Question to the Department of Health and Social Care:

To ask the Secretary of State for Health, how many diabetes-related amputations there were in each county in the last three years.

NHS England and clinical commissioning groups (CCGs) have responsibility for determining the overall approach to improving clinical outcomes from healthcare services for people with diabetes. There are various actions at a national level to help ensure that all patients with diabetes receive good quality care, including foot care.

The National Institute for Health and Care Excellence (NICE) has published clinical guidance and quality standards on the treatment of diabetes and its complications. The NICE Diabetes Quality Standard is clear that people with diabetes who are at risk of foot ulceration should receive regular reviews by a foot protection team in accordance with its clinical guidance. The Health and Social Care Act (2012) places a duty on NHS England to have regard to the NICE Quality Standards. CCGs should also have regard to them in planning and delivering services, as part of a general duty to secure a continuous improvement in quality.

As part of the Quality and Outcomes Framework (QOF), general practitioners are remunerated for assessing nerve damage and poor blood supply to the feet in people with diabetes on an annual basis. Information is collected annually both through the QOF returns and through the National Diabetes Audit (NDA).

The new National Diabetes Foot Care Audit, a module of the NDA, aims to establish the extent to which national guidelines on the management of diabetic foot disease are being met. The audit will provide local teams with the evidence needed to tackle any identified differences in practice which will lead in turn to an overall improvement in management and outcomes for patients. Local and national level results will be available in March 2016.

People with active diabetic foot disease should be referred up to the hospital-based multidisciplinary diabetic foot teams and seen within 24 hours of referral. There has been an increase in the proportion of trusts with multidisciplinary diabetic footcare teams, from around 60% in 2011 to 72% in 2013.

Diabetic foot disease is also a focus of the cardiovascular Strategic Clinical Networks across England, with an emphasis on rolling out best practice.

The attached table gives a count of finished consultant episodes with a primary diagnosis of diabetes and a primary or secondary procedure of amputation between 2010-11 and 2012-13 as well as the number of diabetes patients from the 2009-10 and 2010-11 diabetes audits having an amputation the following year. The figures have been divided by primary care trust as we do not hold this data in the format requested.

Reference should be made to the notes provided with the table when interpreting these figures.