Improving Diabetic Foot Care: A Guide for Commissioners

The NHS Priorities and Operational Planning Guidance 2022-23 sets out four strategic purposes for ICSs:

• improving outcomes in population health and healthcare

• tackling inequalities in outcomes, experience and access

• enhancing productivity and value for money

• supporting broader social and economic development.

 

Improvements in diabetic foot care can deliver measurable impacts in all four areas:

​

Improving outcomes in population health and healthcare

​

Diabetic foot problems affect large numbers of people, have substantial impacts on quality of life, and are associated with premature mortality. A large body of evidence shows that better care leads to increased healing, fewer amputations and higher quality of life. 

​

Tackling inequalities in outcomes, experience and access

​

People living in deprivation are more likely to have diabetic foot ulcers: 25% of ulcers reported to NDFA occur in people from the most deprived IMD quintile, and 15% in people from the least deprived quintile. There is also inequality across the country (and within ICSs) in access to high-quality coordinated footcare services. Inadequate provision can lead to delayed care and more severe ulceration. People living in deprivation are more likely to have a severe ulcer at first expert assessment; 45% of ulcers are severe in people from the most deprived IMD quintile, and 42% in people from the least deprived quintile. Severe ulcers are less likely to heal, and are more likely to lead to amputation. Addressing inequalities in access to diabetic foot care has the potential to improve outcomes and quality of life for the most deprived groups.

​

Enhancing productivity and value for money

​

If patients do not receive the right care for an ulcer in the early stages, there is more likelihood that it becomes severe. Severe ulcers take longer to heal and are more likely to lead to amputation. Many take months to heal; some never heal. Early access to expert care increases the likelihood and speed of healing. Care for a mild ulcer that lasts 12 weeks costs on average £1,100, while care for a severe ulcer that lasts 23 weeks costs £7,250. Evidence from multiple services across England shows that improved diabetic foot care saves NHS money, as well as transforming patients' lives. 

 

Supporting broader social and economic development

​

Diabetic foot ulcers and amputations interfere with people's ability to work and to interact socially. Almost 40% of diabetic foot ulcers occur in people aged under 65. Absence from work and loss of employment can have catastrophic impacts on the lives of individuals, and there are also economic consequences for society. As well as the direct consequences for those who suffer ulcers or amputation, family members are often impacted, taking on caring responsibilities, and these also have broader economic effects. Improved diabetic foot care can reduce the incidence of severe ulcers, increase the likelihood of healing, and reduce amputations; these improved outcomes not only transform the lives of individuals, but also deliver broader social and economic benefits.

​

​

​

​