MPs condemn varying rates of amputations

Thousands of patients are undergoing unnecessary leg amputations due to variations in practice around the country, MPs and peers have warned.
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A new report from the All Party Parliamentary Group on Vascular Disease shows variation across the country in amputation rates and implementation of the best clinical practice.

It suggests that amputations for issues including diabetes and peripheral arterial disease are dependent on where you live, which is dependent on the service provision policies of local health authorities.

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The report showed that patients in Yorkshire and the Humber have a 44 per cent greater risk of amputation compared to patients in London.

Clinical commissioning groups (CCGs) in Hull, Scarborough and Ryedale and the Vale of York had some of the highest number of major amputations for patients with diabetes, whilst the Bradford area was one of the lowest.

Neil Carmichael MP, chair of the group, said: “Too many patients aren’t getting the treatment they need to avoid losing their legs.

“The All Party Parliamentary Group on Vascular Disease, working with the country’s top experts in this field, recommends that the Department of Health make reducing lower limb-loss a major priority.

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“The unacceptably high level of lower limb amputations among people with diabetes in certain areas is a real cause for alarm.

“There clearly is a serious problem if some regions of England have much higher amputation rates than others.”

The new study was based on Freedom of Information requests to NHS trusts and NHS CCGs.

It found that from 2012 to 2013, there were almost 12,000 lower limb amputations in England – a figure the report said remains “stubbornly high”.

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It also argued there is a lack of planning of how to treat patients at risk of lower limb disease, with CCGs in areas without a dedicated patient pathway having 11 per cent more amputations on average than those with one.

Almost a third of NHS trusts handling vascular and diabetes patients also did not have multi-disciplinary teams to manage care for diabetes, despite evidence they lead to better outcomes. Some 28 per cent also lacked the teams for peripheral arterial disease.

Professor Jonathan Valabhji, national clinical director for diabetes at NHS England, said: “The report highlights an extremely important issue, lower limb amputation, which is one of the most feared complications of diabetes and peripheral vascular disease.

“The report highlights the geographical variation, which was highlighted previously in research in 2012. Since that time, efforts have been focussed on reproducing good practice and high quality care across the country for the management of diabetic foot disease, which has seen the proportion of Trusts with multidisciplinary diabetic footcare teams increase from around 60 per cent in 2011 to 72 per cent in 2013. However, there is still much more to do, and from July this year we will see the launch of the National Diabetes Footcare Audit.

“The audit aims to establish the extent to which national guidelines on the management of diabetic foot disease are being met.”