Mapping Diabetes against the needs for London Leena Sevak: National Improvement Lead, NHS Improving Quality – Delivery Team

Challenge: National reduction in amputations by 50% in 5 years Overall objective: To see diabetic foot care pathway included in the Joint Strategic Needs Assessment on the Health and Wellbeing Board

Nationally agreed outcomes 2012 Implementation of integrated foot care pathway MDT/FPT group established in each district, including commissioners and service users Ensure competencies in HCPs including ulcer awareness, patients education on diagnosis, patients know risk status Engage commissioners in the network 24/7 facility for receiving foot care patients by a competent member of MDT team and seen within 24 hours by the foot care specialist team. Map foot care services in primary, community and acute sectors to identify gaps Participate in foot care audits Root cause analysis for minor & major amputations

Preventing people from dying prematurely Domain Indicators   Domain 1 Preventing people from dying prematurely 1a Potential Years of Life Lost (PYLL) from causes considered amenable to healthcare Reduce diabetes related amputation rates by 50%. Prevention and early detection of foot ulcers in primary care & support of people with diabetes to self- care. Increase GP & CCG participation in NDA and National Foot Audits. Reduce emergency admissions for diabetic foot problems. Footcare Educational and Training Programme in Care Homes Better footcare and risk factor awareness ii.Potential years of life lost (children and young people) 1b Life expectancy at 75 i males ii Females

Treating and caring for people in a safe environment Domain 5   Treating and caring for people in a safe environment from avoidable harm protecting them and 5a. Patient safety incidents reported Reduce diabetes related amputation rates by 50%. Prevention and early detection of foot ulcers in primary care & support of people with diabetes to self- care. Increase GP & CCG participation in NDA and National Foot Audits. Increase foot examination in people with diabetes admitted in hospitals to more than 70% of patients admitted with diabetes (currently 26%) & implement inpatient foot care pathway. Reduce emergency admissions for diabetic foot problems. 5b Safety incidents involving serious harm or death Footcare Educational and Training Programme in Care Homes 5c. Hospital deaths attributable to problems in care 5.3 Incidence of newly acquired category 2,3,4 pressure ulcers Implementing effective foot risk surveillance Footcare e-learning module

Opportunities Alignment between Public Health, NHS & Adult Social Care Outcome Frameworks Prevention & early detection NHS England priority Integration of health & social care Public health integrated in LA with reach in local communities – opportunity for self-care Health & Wellbeing Boards driving health improvement – influence CCGs & primary care

Recent Developments & foot care Strategic Clinical Networks – setting local priorities CVD Outcome Strategy – driver for integration of heart, diabetes, stroke and renal Academic Health Science Networks NHS England & NHS IQ - Integrated care pioneer sites

Resources www.diabetes.nhs.uk - http://webarchive.nationalarchives.gov.uk/20130513172055/http://www.diabetes.nhs.uk www.kidneycare.nhs.uk -  http://webarchive.nationalarchives.gov.uk/20130504185629/http://kidneycare.nhs.uk