PUTTINGFEETFIRST

September 2013

Overarching campaign objectives

• To raise awareness of the importance of people knowing their risk status to empower them to take action to reduce risk of foot problems and amputations

• To improve access of people with diabetes to quality foot checks and appropriate referral by competent practitioners in primary and secondary care

• To increase the proportion of localities delivering the integrated footcare pathway, including provision of Foot Protection Teams and Multidisciplinary Specialist Footcare Teams to provide a structured programme of care

Integrated footcare pathway

Risk stratification tool

The first year: what we achieved• Getting the footcare pathway used

throughout the UK − over 3,000 ordered• Campaign Narrative downloaded 1,197 times

and 1,716 ordered • Nearly 9,000 Top ten tips were ordered• 22 PCTs/CCGs committed to reviewing their

footcare services

Parliamentary success in 2012 – 13 • Think tank and parliamentary reception Oct 12• Lords debate – Nov 2012 – campaign mentioned

four times including by Earl Howe who said the Government supported it

• Commons debate Jan 2013 – campaign mentioned three times

• Times 26th January 2013 – Jeremy Hunt says “we want to reduce levels of amputations by 50 per cent over the next five years”

2013:TARGETING HIGH RISK GROUPS AND POOR OUTCOMES

2013 objectives and focus

• To raise awareness amongst those at high risk of foot ulcers and amputations about what to look out for and how and where to seek help

• To raise awareness of those caring for people with high risk feet (including in community, hospitals and care homes) about what to look out for and how/where to seek help/refer

• To increase the number of people with diabetes accessing specialist multi-disciplinary footcare team within 24 hours of presenting with an acute foot problem

• To increase the number of people with diabetes who have their feet checked when in hospital

The audiences we are targeting:

• People with high risk feet and those who care for them in various settings

• Commissioners and providers (CCGs and NHS hospital trusts) with high numbers of amputations

• Healthcare professionals (working in primary and community services as well as hospitals)

• Government, parliamentarians and NHS key decision makers (in all nations)

Multidisciplinary footcare teams• There is evidence that rapid access to MDfTs

can lead to faster healing, fewer amputations and improved survival

• But, 30% of hospitals don’t have such teams in place (an improvement on previous years)

• Nearly half of diabetes specific admissions are for foot disease (44%) but over half of these (53%) are not seen by a multi-disciplinary team within 24 hours

Targeting CCGs Report of Policy Think Tank – Fast track for a foot attack published February 2013www.diabetes.org.uk

Recommendations for CCGs including:• Root cause analysis for every amputation• Supporting footcare networks• Using footcare profiles to target

improved care

Targeting CCGs with high amputation rates• Engagement with CCGs highlighting high

amputation rates and poor aspects of care in local hospitals

• Media focus to highlight CCGs with high amputation rates and any action being taken − focus on 24 hour access to MDT and foot checks in hospital

• Following up on commitments made by CCGs with high amputation rates

What we have achieved so far in 2013• Over half of the 50 CCGs with high amputation

rates have committed to action to reduce these• NHS Trusts in high amputation rate areas have

told us about changes made since last year’s audit which should show improvements in this year’s performance

• The media coverage has again focused attention on the issue in areas of high amputation rates

Next Steps: 2013 • Launch of red card for people at high risk of foot

ulcers and amputations and those with active foot disease (expected Winter2013)

• Working with Vascular APPG on inquiry into diabetes related amputations and PAD

• Following up on commitments made by CCGs in high amputation rate areas (through Diabetes Voices and Diabetes UK regional teams and media)

Next Steps: 2014• Exploring and highlighting impact of vascular

surgery reorganisation on MDTs and amputations

• Focus on community support for medium and high risk – Foot protection teams, podiatry and peer support

• Focus on quality foot check in primary care

Working with healthcare professionals

• The Putting Feet First Campaign is supported by healthcare professionals and is advised by a group including the Society of Chiropodists and Podiatrists, RCN and ABCD

• Diabetes UK are continuing to work closely with partner organisations to make a real impact on the devastating effects of amputation.

http://www.rcn.org.uk/