Transforming a foot service with transformation funding: Cutting the amputation rates across the region of St Helens and Knowsley.

Published Date: 01st April 2024

Publication Authors: Sullivan. H, Cairns. J, Cowan. M, Sritharan. K, Shamsaldeen. M, Omer. M, Westall. S, Furlong. NJ

Conference Abstract

Introduction: In 2016, the Diabetes Foot multidisciplinary service consisted of two clinics per week. These were overbooked and overran, with major amputation rates in our area greatly above the national average. In 2017, with transformation funding the service was gradually and effectively expanded. Action: We implemented a Foot MDT with administrative support to discuss complex patients, a weekly inpatient ward round for all inpatients with diabetic foot ulcers, daily inpatient podiatry reviews and a daily outpatient Foot MDT clinic, including a twice weekly Joint Vascular and once monthly Joint Orthopaedic presence. Vascular 'hot slot' and TCC access was available, if required and closer working relationships with community orthotics was developed with in-house insole measurement and fitting, weekly telephone diabetes specialist nurse clinics and an almost virtual antibiotic ward.
Outcome(s): In 2013-2015, the major amputation rates in St Helens were 13.6 per 10,000, and in Knowlsey, it was 7.8, compared with the England national average of 8.1 per 10,000. By 2019 to 2021, these major amputation rates fell to 9.1 and 5.0, respectively, compared with the national average of 7.7. A reduction was also seen in minor amputation rates in St Helens over the same period, from 28 per 10,000 to 20.4, while the national average remained between 21 and 22 per 10,000. Positive patient feedback regarding experiences has also been reported.
Discussion(s): With changes to the service, made possible with transformation funding, an improvement in major and minor amputation rates have been achieved. There has also been a positive impact on the patient experience.

Sullivan, H.; Furlong, N.; Pendlebury, H.; Cairns, J.; Cowan, M.; Sritharan, K.; Shamsaldeen, M.; Omer, M.; Westall, S. (2024). Transforming a foot service with transformation funding: Cutting the amputation rates across the region of St Helens and Knowsley. Diabetic Medicine. 41(Supp. 1), p... [Online]. Available at: https://dx.doi.org/10.1111/dme.15296 [Accessed 19 December 2025].