Date

NHS London Diabetes Strategic Clinical Network: Foot care steering group

Co-Chairs Stella Vig and Richard Leigh

Clinical Director: Dr Stephen Thomas

4th February 2016

2

London – overview

Clinical Commissioning Groups

• 32 CCGs

• Also cross-boarder patients from the home counties

Acute Sites

• 36 Acute Hospitals

Clinical Networks

• 5 clinical networks

Hubs

• Vascular Hubs (8)

• Renal Hubs (8)

Private Practice

• Figures do not include

private healthcare providers

3

Diabetes Related Amputations in London

2010-13 Data for London

• Major Amputation rate 0.6 per 1000 people with diabetes.

• Minor Amputation rate 1.3 per 1000 people with diabetes.

• These figures are lower than the national average for England.

4

Amputations in London Atlas of Variation

• There is a variation in amputation rate within London (0.4 – 2.1 per

1000)

5

NHS Diabetes

A working group comprising

clinical ‘champions’ started meeting to

discuss London wide implementation

of diabetic foot guidance supported by

NHS Diabetes Improvement Coordinator

started in 2010.

• The group initiated ‘Pan London Diabetic

Foot Meetings’ to discuss how to reduce

variation of outcomes across sectors and

implement current guidance.

• Root Cause analysis for amputations in

London – 13 hospitals participated.

• Started an audit to map diabetic foot

resources in London.

• Other work on the NHS Diabetes website

Has been archived.

6

NHS London Diabetes SCN Foot care steering group

Foot Steering Group Representation

• NHS England (London)

• Lay membership

• Podiatry

• Vascular surgery

• Endocrine

• Orthotist

• Renal

• Diabetes UK

• College of Podiatry

7

NHS London Diabetes SCN Foot care steering group

Foot Steering Group Work

• Ongoing audit of resources in London (primary and acute care)

• Ongoing London Foot Care Network Meetings

http://www.londonscn.nhs.uk/publication/aspiring-to-foot-care-

excellence-meeting-resources-5-march-2015/

• Local Priority Settings for the 5 networks

• Promoting the National Diabetic Foot Audit to all providers

8

NHS London Diabetes SCN Foot care steering group Publications

Publications

A guide for commissioning foot care services for people with diabetes (May 2015) http://www.londonscn.nhs.uk/publications/

Commissioning guidance: Foot care service for people with diabetes

9

NHS London Diabetes SCN Foot care steering group Publications

Publications

Best Practice renal foot care guidance (November 2015) http://www.londonscn.nhs.uk/publications/

• Call to Action To ensure these care processes can be implemented by London renal

and dialysis services, the foot care work stream of the London Diabetes Strategic Clinical recommends the following actions be implemented as soon as possible: • Training for staff • Strengthen Individual empowerment • Joint podiatry and renal visits

10

NHS London Diabetes SCN Foot care steering group Publications

Production of literature for patients

who dialyse

Production of a card with simple

foot checks and when to refer

for healthcare professionals

11

NHS London Diabetes SCN Foot care steering group

Outcomes

• Data from the London Resources Audit

• Updates on completion of London Sector priorities

• National Diabetic Foot Audit results

• Amputation rates (Atlas of Variation + National Diabetes Audit)

• Root Cause Analysis

12

NHS London Diabetes SCN Foot care steering group

Current Issues

• Commissioners will not engage with the SCN

• Lack of mandatory tools

• NDFA is not mandatory

• Root Cause Analysis tool is not mandatory (this was raised at a

Parliamentary Policy Think Tank in 2012)

• Local audit is not mandatory

• Local and National commissioning guidance is not mandatory

• Clinicians find difficulty attending meetings as Trusts are refusing time

away from clinic (the role is voluntary and many clinicians take annual

leave to attend)

13

NHS London Diabetes SCN Foot care steering group

To facilitate the SCN in providing robust and meaningful outcomes

we need

• Commissioners to engage with the SCN

• Incentives/Disincentives to ensure CCGs provide the right services,

staffing and improved outcomes.

• Mandatory collection of data

• Clinicians must given time to participate in the networks

14

Who is listening to what the SCN do?

Neil Carmichael MP Chair for the APPG for Vascular Disease and Secretary of the APPG on Health

15

Who is listening to what the SCN do?

16

Who else is listening to what the SCN do??