Diabetic foot lesions remain a considerable cause of ill-health and a leading cause of hospitalization in people with diabetes. Unfortunately, despite intensive self-care and NHS treatment, many people with diabetes will eventually reach the stage when they need an amputation. Undergoing an amputation has a major social and psychological impact on patients, as well as considerable financial costs for health systems. In a recent study published in the journal Diabetes Care, Eszter Vamos and colleagues examined time trends in rates of amputation in people with diabetes aged over 16 years between 2004 and 2008 using national hospital activity from data from all NHS hospitals in England. They found an increase in the number of people with diabetes undergoing amputations. This was largely due to the increased prevalence (i.e. increased number of patients) with diabetes. The findings illustrate the need to continue to improve the quality of care of people with diabetes to reduce the risk of important adverse complications such as amputation, in addition to public health programmes to prevent or delay the onset of 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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