News and updates from today' Diabetic Foot Problems conference
Today's conference focuses on improving practice in the prevention and management of diabetic foot problems including implementing the 2015 updated NICE guideline and Quality Standard, and the implementation of the May 2016 operational framework to improve care for patients with diabetic foot disease.
Following the chair's introductions, Catherine Gooday Implementation Group Member Putting Feet First Implementation Group Diabetes UK Principal Podiatrist Norfolk & Norwich University Hospitals NHS Foundation Trust & Member Guideline Development Group Diabetic foot problems NICE, whose presentation will looks at the work of the ‘Putting Feet First’ program and other national initiatives in raising the profile of diabetic foot care, with patients, clinicians and commissioners.
"why are we here, we are fighting a battle to get feet into multi disciplinary clinics early enough to make a difference
- lots of challenges ahead, we need the foot at the right time and right place
- £8 million released into Diabetic foot services just before Christmas
- 4 million people in the UK with diagnosed diabetes, a problem that's not going away
- take 5 things you have learnt from the course today and share with 5 colleagues, create a pandemic of foot knowledge
- we have all redesigned our services, probably more than once but will come a point we cannot improve and be innovative any more
- The total cost (direct care & indirect costs) associated with diabetes in the U.K. is currently estimated at £23.7 billion
- Diabetes UK are fabulous at publicising"
In order to achieve an integrated diabetic foot service, it is essential to engage with all the relevant stakeholders. The first and most important of these are patients, alongside commissioners, provider organisations and patient representative groups.
The measure of success for a diabetic foot service will depend upon who is assessing it. Outcome data from reports such as the Diabetes foot care activity profiles http://www.yhpho.org.uk/diabetesprofilesfoot/default.aspx and the National Diabetes Foot Audit http://www.hscic.gov.uk/footcare are the main ways by which foot services are measured.
In order to improve outcomes NICE guidance on Diabetic foot problems: prevention and management (NG19) https://www.nice.org.uk/guidance/ng19 recommends the development of integrated foot services spanning primary, community and secondary care services providers. Despite this there is still considerable variation in access to and the type and level of services available for patients.
Diabetes UK is committed to ensuring that people with diabetes receive high-quality care wherever they live, and that they know what care to expect. https://www.diabetes.org.uk/putting-feet-first
Professor William Jeffcoate Steering Group Chair National Diabetes Footcare Audit & Consultant Diabetologist Nottingham City Hospital follows with a focus on 'Learning from the National Diabetes Foot Care Audit (NDFA)'
Professor Jeffcoate comments:
"our structure audit questionnaire sent annually to commissioners and service administrators had a very disappointing return as only 60% answered all 3 questions as they don't know
- longer you wait to see a specialist the greater the prevalence of severity. May not be a direct result but is suggestive and is concerning
- we have an ever-increasing dataset from UK population, it's unique in the world and the possibilities are enormous
- a lot has been achieved in last 25 years. Have gone from 3.5 major amputations per 1,000 to 0.8"
The aim of the National Diabetes Foot Audit is to explore the reasons for differences which exist in the outcome of managing diabetic foot ulcers in different parts of England and Wales. The intention is not to find fault with individual specialist teams but to explore the extent to which better outcomes reflects compliance with national guidance – and effectively to provide evidence to justify the guidance itself. Moreover, the audit explore every aspect of the foot care pathway from the structure of services (which is effectively the responsibility of CCGs in England and LHBs in Wales). The initial results from the launch in July 2014 have identified a close relationship between time that elapses before first expert assessment and (a) the severity of the ulcer and (b) the outcome. The aim is to eliminate geographical variation and thus to improve outcome overall.
Conference chair Dr Matthew Young Consultant Diabetologist Royal Infirmary of Edinburgh & Editor Diabetic Foot Journal, delivers an extended session on 'Effective Risk Assessment and Identification of the at risk foot', and discusses:
• developing effective screening for early identification of problems
• risk assessment, risk stratification and identification of the foot at risk
• moving from risk assessment to action: ensuring appropriate referral
• developing effective foot protection services
Dr Young comments:
"we are not screening for neuropathy, we are screening for the loss of protective sensation
- the biggest risk of having a foot ulcer is already having had a foot ulcer. 6.59 times more likely to get a foot ulcer if previous history of ulceration
- in Scotland we have a national database of all diabetes patients
- can we argue that diagnosis and treatment should be cost effective via foot screening
- foot protection service may not prevent ulceration but definitely worth the investment"
Dr Matthew Young's biography:
Matthew Young is the Editor of the Diabetic Foot Journal and foot section of Diabetes Digest He qualified from Newcastle University Medical School in 1985 and trained in a variety of centres including the Sheffield and Manchester diabetic foot clinics. Matthew has been a Consultant Diabetologist at the Royal Infirmary of Edinburgh since 1995 where he now leads the multidisciplinary team of the largest diabetic foot clinic in Scotland. His research interests include foot screening and skeletal change in the diabetic foot, particularly Charcot joints. He serves on the Scottish Intercollegiate Guidelines Network (SIGN) group, for diabetic foot guidelines, and the Foot Advisory Group of the Scottish Diabetes Group. He has published extensively on diabetes and its complications, particularly the diabetic foot. HE was recently awarded an honorary fellowship of the College of Podiatric Medicine in recognition of his work in promoting podiatry and multi-disciplinary working.
Also of interest:
Eliminating Heel Pressure Ulcers
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De Vere West One Conference Centre, London
20 January 2017