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Commissioning variation leads to 'thousands' of amputations

Commissioning variation leads to 'thousands' of amputations

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Thousands of patients may be facing unnecessary leg amputations due to regional variations in care, the government has found. 

Using freedom of information (FOI) requests to trusts and clinical commissioning groups (CCGs), the All Party Parliamentary Group on Vascular Disease found that "too many patients aren't getting the treatment they need to avoid losing their legs".

Patients in the South West of England are twice as likely to have their legs amputated compared to patients in London. The CCG with the highest number of amputations and major amputations was Somerset CCG. 

And the CCG with the lowest number of amputations was Brent CCG. 

The FOI revealed that CCGs without a patient pathway for peripheral arterial disease had 11% more amputations on average than those with a pathway. 

A further driver of high amputation rates is the act of multi-disciplinary teams (MDTs). Close to a third (30%) of trusts lacked MDTs for vascular and diabetes patients, and 28% of trusts lacked MDTs for peripheral arterial disease. 

The group has called on commissioners to have a sub-24 hour policy to refer patients with suspected CLI to a Multi-Disciplinary Team. 

Also, all commissioners and providers should have a clear pathway for patients suspected of Peripheral Arterial Disease and the diabetic foot, the group recommends. This pathway must be made standard practise and properly understood by all healthcare workers from primary care up to specialist care.

Neil Carmichael MP, chair of the Group, said: “The unacceptably high level of lower limb amputations among people with diabetes in certain areas is a real cause for alarm. There clearly is a serious problem if some regions of England have much higher amputation rates than others. 

“Too many patients aren’t getting the treatment they need to avoid losing their legs. The figures for parts of the South-West of England are particularly alarming, and this needs to be tackled. The All Party Parliamentary Group on Vascular Disease, working with the country’s top experts in this field, recommends that the Department of Health make reducing lower limb-loss a major priority. This is especially important given the country’s ageing population.”

The full report is available to view online

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