Chronic Wound Management

Chronic Wound Management – challenges to address

Why is Transformation of Chronic Wound Management important?

  • There is a significant opportunity to improve outcomes and cost-effectiveness in management of patients with chronic wounds (ulcers) in the UK.
  • There is unwarranted variation in wound outcomes for chronic wounds across the UK and best practice is not consistent at a national level.
  • The range of chronic wounds affecting patients includes diabetes foot ulcers, leg ulcers, pressure ulcers and complex wounds.
  • Serious impact on patients with high social and personal cost due to reduced quality of life and productivity.
  • There is variable compliance with NICE and national guidelines.


References: 1,2,3,4,5,6,7,8

Transformation of Chronic Wound Management – the why


“Health economic burden that wounds impose” Guest et al (1)


This pivotal health economic study estimated the prevalence of wounds (all types) managed by the UK’s National Health Service (NHS) in 2012/2013 and the annual level of resources spent in managing patients with these wounds. The study used retrospective cohort analysis of the records of patients in The Health Improvement Network (THIN) Database.

Key Findings

The annual NHS cost of managing these wounds and associated comorbidities was £5.3 billion.

Approximately 30% of wounds lacked a differential diagnosis.

Model estimates 2.2 million wounds were managed by the NHS (2012/2013), equivalent to 4.5% of the adult population.

Annual levels of resource use attributable to managing these wounds and associated comorbidities included 18.6 million practice nurse visits, 10.9 million community nurse visits, 7.7 million GP visits and 3.4 million hospital outpatient visits.

Sixty one per cent of all wounds healed in the study year; 79% of acute wounds healed and 43% of chronic wounds.

The study did not account for cost of wounds that had not healed at end of the study period.

Transformation of Chronic Wound Management – the why

“Health economic burden that wounds impose” Guest et al (1)

The study identifies some of issues leading to the high burden of wound care in the NHS:

  • Lack of involvement of tissue viability nurses and other specialist nurses in the management of patients with wounds
  • Inconsistencies in differential diagnosis of wounds
  • Gaps in compliance with National guidelines
  • Poor care pathway processes
  • Variance in staff competencies with wound management

Key Recommendations 

(1) the need to refer patients to a specialist for investigation and a differential diagnosis with a shared management plan to be implemented in the community. Leg Ulcer management identified as a key opportunity for improvement.

(2) training of non-specialist clinicians in the fundamentals of wound management.

(3) Improved systems of care to support better wound outcomes.

Resources for further information

1. Health economic burden that wounds impose on the National Health Service in the UK.

Guest JF, Ayoub N, McIlwrait T, Uchegbu I, Gerrish A, Weidlich D, Vowden K, Vowden P.

BMJ Open.2015;5(12):e009283. doi:10.1136/bmjopen-2015-009283,
Link here

2. The Smith and Nephew Foundation: Skin Breakdown – The Silent Epidemic. Posnett J, Franks P.J. (2007). The cost of skin breakdown and ulceration in the UK. Smith and Nephew Foundation, Hull

4. The resource costs of wound care in Bradford and Airedale primary care trust in the UK. Vowden K, Vowden P, Posnett J. (2009). Journal of Wound Care; 18: 93- 102.

5. NHS England. A Framework for nursing, midwifery and care staff, Leading Change, Adding Value. [Online] 2016. [Cited: 11 October 2016.] Link here.

6. Srinivasaiah N, Dugdall H, Barrett S, Drew PJ. A point prevalence survey of wounds in north-east England. Journal of Wound Care. [Online] 29 September 2013. [Cited: 23 December 2016.]
Link here

7. Wounds research for patient benefit: a 5-year programme of research. Cullum N, Buckley,H, Dumville J, Hall J, Lamb K, Madden M, Morley R, O’Meara S, Gonclaves PS, Soares M,Stubbs M. 13, s.l. : National Institute for Health Research, Programme Grants for Applied Research, Vol. 4. ISSN 2050-4322.

8. Green J, Jester R, McKinley R, Pooler A. The impact of chronic venous leg ulcers: a systematic review. [Online] [Cited: 10 October 2016.]
Link here.

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Silhouette as a Technology-enabler for Chronic Wound Management Transformation

There is an innovation opportunity to deploy Silhouette capability for clinical and system-wide improvements in tissue viability services and community-based through use of digital wound imaging, wound assessment and sharing of quantified wound outcomes data across the care pathways.

Silhouette supports pro-active, outcomes-led, evidence-based wound management with objective assessment, monitoring and sharing of wound outcomes data.

Benefits for the NHS:

  • Support effective care in community and secondary care with high visibility of wound outcomes
  • Build community capability to support improved systems of care
  • Reduce cost of wound care services through teleconsultation model of care
  • Avoid unnecessary hospital admissions with high surveillance of healing progress
  • Release capacity in acute out-patient clinics with improved community capability

Benefits for patients:

  • Assurance of safe and effective care in all care settings through focus on outcomes-led care
  • Accurate assessment of wounds for personalised treatment
  • Timely service access to get on right track to healing with pro-active care

Discover more


Reference Sites & Client Testimonials

Entec Health is collaborating with a number of NHS Tissue Viability and Wound Care Services on Transformation of Wound Management practice and service delivery, enabled by Silhouette. Evaluation results and client testimonials are available on request.


Case Studies & Evidence


Wounds UK Product Review Publication 2012

The use of electronic data capture devices in wound care settings. J.Fletcher, Wounds UK 2012, Vol 8, No 4

Download here


Case Study – Capital Coast District Health Board, New Zealand

Taking the guess work out of community wound care, ARANZ Medical


 Case Study – Capital Coast District Health Board, New Zealand

Silhouette helps patient to navigate his healing journey


Case Study – Pressure Ulcer Management

Barlow Respiratory Hospital, Long Term Acute Care Facility, Los Angeles, US, October 2013, ARANZ Medical,


Silhouette Evaluation Report – Eastbourne Wound Healing Centre

Experience of Silhouette, a new wound assessment and information management system, in clinical practice. S.Hampton, C.Bree-Aslan, D.Verrall, Eastbourne Wound Healing Centres, Evaluation Report, December 2011.

Download here


Health Economics & Business Case

Entec Health has expertise to support development of a health economic model and business case for technology-enabled transformation of Tissue Viability and Wound Care Services. Please get in touch to discuss your wound care transformation plans and how we can support you. Email