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 2013

www.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/