The NHS’s defence organisation, NHS Resolution, are reviewing past medical negligence claims against the NHS by patients with diabetes who suffered lower limb complications. Most of these cases relate to patients with non-healing foot ulcers, who then needed major lower limb amputations. The aim of the review is to identify and report on the themes which are common in these cases to help the NHS learn from its mistakes. NHS Resolution hope that by raising awareness of the risks and need for consistent, correct treatment of diabetes-related lower limb problems, both the number of amputations and the cost to the NHS can be reduced. The key message of the review will be that lower limb amputations are often preventable, but this requires NHS organisations to work together to improve care for these patients. The review will be published within the next few months.

What is diabetes?

When someone has diabetes it means that their blood sugar level is too high. Type 1 diabetes is caused by the body’s immune system attacking and destroying the cells that produce the blood sugar controlling hormone, insulin. Type 2 diabetes, which affects 80% of diabetes sufferers, occurs when the body becomes resistant to insulin or is unable to produce enough insulin to control the blood sugar level. There are other types of diabetes, but these are less common.

Diabetes is a serious condition which can be related to other health conditions, such as thyroid or coeliac disease, but it also has serious complications of its own. These include hypoglycaemia (low blood sugar), cardiovascular/heart disease, kidney damage, sight loss, and nerve damage also known as neuropathy. People with diabetes can reduce (but not always avoid) many of the risks of suffering these complications by living a healthy lifestyle. They also need good foot care to avoid serious complications from injuries to their feet.

How common is diabetes?

The number of people with a diagnosis of diabetes has more than doubled in the last 20 years and is still increasing. More than 4.9 million people in the UK are diagnosed with diabetes and another 850,000 people are estimated to have type 2 diabetes who have not yet been diagnosed.

10% of the NHS’s total budget is spent on diabetes and its complications. The GIRFT report on diabetes put the cost to the NHS of caring for inpatients with diabetes at £2.5 billion each year.

Up to £1 billion of that cost, making up almost 1% of the total NHS budget for England each year, is spent on the care of diabetes-related ulcers and amputations. That is because diabetes currently leads to more than 9,500 leg, toe or foot amputations every year.

Why are people with diabetes at higher risk of foot problems and lower limb amputations?

People with diabetes often have reduced sensation in their feet. This is because when blood sugar stays high, over time, it causes damage to the blood vessels and affects the circulation of blood to the legs and feet. The poor blood circulation affects their nerves, which reduces their ability to feel their feet. This means that they are less aware of minor injuries to their feet, such as knocks, scratches, cuts and blisters. If their vision is affected by diabetic retinopathy they may also find it difficult to visually check their feet.

People who feel pain from a minor foot injury are prompted to take action to protect the damaged skin and let it heal. However, someone with reduced feeling in their feet from diabetes may remain unaware of the cut or blister until it has developed an ulcer or become infected. This increases their risk of developing more serious complications, such as Charcot foot (a bone deformity), ulcers, infection, gangrene and lower limb amputation.

10% of people with diabetes will have a foot ulcer at some time in their lives. Having a foot ulcer increases the person’s risk of amputation and early death. 80% of the lower limb amputations which take place in the UK began as ulcers. Most of these could be avoided with better care.

Compensation claims for people with diabetes who need amputations after negligent foot care

Unhealed foot ulcers and infections are the main cause of diabetes-related amputations, but people with diabetes can avoid foot ulcers with proper foot care. They can also be healed if spotted early and treated properly.

Medical negligence claims for people who have diabetes and have suffered amputation usually follow negligent delays in diagnosis and treatment of foot injuries or conditions such as ulcers, infections, ischaemia, or Charcot foot. GPs and other health practitioners are expected to recognise that people with diabetes are at increased risk from problems with their feet. Claims often arise from failure to refer a patient with diabetes, who is at increased risk of their foot injury leading to serious disability from amputation, to a multi-disciplinary footcare clinic for specialist treatment.

Boyes Turner’s clinical negligence team have helped many clients with diabetes recover compensation to restore their mobility and independence, and rebuild their lives, after negligent care of their feet has led to amputation.

You can read more about some of our recent settlements here: