By Branwen Jeffreys
Variations in the amputation rates in diabetes patients in England have been described as shocking by a charity.
Department of Health data reveals the rate of major amputations in the South West, at three in 1,000, is almost twice the rate in the South East.
The Diabetes UK charity says the majority could be prevented.
The government says it is publishing the information, which also covers other conditions and has been dubbed an “atlas of care”, to help improve care.
The amputation difference is one of the most striking revealed in a series of 34 “maps” of healthcare produced.
It also looks at key treatments for some of the most serious conditions including stroke, heart disease and asthma.
The treatment of high risk mini-strokes (transient ischaemic attacks or TIAs) varies significantly, with some areas treating 100% of cases within 24 hours, while others treated virtually none.
Joe Korner of the Stroke Association said: “Up to 10,000 strokes could be prevented every year if we improved TIA services. It is disappointing that people in many areas of the country are not being treated for TIA quickly enough, putting them at risk of having a major stroke.”
Treatment of last resort
There are more than 70 major amputations a week carried out on type 2 diabetes patients in England. It is thought 80% of amputations are potentially preventable.
Diabetes can lead to a loss of sensation in the feet so minor injuries can become badly infected without the patient noticing.
If the infection becomes too severe, amputation of a foot or the leg below the knee becomes the treatment of last resort.
Barbara Young, the chief executive of Diabetes UK, said: “The existing situation around foot care and amputations is shocking, given the that the majority of amputations can be prevented.”
The atlas also reveals a big variation in the percentage of people with diabetes who are receiving all the essential checks to monitor their condition.
This includes the simple foot checks which can help prevent amputation.
While some geographical differences would be expected, researchers say unwarranted variation is a cause for concern. They adjusted their data to take account of different populations in different areas.
Sir Muir Gray, the public health academic who led the research within the Department of Health, said: “Most people in the health service are so focused on what they’re doing, working so hard, they’ve got no idea if they are doing better or worse than someone else.
“The atlas is now going, for the first time, to give them a clear idea of where they are.”
This is particularly true in areas of care where the evidence is clear. Patients with a suspected mini-stroke are at higher risk of a major stroke. The national guidelines recommend they should have specialist tests within 24 hours.
The atlas shows a greater than 10-fold difference in the percentage of patients who are getting that gold standard treatment.
A handful of areas are managing for all the patients at risk but in many parts of England that falls to fewer than half.
Some experts believe reducing the variations to give priority to treatments backed by evidence could help find the savings it needs.
Professor Chris Ham, chief executive of the King’s Fund, said: “If performance across the NHS can be brought up to the level achieved by the best, then much of the pressure on local NHS budgets can be relieved without having to cut services for patients.”
The data in the atlas predates the coalition government but ministers have supported its publication.
Health minister Lord Howe said: “Making this information available will help to identify and address unwarranted variation to better meet the needs of their local populations.”