Adam Mence from L&R Medical UK walks us through rebalancing wound care, explaining the challenge of overusing sub-therapeutic compression through evidence-based pathways
The UK’s wound care system is under immense pressure. Despite unprecedented investment in resources, clinical outcomes for patients with venous leg ulcers (VLUs) remain suboptimal. This imbalance between expenditure and efficacy points to a systemic flaw – most notably, the overuse of reduced or sub-therapeutic compression therapy.
The current crisis in wound care
A 2020 study by Guest et al. revealed that leg ulcers alone cost the NHS an estimated £3.1 billion annually, accounting for a significant share of the £8.3 billion spent managing all wounds (Guest et al., 2020). The prevalence of wounds has increased by 71%, with over one million people, or 2% of the adult population, affected by leg ulcers in any given year.
Click here to view Table 1
Alarmingly, despite this outlay, only 49% of chronic wounds heal within 12 months, and up to 69% of VLUs reoccur annually. This reflects a care model where root causes are not systematically addressed, and when compression therapy is used, it’s often under-applied or inappropriate.
Sub-therapeutic compression: A hidden drain
Reduced or sub-therapeutic compression remains a widespread issue. Whether due to lack of training, fear of litigation, or product complexity, too many patients are managed with inadequate levels of compression.
This contributes directly to prolonged healing times, ulcer recurrence, and increased visits to overstretched community teams.
Click here to view Table 2
Yet evidence shows that strong, effective compression (≥40 mmHg), such as that delivered by systems like ReadyWrap®, Actico® or Activa®/ ActiLymph® Hosiery Kits, leads to significantly better outcomes in terms of healing, recurrence, and resource use (Ehmann, 2016; Muldoon & Hampton, 2017).
The L&R Medical UK model: A proven pathway
L&R Medical UK’s Lower Limb Wound Care Pathway (Atkin & Tickle, 2016) offers a systematic, evidence-based solution to this evolving crisis. Designed to drive consistency in assessment and treatment, the pathway integrates:
- Accurate and timely diagnosis.
- Appropriate use of strong compression therapy.
- Upskilling of clinical teams.
- Patient empowerment through supported self-care.
This approach, recently highlighted in their “Advancing Lower Limb Care” article (L&R Medical UK, 2024), not only improves outcomes but significantly alleviates pressure on clinical teams.
Unlocking self-care to transform services
Supported self-care is the backbone of this model. Mirroring strategies from diabetes and respiratory care, L&R Medical UK’s pathway and self-care delivery system gives patients the tools, knowledge, and confidence to manage their condition independently.
The results from South West Yorkshire Partnership NHS Foundation Trust (SWYPT), in collaboration with L&R Medical UK, are compelling. According to Hallas-Hoyes et al. (2021), their advanced self-care model achieved:
- 72% healing at 18 weeks.
- 99% healing at 42 weeks.
- Reduction in nursing hours from 24.5 to 1.3 per patient.
- Per-patient cost savings of £1,539.
- 6 FTE nursing hours saved per 100,000 population.
The benefits extend beyond direct care: 67% of staff reported a reduction in workplace stress, and 100% said they felt more motivated to support patient self-care. Moreover, the environmental gains – such as a 60% drop in travel- related CO2 emissions – further support the NHS’s net-zero goals.
Scaling for system-wide impact
The pathway’s design allows for national scalability. If just 25% of leg ulcer patients adopted the self-care model:
- £903,500 could be saved per 100,000 population.
- £226,000 in product-related savings could be achieved.
- 6 full-time equivalent (FTE) nursing roles could be reallocated.
If scaled to 40% of eligible patients, national cost savings could reach £404 million annually, with £1.45 million saved locally across SWYPT (Hallas-Hoyes et al., 2021).
These savings are not just financial – they reflect improved clinical outcomes, greater patient autonomy, and workforce sustainability at a time when community nursing faces critical shortages.
Driving best practice: Compression that works
At the core of L&R’s pathway is compression, which is effective and easy to apply. Their ReadyWrap® adjustable compression system delivers strong compression (40–60 mmHg) with a high Static Stiffness Index (SSI), which is essential for managing oedema and supporting venous return (Wigg & Lee, 2014). Its intuitive Velcro® design ensures safe and reproducible application, supporting broader skill mixes in care delivery (Crinchley & Atkin, 2017).
Alongside ReadyWrap®, hosiery kits like Activa® and ActiLymph® support ulcer healing to long-term maintenance, whilst reducing recurrence and reinforcing patient independence.
A call to action for procurement leaders and ICBs
With evidence, financial modelling, and clinical backing, the case for changing the VLU care model is overwhelming. Procurement leaders, ICB board members, and NHS decision-makers must now ask:
- Are we investing in therapies that deliver outcomes?
- Are care models enabling or inhibiting clinical efficiency?
- Can we scale proven models to deliver financial and workforce sustainability?
The L&R Medical UK model demonstrates that transformation is not only possible, but evidently, necessary.
Conclusion: A pathway to sustainable care
The wound care burden is growing, both financially and operationally. Continuing to invest in models that rely on sub-therapeutic compression and repeated clinical interventions is unsustainable.
By adopting evidence-based pathways, such as those offered by L&R Medical UK – anchored in strong compression, structured self-care, and scalable service delivery – the NHS can reclaim control of wound care and, more critically, eliminate unnecessary waste.
The challenge now lies not in the evidence, but in the will to implement it at scale.
References
Table 1: Guest JF, Fuller GW, Vowden P (2020) Cohort study evaluating the burden of wounds to the UK’s National Health Service in 2017/2018: update from 2012/2013. BMJ Open 10(12): e045253. Available online: https://bmjopen.bmj.com/content/10/12/e045253
Table 2: Data from GPrX, 2024
Atkin, L., & Tickle, J. (2016). A new pathway for lower limb ulceration. Wounds UK, 12(2)
Crinchley, A. & Atkin, L. (2017). The leg ulceration pathway: impact of implementation. Wounds UK, 13(4).
Ehmann, S. (2016). Multinational, pilot audit of a VELCRO adjustable compression wrap system for venous and lymphatic conditions. Journal of Wound Care, 25(9), p513–p520.
Guest, J.F., Fuller, G.W., & Vowden, P. (2020). Cohort study evaluating the burden of wounds to the UK’s NHS in 2017/2018: update from 2012/2013. BMJ Open, 10(12): e045253. https://bmjopen.bmj.com/content/10/12/e045253
Hallas-Hoyes, L., Williamson, S., Kerr, A., Andrews, T., & Calladine, L. (2021). An advanced self-care delivery model for leg ulcer management: a service evaluation. Journal of Wound Care, 30(9): 751–762.
L&R Medical UK. (2024). Advancing lower limb care: L&R Medical UK’s pathway to sustainable care. Open Access Government. https://www.openaccessgovernment.org/advancing-lower-limb-care-lr-medical-uks-pathway-to-sustainable-care/191075/
Muldoon, J. & Hampton, S. (2017). Validity, inter-rater and intra-rater reliability of an adjustable compression device application. SAWC, San Diego.
Wigg, J. & Lee, N. (2014). Redefining essential care in lymphoedema. British Journal of Community Nursing.
This work is licensed under Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International.
