# Intermittent claudication services in England: insights from a freedom of information request

## TL;DR

This study examines the availability of services for intermittent claudication in England, revealing significant gaps in care aligned with national guidelines.

## Contribution

The study provides new insights into the inconsistent provision of intermittent claudication services across NHS Trusts in England.

## Key findings

- Fewer than half of NHS Trusts offer dedicated claudication clinics.
- Only 29.3% of Trusts provide structured supervised exercise therapy programs.
- Lifestyle and psychological support for PAD patients is limited across most Trusts.

## Abstract

Peripheral arterial disease (PAD), presenting as intermittent claudication (IC), affects 20% of adults over 60 years of age in the UK. Claudication reduces patients’ mobility, quality of life, and increases their risk of cardiovascular mortality. National guidelines recommend a holistic, multidisciplinary approach including supervised exercise therapy (SET), pharmacotherapy, and lifestyle modifications. However, clinicians raise concerns about inconsistent service provision across NHS England. Freedom of information requests (FOIR) have become an important tool for researchers to access government information and examine practices. This study aimed to explore the availability and structure of services for the management of patients with IC in England.

A FOIR was distributed to NHS Trusts in England in January 2025. The request included questions about IC clinics, SET availability, staffing, access to lifestyle and psychological support, and the referral process to IC services. The questionnaire was piloted with vascular specialists and was refined before dissemination. The data were analysed using descriptive statistics in SPSS (v29).

Of the 138 Trusts contacted, 124 (89.9%) responded, with 82 (66.2%) providing vascular services. Fewer than half (46.3%) offered dedicated claudication clinics, and only 29.3% provided structured SET programmes. Yet of these SET programmes, only 12.5% of were delivered in line with national guidelines. Most clinics were nurse-led, whereas most SET programmes were physiotherapy-led. Lifestyle support was limited: only 22% provided smoking cessation services internally, 25.6% offered dietetic support within the Trust, and just one Trust reported access to psychological services for PAD patients. Most Trusts (94%) used an electronic referral form, whereas only 34% had a specific vascular proforma.

This FOIR highlights substantial regional variation and gaps in claudication service provision across England. Many Trusts do not consistently deliver care aligned with national clinical guidelines, particularly in offering SET and integrated lifestyle care. Future research should focus on bridging the gap between policy and practice, expanding access to evidence-based interventions, and ensuring equitable, holistic care pathways for patients with IC.

The online version contains supplementary material available at 10.1186/s12913-026-14215-9.