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Peripheral Arterial Disease

I have been a great advocate of stopping people smoking, including people in my family, and I will refer a little later to smoking as a causative factor of narrowing arteries. Diabetes is a major cause of peripheral arterial disease. Diabetics have an increased risk of developing the disease and account for up to 70 per cent. of non-traumatic amputations. The relative risk of amputation is 40 times greater for diabetics. Anther pretty stark statistic for right hon. and hon. Members to digest is that a diabetic who smokes runs an approximately 30 per cent. risk of amputation within five years—the point made by the hon. Gentleman. We all know how the prevalence of diabetes is increasing to worrying proportions as a result of lifestyle and obesity. There are an estimated 3 million people with diabetes in the UK, and large increases in amputation rates are a possible unfortunate consequence of the growing number of diabetics. However, the good news is that, according to the International Diabetes Federation, 85 per cent. of amputations in patients with diabetes can be avoided, and that is the main point of today's debate. The impact of amputation on patients is stark and evident. Amputations also cost the country and the NHS large amounts of money. The amputation rate is between 5 and 6 people per 100,000, but the figures range broadly between strategic health authorities. I have just received the latest statistics on the numbers of amputations in England, which are broken down into the different kinds of amputations. The numbers are still rising. Each surgical procedure costs between £10,000 and £15,000, which means an annual bill to the NHS of between £50 million and £75 million. However, that does not take into account the substantial costs of rehabilitation, the provision of prostheses and social care, and the social and economic impact on society. The wider cost of patients in employment with moderate-to-severe peripheral arterial disease can be measured in terms of working days lost through illness and disability. We should also consider the loss of taxation revenue to the Exchequer and the cost of benefit payments to ill and disabled people, which are likely to amount to hundreds of millions of pounds on the taxation bill. Some 85 per cent. of amputations are preceded by a foot ulcer. The estimated cost of foot complications alone to the NHS is £256 million per annum. The past 20 years have seen major developments in the healing of foot and/or leg tissue loss, which have been driven by innovations in assessment and treatment, the development of modern wound-care dressing materials and the development of surgical and other, less invasive interventional treatments by vascular specialists. Despite that, the numbers of lower-limb amputations are still high. At this point, I pay tribute to the work of the Circulation Foundation, the Vascular Society and the British Society of Interventional Radiology, whose members have done, and are still engaged in, excellent work highlighting the need to save people's legs. Indeed, I recently hosted a parliamentary reception to highlight the subject. Groups such as the Lindsay Leg Club Foundation also do excellent work helping patients with leg and foot tissue loss through direct support and care. Clinicians are only too well aware of the challenge of rising amputation rates. Put simply, patients are being seen by vascular specialists far too late, when amputation is the only option available. When a patient first goes to their general practitioner with mild symptoms of intermittent claudication, they are correctly advised to change their lifestyle and particularly to cease smoking and undertake some exercise. Medication with aspirin or statins can reduce clot formation and cholesterol levels and can help to limit disease progression. Other cardiovascular risks to which the patient is likely to be subject can be addressed at the same time. Unfortunately, treatment by a vascular specialist is often seen as a last resort. However, revascularisation through an open surgical procedure or angioplasty, with or without a stent, can bypass or unblock arteries, improving blood flow in the lower extremities. Revascularisation can significantly add to the benefits of lifestyle change. Britain has one of the lowest revascularisation rates for legs in Europe and some of the highest amputation rates, which tells us a lot. If patients were referred to vascular specialists a lot earlier, they could get the appropriate treatment, and we could save a hell of a lot of legs. We must increase awareness of peripheral arterial disease among health professionals and particularly among GPs. That is what I am trying to do today. A clear referral pathway from primary care to secondary care would help vascular specialists to see patients sooner. Peripheral arterial disease is not, however, a condition that involves just one discipline, which is why I mentioned an holistic approach at the beginning of my speech. A diabetic patient with foot ulcers and advanced intermittent claudication should be seen by a wound care specialist, as well as by a diabetologist and a vascular specialist—either a vascular surgeon or interventional radiologist. Peripheral arterial disease requires a multidisciplinary approach. There are some great examples here in the UK where that approach is seen to be working and is already saving legs. An 11-year survey of diabetic amputation rates, conducted between 1995 and 2005 at Ipswich hospital, showed a significant decrease in lower-leg amputation rates following introduction of a multidisciplinary foot team. Over the survey period, the incidence of all amputations fell by a staggering 40 per cent., and among people with diabetes by a more staggering 70 per cent. Similar outcomes have been achieved in Middlesbrough and Southampton, and there are probably other examples of best practice in this country of which I am unaware. Although I have painted a generally bleak picture, I hope that I have shown hon. Members, and particularly my hon. Friend the Minister, that we can achieve great improvements through a co-ordinated effort and bringing services together. In the end, the improvements in care I suggest would lead to a higher quality of life for many patients and could be cost-effective overall, too. The Government have made great strides in improving survival rates and treatment for patients with coronary heart disease, and we know that the NHS, with a clear strategy, can achieve great things—there have been many examples of that in the past 10 years. Peripheral arterial disease is often seen as a poor relation to stroke and heart disease. I think it is high time that we should focus on peripheral arterial disease as well. We can save legs and save money, even in an age of austerity. I am confident that, by learning the best practice from our European partners, which do much better than we do, particularly through early referral; by incorporating best practice from the UK; and by bringing into every hospital multidisciplinary collaboration between leading clinicians, we can reduce amputation rates, despite an ageing population and more patients unfortunately being diagnosed with diabetes. That view is shared by many consultants, some of whom I have talked to personally. Such improvements in care fit perfectly with the drive in the NHS for better quality of patient care and improved productivity but, of course, it is also important to prevent the ever-increasing occurrence of diabetes. We need much more research to find out what is really causing the increasing prevalence of that difficult disease. Prevention is always better than cure, for the patient as well as the NHS. Now could be the right time for a national target to reduce Britain's rising amputation rates. A national campaign to raise awareness, among not just health professionals—especially GPs—but the general public, seems justified at this time.