Patient faces losing toe after NHS trust failings

A patient is at risk of losing a toe to gangrene following a toenail removal procedure performed by the Central London Community Healthcare NHS Trust. The incident, which occurred after the patient presented with severe pain and a blackened toenail with an ulcer on January 16 last year, has led to a Patient Safety Incident Investigation identifying significant care failings.

Failures in Assessment and Care

The investigation found that no assessment was conducted to determine if there was sufficient blood flow to the toe before the surgery. The procedure also proceeded without a preoperative assessment or obtaining written consent from the patient, who is known to have diabetes. The trust failed to recognise and act upon deteriorating blood flow to the toe, contributing to chronic limb-threatening ischaemia and gangrene.

The patient, who had been attending the trust's podiatry service since 2015, experienced worsening pain and circulation issues after the initial procedure. She and her daughter reportedly visited the service multiple times, complaining of 'excruciating' pain. In mid-March 2025, she was admitted to St Mary’s Hospital in Paddington for vascular intervention. She is currently awaiting either the toe to self-amputate or require surgical removal.

Further issues identified in the investigation included a failure to review the patient's diabetic foot classification, a lack of escalation to specialist vascular services, and incomplete clinical paperwork. These omissions delayed the identification of the severity of the peripheral arterial disease, the report stated.

Trust Response and Changes

A spokesperson for Central London Community Healthcare NHS Trust stated that mandatory pre-surgery assessments have been introduced. The trust has also strengthened procedures for escalating patient concerns promptly and enhanced training and competency checks for all podiatrists. Discussions have taken place with the patient and family, and apologies have been offered.

The patient and her daughter reported feeling 'distressed, unheard and uncertain' that their concerns were being taken seriously during the period of care.