Diabetes and lower limb complications: A thematic review of clinical negligence claims

Diabetes and lower limb complications: A thematic review of clinical negligence claims.

Since 2013/14, there has been a growth in the volume and value of clinical negligence claims involving patients with diabetes-related lower limb complications. The majority of claims have involved patients with a diabetic foot ulcer who went on to undergo a major lower limb amputation.

Major amputation is a life changing event for a person with diabetes, but the tragedy is all the greater if it could have been prevented. In such circumstances, at the very least, all possible lessons should be learnt from the circumstances surrounding such amputations and patient safety improved.

The report makes recommendations to improve patient care and proposes certain standards which should be put into practice and regularly audited. By this means, it is hoped that the preventable loss of limbs due to diabetes be reduced and the trend to the increasing number of major amputations in England be reversed.

Standardised care and better education could prevent diabetic patients from undergoing amputations, preserve wellbeing and save the NHS money, an NHS Resolution report has found.

The report identifies themes in compensation claims involving patients with progressive diabetes-related lower-limb complications that in the worst cases can lead to amputation. Up to 85% of amputations are avoidable. Both amputations and other patient harm can be reduced with appropriate, timely care.

Since 2013/14 there has been a steady growth in the volume and value of clinical negligence claims in diabetic patients with lower limb complications in England. Globally, both the number of cases and the prevalence of diabetes have been steadily increasing over the past few decades.

It is important to recognise that in the majority of cases a good standard of care is provided to patients with diabetes by the NHS in England.

This is a detailed report including 92 claims and of these, 55 patients underwent a major lower limb amputation. Only claims that had been settled since 2018/19 and with an incident date after 2012/13 were included in the report.

The report identifies several key time points during the patient journey where intervention could improve care quality. This includes ensuring standardised, evidence-based assessment techniques are used to diagnose the patient promptly.

Once a patient has been diagnosed, the report highlights the importance of rapid access to a multi-disciplinary foot team (MDfT). This team would provide oversight and management of the entire patient care pathway to ensure consistency, appropriate timely decision-making and follow up. Follow up includes education to empower patients to self-manage and commence safe foot and lower limb care habits.

One of the issues highlighted in the report is that patients often do not know that their condition is getting worse because they don’t feel pain, due to a condition called neuropathy, resulting from nerve damage. This means patients often delay seeking help.

The report also found that diabetic foot disease is a condition that is not always well recognised or taken seriously. It highlights the need for a national focus on this issue, to ensure that the both clinicians and patients are better equipped with the right information to take preventative action early.

As well as impacting the patient’s physical and mental wellbeing, delays in diagnosis and treatment have financial costs. Managing the diabetic foot, coupled with the cost of associated lower limb amputations, costs the NHS up to £1 billion annually.

Co-developed with experts across the healthcare system, the report includes seven recommendations to improve the care of diabetic patients with lower limb complications. Work with stakeholders will continue over the coming months to help implement the suggested recommendations.