Lower limb wound care is one of the NHS’s most persistent and under-addressed challenges.
It is currently estimated that 3.8 million people are living with a wound (1) – those left untreated cost the NHS over £5.8 billion every year (2). Wound care accounts for 50% or more of community nursing time, equating to over 54.5 million visits annually (3).
Lower limb wounds, particularly leg ulcers, often take longer to heal and may require more specialised care. It is estimated that approximately 1.5% of the adult population in the UK is affected by active leg and foot ulceration, which equates to 730,000 patients (4). Without correct treatment, ulcers can remain unhealed for many months or sometimes years, causing pain, immobility and infection risk.
Despite the clear pressure lower wounds place on the NHS, evidence-based interventions such as compression therapy are still not consistently applied to treat lower leg wounds.
The National Wound Care Strategy Programme (NWCSP) was commissioned by NHS England and aimed to improved wound care in England by developing a strategy that address variations in care.
In October 2022, the Health Innovation Network launched the Transforming Wound Care programme (TWC), led by Health Innovation East, to improve care for patients with lower limb wounds.
The programme used the evidence, learning and recommendations from NWCSP and aimed to achieve:
The TWC programme was structured around three enablers to support the programme delivery and ensure all key elements were addressed;
Health Innovation East established a central team which adopted a learning health system approach as a foundation for implementation expertise and were driven to ensure a focus on equity for those receiving better lower limb wound care. The team also dedicated significant attention to evidence impact.
Eight test and evaluation sites (TESs) were recruited to deliver the NWCSP lower limb recommendations which included: wound identification, immediate and necessary care, assessment, diagnosis and treatment, ongoing care, review of healing, and care following healing.
The eight TESs provided data from populations in urban, rural and coastal communities with different levels of deprivation, to introduce dedicated lower limb services to improve the assessment, diagnosis and treatment of lower limb wounds. Various providers were represented, including NHS trusts, primary care and community interest companies.
An independent evaluation of the programme was undertaken by Health Innovation Wessex to provide insights into how the recruited TESs implemented the lower limb recommendations and the impact of the programme on wound healing, and patient and staff experience.
“My legs are not as swollen and heavy so I am able to mobilise easier. I am now able to get into a car and go out which I have not done for a very long time. I am no longer in pain all the time.”
Patient feedback
During the evaluation period the TWC programme engaged almost 4,000 patients across all sites and reached over 500 staff.
The programme showed to improve lower limb wound healing rates. Of those healed, 65% of patients healed at 6-12 weeks, 84% at 12-24 weeks and 94% at 52 weeks. Patient healing rates varied between 53% and 78% recorded as healed within 12 weeks.
100% of surveyed patients reported positive experiences with the service, highlighting staff attentiveness and adaptability. Staff were also enthusiastic about the programme aims, reporting improved patient care and outcomes.
77% of staff indicated that a wound management digital system and similar technologies made a positive difference to their service or patients. Staff also highlighted the benefits of remote access to wound images to record wound healing and improve patient care oversight.
“Working with the Health Innovation Networks to implement the National Wound Care Strategy Programme Leg Ulcer recommendation has given us a huge amount of insight and knowledge into programme management, data collection and collaborative working.”
Professor Charlotte McArdle, deputy chief nursing officer, NHS England
The programme also provided net zero benefits through fewer appointments for district nurses and efficiency savings. During the course of the evaluation 1,575,908 kg CO2 was saved, the equivalent annual mileage of around 923 cars. This would take 64,000 planted trees or 10 football pitches a year to absorb.
The TWC programme has been a transformative programme within the Health Innovation Network affecting thousands of patients living with a lower leg wound. We’ve seen first-hand how its recommendations can ease pressures on community staff, prevent avoidable harm and hospital admissions, support more care in the community and most importantly, help individuals stay mobile and active. This has such an impact on their daily lives and their overall long-term health.”
Access the full evaluation report here
References:
(1) Guest JF, Fuller GW, Vowden P. Cohort study evaluating the burden of wounds to the UK’s National Health Service in 2017/2018: update from 2012/2013. BMJ Open.
(2) Guest, J.F. (2020) “Burden of wounds to the NHS: what has changed since 2012/13?” Wounds UK 17(1): 10 15.
(3) NHS Benchmarking Network. (2021). Generic Community Services Report 2020/2021. [Online]. NHS Benchmarking Network. Last Updated: 2021. Available at: https://apcp.csp.org.uk/system/files/documents/2022-01/generic_community_services_report_2020_21_1.p [Accessed 20 April 2025].
(4) NHS Oxford Health NHS Foundation Trust. (2025). Lower limb – tissue viability. [Online]. NHS Oxford Health NHS Foundation Trust. Last Updated: 25 February 2025. Available at: https://www.oxfordhealth.nhs.uk/tissue-viability/conditions/lower-limb/ [Accessed 20 April 2025].