 1,000 patients with diabetes over the three years to 2011-12, with the area now covered by the Somerset clinical commissioning group recording a figure of 4.7 per 1000.
The parliamentarians' report, which based its findings on NHS statistics and answers to freedom of information requests, showed the comparable figure in London was 1.94.
Ian Franklin, a council member of the Vascular Society, said :"To be honest, nobody ever wants to perform an amputation … you only ever amputate a limb to save someone's life.
"In the same way that the standard of breast cancer care is national, the treatment you get in Stockport is the same as Kent, we need the same thing for limb-threatening problems. We are getting unnecessary amputations because in some parts of the country the treatment is prompt, in some parts of the country the treatment is sluggish, and it's sluggish without contravening any guidelines."
Nikki Joule, policy manager, at Diabetes UK, said:"Up to 80% of amputations are avoidable with good preventative foot care in the community and fast access to a specialist multidisciplinary team when needed."
Somerset clinical commissioning group (CCG) said new diabetes foot care services would start next month. Additional clinics with podiatrists would provide a patient review within 24 hours in most cases and there would be better working with hospitals and access to other specialists.
This new clinical pathway would also see the county complying with the guidance recommended by the NHS's National Institute for Health and Care Excellence. The CCG was confident that amputation rates would fall.
Professor Jonathan Valabhji, national clinical director for diabetes at NHS England, said: "The report highlights an extremely important issue, lower limb amputation, which is one of the most feared complications of diabetes and of peripheral vascular disease.
"The report highlights the issue of geographical variation, which was highlighted previously in research in 2012. Since that time, efforts have been focussed on reproducing good practice and high quality care across the country for the management of diabetic foot disease, which has seen the proportion of Trusts with multidisciplinary diabetic footcare teams increase from around 60% in 2011 to 72% in 2013.
"However, there is still much more to do, and from July this year we will see the launch of the National Diabetes Footcare Audit. The audit aims to establish the extent to which national guidelines on the management of diabetic foot disease are being met, and will provide local teams with the evidence needed to tackle any identified differences in practice which will lead in turn to an overall improvement in management and outcomes for patients." The Guardian
People with diabetes are having their legs and feet amputated unnecessarily, according to a group of MPs and peers who have highlighted stark differences in treatment of the condition across the NHS in England.
The all-party parliamentary group on vascular disease said amputations are twice as likely for adults with diabetes in the south-west compared with London. It calls for reductions in the "stubbornly high" numbers of patients losing limbs, feet or toes.
NHS commissioners and hospitals must ensure a more consistent approach to treating conditions such as peripheral arterial disease, which affects the blood supply to muscles, and "diabetic foot" and ensure they have appropriate multi-disciplinary health teams, the report said. Its demands were backed by a senior surgeon, who warned that unnecessary amputations were being carried out because of the lack of national standards, and by the charity Diabetes UK which called present variations in treatment "unacceptable".
It has complained existing best practice guidance for the NHS on PAD is often not followed.
Neil Carmichael, Conservative MP for Stroud, who chairs the parliamentary group, said:"Too many patients aren't getting the treatment they need to avoid losing their legs. The figures for parts of the south-west of England are particularly alarming, and this needs to be tackled."
Reducing lower limb-loss must be a priority, given the country's ageing population, he said.
In the south-west there were on average 3.88 amputations per 1,000 patients with diabetes over the three years to 2011-12, with the area now covered by the Somerset clinical commissioning group recording a figure of 4.7 per 1000.
The parliamentarians' report, which based its findings on NHS statistics and answers to freedom of information requests, showed the comparable figure in London was 1.94.
Ian Franklin, a council member of the Vascular Society, said :"To be honest, nobody ever wants to perform an amputation … you only ever amputate a limb to save someone's life.
"In the same way that the standard of breast cancer care is national, the treatment you get in Stockport is the same as Kent, we need the same thing for limb-threatening problems. We are getting unnecessary amputations because in some parts of the country the treatment is prompt, in some parts of the country the treatment is sluggish, and it's sluggish without contravening any guidelines."
Nikki Joule, policy manager, at Diabetes UK, said:"Up to 80% of amputations are avoidable with good preventative foot care in the community and fast access to a specialist multidisciplinary team when needed."
Somerset clinical commissioning group (CCG) said new diabetes foot care services would start next month. Additional clinics with podiatrists would provide a patient review within 24 hours in most cases and there would be better working with hospitals and access to other specialists.
This new clinical pathway would also see the county complying with the guidance recommended by the NHS's National Institute for Health and Care Excellence. The CCG was confident that amputation rates would fall.
Professor Jonathan Valabhji, national clinical director for diabetes at NHS England, said: "The report highlights an extremely important issue, lower limb amputation, which is one of the most feared complications of diabetes and of peripheral vascular disease.
"The report highlights the issue of geographical variation, which was highlighted previously in research in 2012. Since that time, efforts have been focussed on reproducing good practice and high quality care across the country for the management of diabetic foot disease, which has seen the proportion of Trusts with multidisciplinary diabetic footcare teams increase from around 60% in 2011 to 72% in 2013.
"However, there is still much more to do, and from July this year we will see the launch of the National Diabetes Footcare Audit. The audit aims to establish the extent to which national guidelines on the management of diabetic foot disease are being met, and will provide local teams with the evidence needed to tackle any identified differences in practice which will lead in turn to an overall improvement in management and outcomes for patients." The Guardian
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