The Manchester Amputation Reduction Strategy (MARS Programme) is a new way of tackling an old problem. How do we reduce lower limb amputations? It began by asking, academically, who is having an amputation and why? It then broadened the question into what are the regional, gender, ethnic and diabetic inequalities surrounding these amputations in England? We learned amputation rates are higher in Northern England, men, the black population and rather importantly half of all amputations are in people who do NOT have diabetes. Having established the inequalities across England, we also learned the same was true of Greater Manchester.
We have approximately 1000 major and minor amputations every year. Not only are the national inequalities present locally but our rates of major amputation are 36% above the national average with rates varying by over 70% across localities. The main causes are diabetes, peripheral arterial disease, venous disease and lymphoedema. These are responsible for 95% of amputations in those aged 50 and over. They potentially lead to an amputation by causing foot and leg ulcers. The annual cost of ulcer care in Greater Manchester is currently £200m and predicted to rise to £350 within five years.
MARS is based on the principle that an amputation is the culmination of a number of steps and therefore each phase, in the iceberg of disease, leading to an amputation requires an intervention. This ‘whole systems analysis’ should lead to ‘population based transformation’ through a ‘deep dive service review’. It is for this reason MARS has three facets; a public health framework, a community health service review and a hospital based plan. The three programs of work are linked through cross sectoral collaboration and innovative IT solutions.
MARS has been developed and continues to be shaped by the close collaboration of its stakeholders. We are an enthusiastic crew of academics, public health specialists, health service commissioners, health and social care professionals, politicians, industry and patient groups. This document describes the epidemiological problem we wish to tackle and the strategy we propose to use. The ultimate aim is to not only save limbs, but also, through integrated working, save lives.