A recent article in the journal Diabetes Research and Clinical Practice examined trends in lower extremity amputations in people with and without diabetes in England during the period 1996-2005. The study, which was reported on the BBC News Website, found that although overall numbers of amputations fell, the number occurring in people with type 2 diabetes increased. This may be because the prevalence of type 2 diabetes increased over this period and because surgeons are intervening earlier to prevent more serious damage to the feet and legs of people with type 2 diabetes.
NHS budgets are under considerable pressure. It is therefore unsurprising that many NHS Integrated Care Boards (ICBs) In England will aim to prioritise price in contract awards, But this approach is a significant threat to community-centred healthcare. While competitive tendering is a legally required, an excessive focus on costs in awarding NHS contracts risks overshadowing key factors such as established community trust, local expertise, and the long-term impact on continuity of care. This shift towards cheaper, often external, commercial providers threatens to cut the links between communities and their local health services. The argument that competitive tendering is solely about legal compliance, and not cost, is undermined by the very nature of such tendering, which by design encourages the lowest bid. This approach risks eroding the social fabric of local healthcare provision, where established relationships and understanding of specific community needs are essential. Establishe...
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