This article highlights the importance of a proactive approach to managing lower limb wounds through primary and secondary prevention. Focusing on prevention can reduce the financial burden of wound care, alleviate capacity issues, and improve patient outcomes by lowering the incidence and recurrence
Everybody knows that prevention is better than cure. Interventions that protect health tend to be far less costly than dealing with the consequences of illness. Take the NHS-funded Diabetes Prevention Programme, which reduces the risk of type II diabetes by nearly 40%. Given the potential power of preventative interventions, it is perverse that the public health grant to local authorities has been cut so substantially. Analysis from the Health Foundation shows that the public health grant was cut by more than a quarter between 2015-16 and this year. Moreover, cuts to public health allocations have tended to be greater in cash terms in more deprived areas. (Department of Health and Social Care, 2024).
Lower limb wounds, including venous leg ulcers (VLUs), diabetic foot ulcers, and pressure ulcers, have increasingly impacted healthcare systems in the UK, presenting both health and financial challenges. These chronic wounds affect approximately 2% of the adult population and incur an annual cost of £3.1 billion for the NHS, highlighting an urgent need for prevention-focused strategies (Guest et al., 2020). The prevention of chronic wounds has become increasingly critical due to demographic shifts towards an older population and the growing prevalence of diabetes and vascular disorders. Effective preventive measures are essential to maintain patients’ wellbeing, alleviate the financial burden on healthcare systems, and address the challenges of limited medical personnel resources.
The burden of missed prevention opportunities in lower limb wounds
Lower limb wounds are not only painful and debilitating for patients but also have substantial psychological and economic impacts. Unhealed or recurrent VLUs are associated with mental health issues, including depression, anxiety, and social isolation, leading to decreased quality of life (Hughes & Balduyck, 2022). Moreover, for the NHS, unhealed wounds result in longer patient contact time, increased hospital readmissions, and higher staffing requirements.
Preventing lower limb wounds through early risk assessment and intervention offers significant economic benefits. Wounds UK (2024) states that the mean NHS cost of treating a single patient with a VLU over 12 months is estimated at £7,600. However, this cost surges to £13,500 for patients with an unhealed wound, compared to £3,000 for a healed VLU (Guest et al., 2018).
Thus, preventing initial wound development or recurrence can lead to considerable cost savings.
The absence of a proactive prevention approach leads to a cyclical pattern of treatment, non-healing, and recurrence, particularly in venous leg ulcers. This poses a significant challenge in healthcare, with a concerning recurrence rate of 18-28% within the first year after initial healing. This high recurrence rate places additional strain on healthcare resources and negatively impacts patient outcomes. The cyclical nature of VLUs creates a substantial burden, both financially and in terms of human suffering, as patients endure prolonged recovery periods and increased distress with each recurring episode (Ashby et al., 2014).
The impact of staffing constraints on effective wound management
Healthcare staff shortages exacerbate the challenges of managing lower limb wounds. According to the Best Practice Statement from Wounds UK (2024), managing lower limb wounds involves extensive community-based care, including visits from district nurses, healthcare assistants, and practice nurses. In 2017-2018 alone, wound care accounted for 54.4 million district nurse visits and 53.6 million healthcare assistant visits (Guest et al., 2020).
Healthcare professionals, constrained by limited staffing, often struggle to dedicate adequate time to each patient. This time crunch can result in hasty wound assessments, missed differential diagnoses, and delayed treatments. Consequently, patients face increased risks of wound deterioration, infection, and wound chronicity. These complications jeopardise patient health and escalate the complexity and cost of care, creating a challenging cycle for both healthcare providers and patients. Proactive strategies, such as primary and secondary prevention, can help reduce the demand on healthcare staff, enabling them to dedicate more time to providing holistic, effective, and efficient care.
Benefits of a proactive, prevention-based approach
A preventive approach in wound care aims to reduce both the incidence and severity of lower limb wounds. This involves two key aspects:
- Primary Prevention – Reducing Wound Incidence: Primary prevention focuses on identifying at-risk individuals and implementing strategies to prevent wound formation. Patients with venous insufficiency, lymphoedema, obesity, or mobility issues are particularly vulnerable to lower limb wounds. For these high-risk individuals, preventive measures include regular leg checks, monitoring for signs such as oedema or skin discolouration, and early use of compression therapy. Compression is an effective preventive measure for patients with venous conditions, improving circulation and reducing the likelihood of ulcer development (Fletcher et al., 2022).
