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Make Change Happen

Six Vital Steps

Review treatment and outcomes

NICE recommends that treatment and outcomes for the diabetic foot should be reviewed regularly, in line with the National Diabetes Footcare Audit (NDFA).

The NDFA enables all diabetes footcare services to measure their performance against NICE clinical guidelines and peer units, and to monitor adverse outcomes for people with diabetes who develop diabetic foot disease.

It looks at the following key areas:

  • Structures: are the nationally recommended care structures in place for the management of diabetic foot disease?

  • Processes: does the treatment of active diabetic foot disease comply with nationally recommended guidance?

  • Outcomes: are the outcomes of diabetic foot disease optimised?


If your Footcare Service has not yet registered to take part in the NDFA, instructions for participation are provided by NHS Digital.

A summary of NDFA data and other information about diabetic foot services at ICS level can be found in the 'Your Local Area' section of this website. 


Further information is available in diabetes footcare profiles and in the National Diabetes Audit. 

It is likely that local organisations will also require additional data on the impact of change. Service redesign can offer the opportunity to introduce key performance indicators for data collection so that commissioners and providers can monitor service quality and outcomes, identify and solve problems in the pathway, and examine the impact of service change on costs. Robust and timely data flows can also be used to support outcomes-based payments systems.

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