Potential for Improvement

Findings of the National Diabetes Footcare Audit (NDFA)

England and Wales, 2015-18

The NDFA gathers data from diabetes foot services around the country about care structures, processes and outcomes. Its findings reveal deficiencies in care in many parts of the country.

Many people wait several weeks for expert assessment of foot ulcers. Patients who wait the longest are more likely to have severe ulcers, and are less likely to be healed at 12 weeks. 

Having a severe ulcer at first expert assessment triples the likelihood of a foot disease-related hospital admission.

In many areas the basic framework for effective prevention and management of diabetic foot disease is missing.

NICE recommends that people with active foot disease should be referred for expert assessment within 1 working day, for triage within 1 further day.

Many people in England and Wales wait two or more weeks to first expert assessment. One in twelve waits at least two months.

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​Patients not seen for two months or more are most likely to have severe ulcers at first expert assessment (54%).

Severe ulcers are less likely to be healed at 12 weeks, and people who wait the longest for expert assessment are the least likely to be healed. ​

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One in three patients with a severe ulcer at first expert assessment will have at least one foot disease-related hospital admission in the following six months.

Some will have more than one such admission.

The mean cost of these admissions is estimated at £6,750.

For those with less severe ulcers, the likelihood of hospital admission is much lower.

If the prevalence of severe diabetic foot ulcers were reduced by a third, the average ICS would save around £4 million a year.

Professor William Jeffcoate is Chair of the NDFA Advisory Group and Clinical lead for NDFA.