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In April 2023, Locala Health and Wellbeing C.I.C won a funding bid to join the national Transforming Wound Care programme as the first test and evaluation site for the Yorkshire and Humber region. In this guest blog, Amanda Haigh, Tissue Viability Specialist nurse at Locala showcases some of the benefits of increased funding and how this impacts workforce, clinical pathways, patient outcomes and wound care services in Kirklees.

My name is Amanda. I have been working in community nursing since 2004 for Locala, joined the Tissue Viability team in 2022 and have been supporting the national Transforming Wound Care (TWC) programme from a clinical perspective. Through this programme I have been able to have a better focus on improving lower limb wound care services. This includes having more resources to implement a focused assessment for all my patients with lower leg wounds and developing clearer pathways to deliver evidence-based care and guidance on ongoing referrals to the multidisciplinary teams.

I have seen first-hand how the process and time given to refining services and pathways aid wound healing, pace of wound healing and patient care outcomes and want to share a patient story as evidence of this.

Creating lasting impact: a patient’s story

In July 2023, I received a referral for an 89-year-old patient with bilateral lower leg wounds. The patient had been under the care of the District Nursing team since February 2023, and his condition had worsened. The patient had explained that he was not following the advice provided to wear his hosiery to support effective healing. The patient had 41 visits by the community team up to the point of the referral for bilateral painful leaking legs.

Just under two weeks after the referral, I visited the patient and completed a full holistic lower leg assessment including vascular assessment. After diagnosing arteriovenous disease and lymphoedema skin changes, a new treatment plan was proposed, involving compression, leg elevation, and improved wound hygiene.

The patient’s condition improved significantly with reduced bandages, and both legs were almost healed within five weeks. By mid-August 2023, the right leg had fully healed, and the left leg had a small ulcer. The patient’s family became involved to help prevent a recurrence, and I explained to both the patient and their family about the importance of good skin and wound hygiene. By the end of September 2023, both legs had fully healed.

The case highlighted the importance of involving the patient’s family in the care pathway and demonstrated the positive impact of funding on improving healthcare services and pathways. This successful case showed how proper treatment and support can lead to effective healing providing the best care to our patients, reduce patient caseload and deliver a more effective service.

Future plans

Locala’s future plans, bolstered by £70K in funding and the TWC programme, encompass a revision of the Leg Ulcer Policy to align with a broader spectrum of National Wound Care Strategy Programme (NWCSP) recommendations. This entails the implementation of a comprehensive assessment within 14 days from referral and a minimum of 4-weekly healing reviews. Additionally, two new wound care clinics will be established in Huddersfield, one at Huddersfield Mission and the other at a drug and alcohol service, aimed at facilitating outreach efforts and catering to the homeless community, thus contributing to the reduction of health inequalities.

We are planning to provide education within local community teams to facilitate a comprehensive understanding and adherence to the NWCSP recommendations, with a focus on recognizing ‘red flags.’ This initiative aims to optimize the care pathway for specific wounds, promoting faster and more effective wound healing while ensuring that staff are proficient in assessing ‘red flags’ and appreciate the significance of timely referral in cases of wound deterioration, non-healing, stasis, or the need for vascular intervention. Our objective is to accomplish this within two weeks of referral to the District Nurse caseload.

We will introduce stocks of compression hosiery in addition to compression bandages in dressing storerooms. This will enable their accessibility without the requirement for a prescription, consequently minimizing delays in providing appropriate care to patients. Additionally, a new pathway will be implemented to facilitate the selection of the most suitable compression options based on factors such as leg shape, exudate volume, and Ankle Brachial Pressure Index (ABPI) readings.

We are developing a patient passport, designed to provide all individuals with leg ulcers a comprehensive understanding of the causes of their condition, its management, and actionable steps to facilitate their ulcer healing process and prevent recurrence. Additionally, we will produce informative leaflets and booklets to assist patients in caring for their wounds and to educate their families on how to offer support.

Locala has also set up a new self-care team. Collaborating with them, we aspire to redirect the emphasis from conventional bandage healing to providing patients with hosiery kits, thereby granting them greater autonomy and choice in their self-care when it’s suitable. The advantages, both for the patients and the workforce, will encompass a sturdy system crafted to optimize the prospects of prompt leg wound recovery and maintenance. This approach will facilitate swift referrals when necessary, decrease the demand for nurse visits, and lead to substantial savings in resources and leg ulcer care expenses.

Further information about the programme

Health Innovation Yorkshire & Humber is implementing the National Wound Care Strategy Programme across Yorkshire and the Humber commissioned by NHS England and delivered by the Health Innovation Network.

Health Innovation Yorkshire & Humber Project Manager Natalie Wong is working closely with Tracy Conroy, Project Lead at Locala, to improve wound care across the region addressing variations in care while helping to reduce health inequalities. Their efforts are focused on expanding staff training, improving lower limb wound services and patients’ experience, lessen the impact of wound care on NHS resources and release time to care.

To find out more about the programme please contact natalie.wong@yhahsn.com