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National Diabetes Footcare Audit (NDFA)

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.


The National Diabetes Footcare Audit (NDFA) is a continuous collection so please keep collecting and entering your data into the online data collection tool.

The second annual report was published on 8 March 2017. It includes all foot ulcers where the first assessment was prior to 8 April 2016.

The third annual report will be published spring 2018. Submission is now for the fourth annual report 2017-18.

A new 'Hospital Treatment' report will be published on 12 October 2017. It will include data about hospital treatment for patients in the NDFA.

If your Footcare Service has not yet registered to take part in the NDFA but would like to do so, or you would like to add new submitters for the data collection tool you can find more information further down this page in the 'How to participate' section.

If you would like any further information about this, please contact the NDFA team at

What does it measure?

National Diabetes Footcare Audit (NDFA) looks at the following key areas:

  1. Structures: are the nationally recommended care structures in place for the management of diabetic foot disease?
  2. Processes: does the treatment of active diabetic foot disease comply with nationally recommended guidance?
  3. 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, the legal basis for the collection of data will remain as Section 251and 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).

How to participate

1. Step 1: Identify an audit lead for your Organisation or Treating Service.

2. Step 2: Start data collection using the pdf icon NDFA Data Collection Form [269kb] in 'User Documents on the right hand side of this page.

3. Step 3: Register all staff who will submit NDFA data by completing the word icon NDFA Hospital User Registration Form [70kb] in 'User Documents' on the right hand side of this page.

4. Step 4: Submit data using the secure online submission tool - this can only be done by staff once they are confirmed as registered.

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. The data items to collect can be found in the 'NDFA Hospital User Registration Form' in 'User Documents' on the right of this page. 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 10th April 2015

· The 2nd Annual report includes all foot ulcers where the first assessment took place prior to 8th April 2016

· The 3rd Annual report will include all foot ulcers where the first assessment took place prior to 31 March 2017

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. Contact details can be found at the bottom of this page.


Local and national level results are available on the right of this page under 'Access the audit report' 

If you are interested in finding out more about the audit please email the audit team at

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 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.

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.

Contact Us


Telephone: 0300 303 5678


Clinical Audit and Registry Management Service

NHS Digital

1 Trevelyan Square

Boar Lane

Leeds LS1 6AE

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