The latest thematic review by NHS Resolution looking at the issue of diabetes and lower limb complications has found that “standardised care and better education could prevent diabetic patients from undergoing amputations, preserve wellbeing and save the NHS money”.

In this insight, we summarise when healthcare providers can step in to improve patient care, and how to prevent future harm from primary through to tertiary care.

The report comprises a thematic analysis of 92 compensation claims (settled since 2018/19 with an incident date on or after 2012/13, but before the Covid-19 pandemic), involving patients with progressive diabetes-related lower-limb complications. In 55 cases the claimant underwent a major lower-limb amputation. The report identifies key time points during the patient journey and makes recommendations around improved system oversight, clearer national guidance and improved education.

Key time points for intervention

Opportunities highlighted in the report where intervention could improve the quality of patient care include:

  • Assessment and diagnosis. The report notes variations in the provision of diabetic foot care and inconsistencies in care across stages of the patient pathway were noted. Healthcare providers need to use standardised, evidence-based assessment techniques to enable prompt diagnosis.
  • Rapid access to a multidisciplinary foot team (MDfT) who will oversee and manage the entire patient care pathway is essential to ensure consistency and appropriate, timely decision-making. Where this was not done correctly:
    • Patients deteriorated while waiting for intervention or review.
      • The overall severity of the situation was often not recognised.
      • The management plan was not adapted or expedited.
      • The involvement of multiple disciplines in a patient’s care did not necessarily lead to integrated multidisciplinary team working.
    • The MDfT plays a crucial role in patient education and empowerment, so they can maintain good foot care habits independently.

    Seven recommendations to improve patient care nationally and locally

    • Education and training. For example, diabetic foot care education should be provided to all patients on a regular basis from diagnosis.
    • Early pathways and consistent services. ‘Time is tissue’ – the earlier a patient is seen by the specialist team and started on treatment, the better the chances of a positive outcome.
    • Biomechanics and offloading (pressure relief). Accurately assessing lower limb biomechanics and acting on the result to redistribute pressure away from risk areas is crucial.
    • Commissioning of services. One identifiable governing team should have responsibility for and be able to review the entire patient pathway.
    • Public health campaign. A national campaign is proposed to increase awareness of diabetic foot disease and the impact on patients and families, which should prompt increased uptake of preventative measures.
    • Leadership and workforce. Urgent review of current workforce levels is likely required if recommendations are to succeed.
    • Participation in the National Diabetic Foot Audit and local service audits. This is essential for a learning culture to be established.

    What next for healthcare providers?

    The report and its recommendations warrant closer examination from a clinical and medico-legal perspective. NHS Resolution will continue to work with stakeholders to help implement the suggested recommendations.

    How Capsticks can help

    Capsticks is a national leader in representing both NHS and independent sector healthcare providers as well as medical malpractice insurers. Our dedicated team is renowned for advising on the defence and resolution of clinical negligence claims, inquests, management of complaints, serious incident investigations/inquires and safety and learning. We also provide an innovative outsourcing service for claims and inquests handling.

    Capsticks will be taking a more in-depth look at the report in a webinar. The date is to be confirmed shortly, but to register your interest please click here.

    This insight was authored by consultant Cheryl Blundell and partner Majid Hassan. If you would like to discuss any issues around the new report or how we might assist you in meeting the standards, please contact Majid Hassan, Charlotte Rathbone, Dominic Ip or Philip Hatherall, to find out more how Capsticks can help.