We have detected that you are using Internet Explorer to visit this website. Internet Explorer is now being phased out by Microsoft. As a result, NHS Digital no longer supports any version of Internet Explorer for our web-based products, as it involves considerable extra effort and expense, which cannot be justified from public funds. Some features on this site will not work. You should use a modern browser such as Edge, Chrome, Firefox, or Safari. If you have difficulty installing or accessing a different browser, contact your IT support team.
National Diabetes Foot Care Audit
The National Diabetes Footcare Audit (NDFA) enables all diabetes footcare services to measure their performance against NICE clinical guidelines and peer units, and to monitor adverse outcomes for people with diabetes who develop diabetic foot disease.
Deadlines will be developed over the next few months.
We intend to do an annual report in 2021 (to be published in May 2022). So the deadlines will be a June 2021 deadline for the data quality report and a final deadline in July, for ulcers first seen, up to the 31 March 2021.
As we develop the plan we will provide specific deadline dates.
You can keep up to date and receive deadline reminders by subscribing to our NDFA newsletter.
When to collect data
The NDFA is a continuous collection and data can be collected throughout the year. Data can be input at any time during the year into the online collection tool.
A cut of the data is taken each year to include in the annual report, the audit team will announce the cut off date each year for foot ulcers to be included in the next annual report.
- The 1st Annual Report included all foot ulcers where the first assessment took place prior to 10 April 2015
- The 2nd Annual report includes all foot ulcers where the first assessment took place prior to 8 April 2016
- The 3rd Annual report includes all foot ulcers where the first assessment took place prior to 31 March 2017 and was published on 14th March 2018
- The 4th Annual report included all foot ulcers where the first assessment took place prior to 31 March 2018 and was published in May 2019.
- 5th Annual report we are currently gathering data for this. This will cover foot ulcers where first assessments took place up to the 31 March 2021.
How to participate
1. Step 1: Identify an audit lead for your organisation or treating service.
2. Step 2: Start data collection using the NDFA Data Collection form.
3. Step 3: Register all staff who will submit NDFA data by completing the NDFA Hospital User Registration form.
4. Step 4: Submit data using the secure online submission tool - this can only be done by staff once they are confirmed as registered.
Dataset changes 2020
1. It is no longer necessary to record 24 week follow-up data.
The CAP data entry system has been updated to remove the corresponding fields.
2. A new data item ‘First ever diabetic foot ulcer’ has been added.
This is to record whether or not the episode is the first ever diabetic foot ulcer the patient has had on either foot.
You have until 31 March 2021 to put in place systems to collect and record this data item.
To enable these changes a new data entry form has been produced – see user documents below.
For services using bulk uploading a new standard has been produced and goes into effect from 19 August. Learn more about the new guidance and standard.
In line with NHS England’s instructions, participation in National audits such as the NDFA may be suspended in order to provide support for coronavirus work.
If footcare assessments are still being carried out please try to continue recording the audit data either via the paper data collection form or any equivalent electronic system. The data can then be entered or uploaded at a later date when capacity is available.
National Diabetes Audit Integrated Specialist Survey
Find out more about the National Diabetes Audit Integrated Specialist Survey (NDA ISS).
NDFA Quality Improvement Collaborative
In 2018 and 2019 the NDFA was commissioned to produce a collaboration focussed on improving footcare. Twenty diverse teams came together to share ideas and explore areas of the footcare pathway.
This resulted in eight case studies from services in England and Wales.
What the NDFA measures
National Diabetes Footcare Audit (NDFA) looks at the following key areas:
- Structures: are the nationally recommended care structures in place for the management of diabetic foot disease?
- Processes: does the treatment of active diabetic foot disease comply with nationally recommended guidance?
- Outcomes: are the outcomes of diabetic foot disease optimised?
Who manages the audit
From May 2017 the legal basis for collecting, processing and holding data within the National Diabetes Audit Programme changed. Since then, NHS England has directed NHS Digital to collect patient identifiable data for the audits from providers in England. Due to how the contract for the NDFA and collection/submission deadlines fall, it was decided to implement the changeover in August 2017.
The new legal basis for data to be collected by the NDFA (Direction under section 254 of the Health and Social Care Act 2012) will mean the submission of data for the NDFA audit will be mandated for NHS footcare clinics and specialist MDFT services in England. Therefore, primary and secondary health services which deal with diabetic footcare in England will need to work with NHS Digital to supply data from the treatment of their patients.
The NHS England direction only covers service providers in England. For Wales, patients will still need to be consented. There will be no change for how organisations participate in the audit for Wales.