- Secondary Prevention – Preventing Complications and Recurrence: Secondary prevention focuses on early intervention for patients who have developed a wound to prevent complications and recurrence. This will usually include compression therapy for venous ulcers, infection control, and patient education on wound care. Implementing compression therapy early on has been shown to reduce healing times, minimise complications, and lower recurrence rates (Wounds UK, 2024). By implementing compression therapy at an early stage, healthcare providers can potentially improve healing outcomes and prevent the progression of venous insufficiency, thereby enhancing the overall quality of life for patients affected by this condition (Ashby et al., 2104).
Telehealth and remote monitoring technologies present new avenues for prevention by enabling clinicians to monitor wound healing remotely. This approach is particularly valuable for patients in rural or underserved areas, allowing timely intervention and reducing the need for frequent in- person visits, which is especially helpful given the current staffing shortages.
Economic and operational benefits of a prevention- focused strategy
For senior decision-makers, the cost-benefit ratio of implementing prevention strategies in wound care is substantial. Preventing a lower limb wound in a high-risk patient costs significantly less than managing chronic wounds and their associated complications. For example, compression therapy, a cornerstone of VLU prevention, is cost-effective compared to the costs of prolonged wound management (Ashby et al., 2014). Implementing a standardised prevention protocol could yield up to a 30% reduction in wound-related costs, with fewer hospital readmissions, decreased length of hospital stays, and less frequent need for surgical interventions.
Beyond direct cost savings, a proactive approach such as compression hosiery allows patients to manage their own condition, supporting NHS trust efficiency by reducing demand on limited healthcare resources. Preventive strategies reduce the need for intensive nurse and physician involvement, freeing up staff for acute care demands. Moreover, by avoiding repeated episodes of wound recurrence, prevention strategies alleviate the cyclical pressure on community healthcare providers, reducing burnout and increasing job satisfaction among staff.
Integrating preventive care into standard practice
To implement a proactive wound prevention strategy, UK healthcare systems should focus on the following areas:
Risk Assessment and Identification: Systematic risk assessments should be part of routine check-ups for high-risk individuals, particularly those with conditions like diabetes or venous insufficiency. Healthcare providers can utilise tools like the Fletcher Patient Wound Prevention and Healing Pathway, which emphasises risk assessment and early intervention (Fletcher et al., 2022)
Patient Education and Engagement: Educating patients on wound prevention, including the importance of regular leg checks, compression therapy, and self-care, can empower them to manage their health proactively. Programs like Legs Matter provide valuable resources for patients and clinicians, improving awareness of lower limb care and empowering patients in their treatment (Legs Matter, 2023).
Interdisciplinary Care Models: Lower limb wound prevention benefits from a collaborative approach, incorporating expertise from vascular specialists, podiatrists, nurses, and pharmacists. This multidisciplinary strategy ensures that each aspect of patient health – such as vascular function, mobility, and skin integrity – is considered, reducing the risk of wound formation and recurrence.
Investment in Compression Therapy: Compression therapy should be prioritised in high-risk patients as a preventive measure. Starting compression early can prevent the onset of VLUs and significantly lower recurrence rates, yielding cost savings and reducing the ongoing burden on healthcare resources.
To effectively address the increasing need for lower limb care in the UK, healthcare leaders must prioritise wound prevention strategies over traditional wound management approaches. This shift in focus is crucial for meeting the escalating demands on the healthcare system. Preventive care for lower limb wounds yields clear advantages: it reduces overall treatment costs, alleviates pressure on healthcare capacity and resources, and, most importantly, improves patients’ quality of life. By implementing systematic risk assessments, patient education, and early intervention strategies, the healthcare system can address the burden of chronic lower limb wounds more effectively.
With a proactive, prevention-focused approach, senior decision-makers have an opportunity to significantly enhance the efficiency and sustainability of wound care within the NHS, ultimately creating a model that benefits patients, providers, and the healthcare system as a whole.
L&R Medical UK are passionate about driving prevention focused strategies
to reduce the impact on patients, the workforce and the NHS. Our aim is to revolutionise the management of venous insufficiency and lower limb wounds by placing a renewed emphasis on prevention and self-care. Our focus, underpinned by a vision for holistic patient care, extends beyond traditional wound management to promote proactive, evidence-based approaches that empower patients to take an active role in their health. Through strategic collaboration with clinical and industry experts, L&R Medical UK has focused on improving patient outcomes by addressing key areas that impact long-term healing and wellbeing. Our recent publication Best Practice Statement now highlights prevention as the cornerstone of sustainable healthcare, underscoring how systematic change can be achieved to support both healthcare providers and patients. To explore more about these best practice publications and how they pave the way toward sustainable, transformative care, visit our resources on evidence-based wound management.
This work is licensed under Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International.
