Venous leg ulcer services in the United Kingdom: A freedom of information request and national survey of clinicians

Abstract

Background

Venous leg ulceration (VLU) guidance recommends early assessment, compression, and treatment of venous hypertension. However, it is widely perceived that many patients do not receive timely clinical management, and across the country, there are variations in services commissioned to deliver care.

Methods

A survey of clinicians and Freedom of Information Request (FOIR) explored services available to treat patients with VLU. Using Burns and Kho's guidance, a questionnaire was developed and distributed via professional networks and social media. Additionally, a simplified version of the survey was submitted to 42 Integrated Care Boards (ICBs) across England as a FOIR. Descriptive statistics and subgroup analyses were used to interpret results, and common themes categorised free-text responses.

Results

Of 39 FOIR responses, 89 % report that they have a dedicated service for lower limb wounds. Services are largely nurse-led (68 %); however, 29 % are co-led by vascular surgeons and nurses. Compression therapy is routinely provided by 94 % of services, and 79 % provide care for house-bound patients. Of those specifying ulcer duration as part of the eligibility criteria to access services, 45 % required the wound to be present for four weeks or more.

95 % of respondents reported having a dedicated vascular service, and 92 % were described as a specialist service offering surgical intervention. Most (86 %) reported having a dedicated service for venous disease, of which 39 % were multi-disciplinary led as opposed to being led by vascular surgeons alone.

In contrast to the FOIR results, of 211 clinician survey responses, only 54 % reported having access to a lower limb wound service and 57 % do not routinely refer to a leg ulcer service. While the number of VLU patients treated each month varies, 54 % of primary care services report seeing over 41 patients per month. Lower limb services are predominantly nurse-led (87 %), and compression therapy is routinely provided by 95 % of services.

Considering vascular referrals, while 68 % reported having a vascular service, only 53 % routinely referred patients with VLU. The most common indication for a referral was to rule out arterial disease. Of those not routinely referring patients, 46 % reported they were unable to make direct referrals.

Conclusion

Findings indicate that services treating VLU are available throughout England, and lower limb clinics are primarily nurse-led. However, the eligibility criteria and high demand for such services mean they are not always accessible to patients in a timely manner. Further work is needed to establish strategies to improve access to VLU services.