The National Diabetes Audit (NDA) is commissioned and managed under an agreement by the Healthcare Quality Improvement Partnership (HQIP) on behalf of NHS England and the Welsh Government. The NDFA is delivered by NHS Digital (previously known as 'the Health and Social Care Information Centre, HSCIC'), in partnership with Diabetes UK and the National Cardiovascular Intelligence Network (part of Public Health England).
The NDFA only requires explicit signed consent for patients being treated in Welsh healthcare services. Patients being seen in English healthcare services do not need to fill out a consent form.
Patients who do not wish to participate can either inform their clinician, who can remove the record from the data base, or inform NHS Digital by e-mail, post or telephone proof of identity will be required.
ECG Diabetic Foot Ulceration Pilot Study
Each year in England approximately 60,000 people with diabetes present with diabetic foot ulceration (DFU). The 5-year mortality rate for these patients is around 50%. Peripheral diabetic neuropathy is present in almost 100% of these patients and is associated with a high death rate from cardiac events.
Nationally there was no routine process within DFU pathways to identify cardiac issues and to initiate further clinical action. NHS Improving Quality
(an arm's length NHS body which has since become part of NHS England) set up a pilot to address this.
The pilot embeds into routine care, the provision of a 12 lead ECG for all new DFU patients attending the Diabetic Foot Clinic. The ECG is provided to the patient during their first appointment. The results of the ECG are then reviewed prompting further clinical action where necessary. This work marks a more holistic approach with Diabetic Foot Clinics focusing beyond the foot.
All patients in the ECG pilot must first consent to the NDFA. The pilot intends to cross reference NDFA data with national mortality data. This should identify whether patients within the NDFA who receive an ECG as part of routine DFU care have significantly different 1-5 year mortality rates compared to other NDFA patients.
The patient level information will be collected by clinicians and will undergo standard NHS Information Governance processes to protect the data. Additionally sites have sought local Caldicott Guardian approval as part of joining the ECG DFU Pilot. The sites will transfer the data via a secure data depot to NHS Digital.
If you have previously consented to be a part of the pilot study but now wish to opt out you may indicate you wish to do so by emailing firstname.lastname@example.org referencing the National Diabetes Footcare audit ECG Pilot or calling 0300 303 5678 and asking to speak to a member of the National Diabetes Footcare audit team.
Making clinical audit data transparent
In his transparency and open data letter to Cabinet Ministers on 7 July 2011, the Prime Minister made a commitment to make clinical audit data available from the national audits within the National Clinical Audit and Patient Outcomes Programme.
The National Diabetes Foot Care Audit (NDFA) is a continuous audit of diabetic foot disease in England and Wales. The audit enables all diabetes foot care services to measure their performance against NICE clinical guidelines and peer units, and to monitor adverse outcomes for people with diabetes who develop diabetic foot disease.
What information is being made available?
- trust, service, and clinical commissioning group (CCG) audit participation and data completeness for the key fields.
- measures about the process of care given to patients.
- information about care outcomes and treatment.
These data do not list individual patient information nor do they contain any patient identifiable data.
Using and interpreting the data
Data from the National Diabetes Foot Care Audit should not be looked at in isolation when assessing standards of care.
Accessing the data
The data are being made available on the data.gov website. Each year a data file from the National Diabetes Foot Care Audit will be made available in CSV format. Trusts, CCGs and Networks are identified by name and their national code. Foot care services are identified by name and locally derived code.
What does the data cover?
The audit looks at the following areas:
- structures: are the nationally recommended care structures in place for the management of diabetic foot disease?
- processes: does the treatment of active diabetic foot disease comply with nationally recommended guidance?
- outcomes: are the outcomes of diabetic foot disease optimised?
Use of audit tools and documentation outside of the clinical audit
You hereby agree that in downloading or using the documents or tools on this web page for any use outside of the project for which it was developed, you are entering into a royalty free, non-exclusive, licence agreement with the Healthcare Quality Improvement Partnership under the following terms and conditions:
All information, software, products and related graphics contained in the audit tool or data collection form are provided for non commercial purposes "as is" without warranty, including but not limited to the implied warranties of satisfactory quality, fitness for a particular purpose, title and non-infringement of third party intellectual property rights. In no event shall HQIP be liable for any direct, indirect, incidental, special or consequential damages for loss of profits, revenue, data or use incurred by you or any third party, whether in action in contract, tort, or otherwise, arising from your access to, or use of, the audit tool or form. HQIP make no representations about the suitability, reliability, or timeliness, and accuracy of the information, software, products and related graphics contained in the audit tool or forms. HQIP reserves the right to make improvements, changes or updates to forms or tools at any time without notice.
Telephone: 0300 303 5678
Clinical Audit and Registry Management Service
1 Trevelyan Square
Leeds LS1 6AE
Guidance for patients
Access the audit reports
Why and how we process your data in the National Diabetes Footcare Audit (NDFA) system and your rights.