Diabetic foot care costs the NHS in England £1bn. - £1.2bn. a year. That's £25 million per ICS.
It accounts for almost £1 in every £100 the NHS spends.
That's more than the combined cost of three of the four most common cancers.
Delays in access to specialist care are associated with poorer outcomes and higher costs.
The longer a patient waits for expert assessment, the more likely they are to have a severe ulcer when assessed.
Severe ulcers account for the bulk of diabetic foot care costs. Most severe ulcers last many months, and some never heal. Some eventually lead to amputation.
Expert care, delivered early, can improve outcomes for patients and reduce NHS costs.
Much of this spending is invisible to commissioners, wrapped up in block contracts.
Resource use in community and acute settings is intimately connected. Poor community care increases the likelihood of severe long-term ulcers, which in turn make A and E attendances, emergency admissions and amputation more likely.
Effective triage and prioritisation of medium and high-risk patients in the community can increase the productivity of community services, and reduce acute sector spending on ulcers and amputations.
Unless the quality and productivity of care improve, these costs are likely to rise sharply. The number of people with diabetes is expected to rise by around 16% by 2030.