Portsmouth area sees number of diabetic-related amputations decrease

The number of diabetes-related amputations has fallen dramatically in the Portsmouth area
The number of diabetes-related amputations has fallen dramatically in the Portsmouth area

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INITIATIVES to improve how many people with diabetes need amputations have seen the Portsmouth area buck the national trend.

The three clinical commissioning groups (CCGs) in the area have seen significant reductions in diabetic patients needing to have a major amputation.

We are doing the same work across the Portsmouth, Fareham and Gosport, and South Eastern Hampshire areas and have seen an eight per cent reduction in amputation rates in Fareham and Gosport alone this year.

Dr Paul Howden

A major amputation is above the ankle, while a minor amputation is below the ankle.

While nationally the figure has gone up for all amputations, in Portsmouth, Fareham and Gosport numbers have decreased significantly, data from Public Health England showed.

The CCGs have been working with the NHS and Diabetes UK to roll out a number of schemes. They include:

n Increasing the number of foot clinics at Queen Alexandra Hospital from three to five a week.

n Taking a multidisciplinary team approach before surgery, which involves a vascular surgeon, podiatrist and diabetes consultant working together to see if anything can be done to avert the need for amputation.

n A review of podiatry as a current community service so that it focuses on the highest risk patients with diabetes and reducing waiting times.

n Creating a new service where a podiatrist in hospital offers specialist care

n Patient education in practices.

n Encouraging patients to take responsibility for their condition and self-management.

Dr Paul Howden, the deputy chair and clinical lead for diabetes for NHS Fareham and Gosport CCG, said: ‘We obviously very much welcome the decrease in the number of amputations, as shown in the figures. But we are not getting carried away. This is a long-term strategy.

‘We are doing the same work across the Portsmouth, Fareham and Gosport and South Eastern Hampshire areas and have seen an eight per cent reduction in amputation rates in Fareham and Gosport alone this year.

‘Much of the current work focuses on early detection and empowering patients to seek advice as soon as possible so the treatment can start as soon as a problem is identified.’

The figures, which are split into CCGs, show that Portsmouth had a decrease of 17 per cent for major amputations between 2012 to 2015 compared to 2009 to 2012. Thirty-four major amputations were carried out along with 82 minor amputations.

Councillor Luke Stubbs, cabinet member for public health at Portsmouth City Council, welcomed the figures.

He said: ‘Diabetes is a disease that people often underestimate the impact of.

‘We have to welcome the news that the situation has improved in Portsmouth and that we are bucking the national trend. But we cannot get complacent.’

In Fareham and Gosport, there were 43 major amputations carried out between 2012 to 2015, which is an eight per cent decrease compared to 2009 to 2012. In the same period up to 2015, there were 90 minor amputations.

For South Eastern Hampshire CCG, there were 43 major amputations between 2012 and 2015 – a six per cent decrease compared to 2009 to 2012.

However, minor amputations increased by 41 per cent to 105 between 2012 and 2015.

Nationally, the number of diabetes-related amputations is at 7,370 a year compared to the previous figure of 7,042.

Despite the significant decrease, all three CCGs sit above the national average for amputations per 1,000 people with diabetes.

Portsmouth South MP Flick Drummond, who sits on the All-Party Parliamentary Group for Diabetes, said: ‘The recent downward trend in major amputations is to be welcomed.

‘Portsmouth’s figures match what we already know about the city’s health profile, where we have a higher than average rate of obesity and that is major driver of diabetes.

‘England’s amputation figures show that up to 80 per cent of amputations could be avoided through good management of the condition and being aware of the warning signs.

‘So more progress is needed to tackle this problem.’

But for Raymond Hale, chairman of the Fareham and Gosport Diabetes UK Voluntary Group, not enough is being done.

He said: ‘Obviously seeing a decrease is a good thing, but we are still so much higher than everywhere else.

‘In some places, we are twice as high as them. It is appalling. We do recognise there have been some improvements.

‘Doctors have had better training in how to recognise the urgency of foot ulceration and the need for immediate advice from the hospital.’

Mr Hale said educating people about their diabetes is the only way to get the number of amputations down further.

‘If people have adequate control of their sugar levels, they have a lower risk of getting a foot ulcer,’ he said.

On the decrease of major amputations, he added: ‘It is a small step in the right direction. The most important thing is that people don’t get ulcers on their feet.’

Fareham MP Suella Fernandes agreed. She said: ‘Diabetes can be a devastating and life-changing condition, particularly when it leads to amputations. Despite a drop, recent figures in Fareham and Gosport are very worrying.

‘Fareham has one of the highest rates of amputations in the country.

‘I am working to support local health groups, and I have raised with government ministers the need for better preventative care and greater public health awareness.’