In an increasingly complex healthcare landscape, innovation is not a luxury – it’s a necessity. The pressure to meet growing demand, reduce health inequalities and reach net-zero has never been greater.

In January 2025, the UK government outlined three ‘shifts’ which, it asserts, will define the future of healthcare: moving care from hospitals to communities, from sickness to prevention and from analogue to digital.

Delivering on this ambition requires more than policy. It demands systemic transformation grounded in real-world implementation and evidence-backed interventions.

Through initiatives such as the Transforming Wound Care programme (TWC), the Health Innovation Network – the innovation arm of the NHS – offers a compelling blueprint for how transformations focussed on the ‘shifts’ can be achieved.

Local change, national impact

England’s Health Innovation Network comprises 15 regionally embedded health innovation networks. Each regional organisation translates national health and care strategies into local action. Local teams leverage deep knowledge of their health ecosystem to ensure innovations, improvements and best practice benefit more patients, faster.

Strategic investment in health innovation could unlock £278 billion in economic value for the UK, including £113 billion from targeting innovation towards the four health conditions most associated with a loss of economic productivity (1). Since 2018, the collective impact of the Health Innovation Network also speaks volumes. Over 4.9 million patients have been supported and £3.1 billion in leveraged investment (2). In the East of England during 2024/25, £41 million economic value was leveraged by the work of Health Innovation East and the innovations it supports (3).

Health innovation networks are perhaps at their most powerful when leading complex transformation programmes. Health Innovation East implemented one such programme, TWC, across eight healthcare sites – to tackle one of the NHS’s most persistent and under-addressed challenges: lower limb wound care.

Why wound care needs innovation: a united approach

Lower limb wounds affect millions of people nationally and are one of the most expensive and time-consuming conditions to manage within community settings. Wound care accounts for 50% or more of community nursing time, equating to 54.5 million visits annually (4). Wound care is also the third highest area of NHS expenditure[1], after cancer and diabetes.

Despite such compelling context and statistics, evidence-based interventions such as compression therapy are applied inconsistently. As a result, some patients endure avoidable pain and additional health interventions. Getting wound care right is not just a clinical issue, it also affects people’s ability to work and uses capacity within the precious NHS workforce. At scale, improving wound care can release significant NHS capacity, help people return to work and improve patients’ quality of life.

Recognising the potential of scaling an evidence-based approach to wound care, NHS England commissioned the National Wound Care Strategy Programme (NWCSP) which, with TWC as a constituent initiative, delivered outstanding impact.

The TWC programme

Often, when we think about innovation, our minds quickly go to products; typically, those digital or medical technologies that can be placed into a treatment pathway to benefit patients and/or the healthcare workforce. TWC had no physical product as such, rather it sought the transformation of existing ways of delivering a service innovation to ensure lasting changes to the way lower limb wound care is delivered.

The TWC programme worked across eight diverse test and evaluation sites (TES) in urban, rural, and coastal communities – representing a wide range of care providers and local needs. The programme focused on implementing the recommendations of the NWCSP, namely evolving dedicated lower limb services that consistently apply evidence-based interventions.

Delivering results

Healthcare transformation takes place in complex environments. It doesn’t happen by writing guidance, more through thoughtful and well-supported implementation activity. Health Innovation East’s leadership of TWC embodied this principle. Thinking and acting innovatively and facilitating new practices brought the programme’s ambitions to fruition. The team deployed a multi-faceted approach designed to adapt to the realities of community-based care across the varied geographies covered. Their approach, grounded in the principles of  ‘learning health systems’ – systematically making incremental, data-driven improvements (6) – became the foundation for the TWC programme’s success.

The work was delivered around three pillars, ensuring essential aspects of the change process were addressed;

• People – upskilling staff and patient engagement.
• Process – pathway redesign and transformation.
• Data & digital – capturing and analysing patient data to demonstrate impact.

At its completion, the programme’s evaluation highlighted the expert facilitation provided by the team, recognising that it fostered a culture that valued and respected the workforce without being directive.

While great culture facilitates change, tools and documentation help sustain it. In response, the team created implementation toolkits. Each kit included NWSCP tools and documents tailored for each test site, accompanied by exemplar templates to drive implementation activity among e.g. clinicians, providers and commissioners.

Demonstrating impact: an unwavering commitment to change

While TWC was undoubtedly successful, it is also important to recognise that system change leading to positive progress was, at times, hard won.

It was the Data and Digital pillar, capturing consistent data to evidence patient impact, that challenged the team the most. Standardising data and ironing out data flows was essential and the teams’ success in both regards was enabled by leadership grounded in resilience, collaboration and care.

Compared to data from acute trusts and primary care, community data is harder to capture and of inconsistent quality. An extensive engagement with NHS Business Intelligence, clinical and programme teams enabled data quality and consistency to increase and ensured the positive shift towards data was maintained.

Creating space for system colleagues to collect accurate and consistent data were the two most significant reported challenges the TWC team faced throughout the programme’s implementation. The team’s approach to overcoming these challenges majored on developing ‘safe’ relationships – a determination to pursue honest, constructive interactions, underpinned by care meant, in the strong belief of the team, that the weight of the most difficult data and digital challenges was shared – enabling delivery consistency and continued high performance.

An unwavering commitment to change, led not only to heightened capability, but also to the confidence and credibility needed to drive forward the change required.

Lessons in transformation

In addition to a commitment to change and the quantitative patient impact achieved (see above), the TWC evaluation and team’s reflections highlighted the following as important and commend them to other teams pursuing similar aims.

• Establishing clear communication channels and clear timelines from the outset. The alignment this created helped prevent misunderstandings, facilitated smoother processes and reduced the risk of delays caused by miscommunication.
• Engaging business intelligence (BI) teams early helped refine mechanisms for timely data collection and analysis. BI ensured that data was useful and actionable – helping to prevent delays and improve the efficiency of the programme.
• Ensuring continuous improvement: An iterative approach addressed issues promptly, capitalised on successes and ensured that the programme remained relevant.

Conclusion: scaling what works, where it matters most

The success of the TWC programme offers a prime example of how the government’s ‘shifts’ can manifest at the frontline of health and care. The successes celebrated also speak to broader NHS priorities including cutting waiting times and tackling health inequalities.

Whilst the ‘shifts’ are acknowledged as essential, we believe that achieving them necessitates a balance between undertaking new initiatives and transforming existing programmes in ways that can be scaled.

Transforming existing programmes can be difficult, yet thanks to well-run transformation and an unwavering commitment to change, the TWC programme is a story of possibility. One that proves that entrenched challenges can be transformed into models of best practice, ready to scale.