Designing the Service

How could STANCE work for your patients living with diabetes?

 STANCE is an information session that provides people living with diabetes with standard knowledge and advice to support them to confidently maintain their own foot health.

We expect most people living with diabetes to be able to manage their own nails and tissue health with advice, support, footwear and insoles where indicated. However, patients will have different abilities to self-care. Highlighting the importance and increasing their confidence to self-care may take time.

Information works best when people are encouraged to use the information to maintain or improve their foot health, reducing their risk of having a foot health problem that could lead to a wound, infection, hospitalisation or amputation.

Learning about the information prior to a foot health consultation helps involve patients in making informed decisions about their own foot health.

Re-visiting the information at an annual check and providing people with open access to the foot protection team when they need it, not when we think they will need it, works better for everyone.

Providing information and running group sessions in multiple languages means members of all communities feel welcome and confident that they can increase their ability to self-care.

The Mentor Ring (TMR) delivered foot care education in various languages, including Bengali, Urdu, Hindi, Arabic and English, as patients felt comfortable when talking to a trainer who could speak their language. This was then followed by a 1-1 mentoring sessions to empower and encourage individuals to take care of their feet to defer or stop getting more complicated.


There are several settings where the STANCE programme can benefit patients:

Group Education:

People enjoy getting together to discuss their foot health, but many people also find doing video groups convenient as they do not have to travel.

In Primary Care:

Encourage your patients to access STANCE through the EPP provider in your area. This allows practice nurses to have a higher quality consultation with the patients. 

In Podiatry:

Educational information and patient activation are essential elements of treatment planning.  We have found that providing it before the first podiatry consultation manages the expectations of what your service can provide.

Service changes may be needed to see activated patients in a walk-in clinic or short notice booked clinic.  Doing this builds confidence and trust in patients and the service continues the education and ensures that foot problems are seen in a time-critical manner.

Some areas of Wales have access to Patient Activation Measures (PAM’s).  You can contact the Diabetic Foot Network, or visit the Government website for more information.

Evidence for Change

The number of people living with Diabetes in Cardiff Vale University Health Board is expected to be 28,061 by 2025. Research suggests that 30% of these people have a moderate to high risk of developing DFD, requiring access to the Foot Protection Service (FPS).

The expected cost of this is £2,872,800.00. Introducing the STANCE programme to encourage patients to manage their own foot health will reduce this cost significantly.