It’s a hidden epidemic that has hit more than two million Britons and has them struggling with debilitating pain every day.
Chronic wounds – ulcers and cuts, usually on the legs and feet, that don’t heal – cost the NHS £ 5 billion annually.
And they are far from a minor condition, often leading to infections in which thousands of patients end up having limb amputations every year.
Zoom interviews with GPs help physicians treat problems like chronic leg and foot wounds that don’t heal and cost the NHS about £ 5 billion a year
With the help of video call appointments, many patients have finally healed, possibly forever
But, according to new figures, the tide can finally turn, as new home management methods, applied during the lock, are rapidly revolutionizing the treatment of these persistent injuries.
With the help of video call appointments, many patients have finally healed, possibly forever.
This week, the UK’s leading leg and foot problems charity, Legs Matter UK, estimated that half a million patients are now effectively treating themselves at home, with video or phone support from specialist nurses.
Waiting times to speak to a nurse or doctor have fallen from eight weeks to just seven days in some areas.
Dr. Leanne Atkin, vascular nurse practitioner with the Mid-Yorkshire NHS Trust, says the pandemic has forced doctors to try new approaches to patient care.
She said, “We receive photos of wounds by email and phone, which allows us to immediately assess whether there is an infection that needs to be treated – or if that dressing needs to be replaced. Then we give step-by-step advice on how to do this by telephone or video calls.
“This frees up time in the clinic for the more severe cases, which is seen much faster than ever.”
This revolution is well timed as the toll from chronic wounds is expected to increase in the coming years.
The risk of developing a non-healing wound is exacerbated by diseases that affect circulation, including diabetes and heart disease, both of which are increasing due to rising obesity and an aging population.
Experts estimate that wounds in two-thirds of patients with these conditions become chronic. In diabetes, high blood sugar levels can also lead to nerve damage, which means that patients are often unaware of a foot injury and will continue to walk on it, increasing the problems.
Unless treatment is given quickly, the ulcer may not heal to both cover the wound and improve circulation in the legs.
So deep is the concern that last year a parliamentary group with all parties prepared a report on the crisis. In October, MPs on the Committee on Vascular and Venous Diseases warned that “organizational barriers” within the NHS stood in the way of prompt treatment. Patient scores were found to wait two months for an initial referral to a nurse practitioner, with amputation being the only option.
This despite expert advice to stay within the 14-day ‘window of opportunity’ to save limbs.
Previously, once referred by a primary care physician, patients went to a specialist nurse for compression therapy – tight bandages that squeeze the legs to stimulate blood flow.
Thereafter, face-to-face sessions with healthcare professionals were required to change the dressing frequently, possibly at a general practice or specialist clinic. But due to the rising patient numbers and staff shortages, patients are waiting for months for both an initial appointment and a check-up.
When Covid-19 struck, clinicians quickly changed services again, leading to a dramatic improvement in patient treatment. Now, after a referral from a general practitioner, which can happen after a telephone appointment, specialists can intervene within 48 hours.
After reviewing photos, clinicians decide how quickly each patient should be seen. If a visit is not immediately necessary, patients will receive video tutorials to change the dressing or in-depth telephone counseling.
Family members are also involved – partners and children receive step-by-step instructions for changing and cleaning bandages by telephone. Bureaucratic limitations have also been removed, with specialists such as Dr. Atkin being able to prescribe painkillers or antibiotics to treat infections outside of general practice. She says, “We were wrong. Covid has given us the opportunity to go back and see what we should focus on. ‘
A useful result of the pandemic is that many older people have become more familiar with technology because it has kept them in touch with loved ones.
One patient who can take advantage of the new routine is retired truck driver Peter Hilton, 78, who has had leg ulcers for 30 years.
He also has type 2 diabetes and protects with wife Pat, 77, at their home in Leeds. Despite being a bit ‘squeamish’, former dentist nurse Pat admits that she excelled in changing the bandage on her husband’s left foot, where an ulcer had developed.
During the lockdown, Pat had two hours of telephone training with Kate Williams, a wound care specialist in Leeds, and was able to clean and repair the wound more often than was possible during their busy GP practice.
As a result, the wound extending from Peter’s heel to toes heals quickly. Pat sends images via email to Kate weekly to review his progress. “I wasn’t confident at first, but Kate told me what to do,” says Pat. In the beginning it had to be dressed daily. But it is healing well, so it is now every other day. ‘
And her grateful husband adds, “It only takes her 30 minutes. She is absolutely first class! ‘