Journal of Community Nursing

46 JCN 2020,Vol 34, No 4 WOUND CARE T he NHS is driven by the need to improve health economics, as reflected in the work undertaken by NHS England to improve leg ulcer care and ensure coordinated pathways across the country (NHS England, 2017). Clinical commissioning groups (CCGs) face a growing problem of how to address the increasing costs of leg ulcer care in a population with rising comorbidities, including obesity, heart disease and diabetes (Public Health England [PHE], 2018). Guest et al (2016) suggested that the prevalence of chronic wounds could be growing at a rate of 11% per annum, with costs potentially Development of the hybrid tissue viability nurse/lymphoedema nurse Julie Stanton increasing to £8–£9 billion per year. Indeed, the annual cost of treating patients with leg ulcers in the UK is an estimated £1,938 million (Guest et al, 2016). Wound care is managed across multiple settings, such as GP surgeries, walk-in centres, and patients’ own homes, by a range of healthcare professionals with varying levels of expertise (Srinivasaiah et al, 2013; Guest et al, 2015; Gray et al, 2018). They are constantly under pressure to make the right choices for their patients, often in silos, where decisions may not be based on best evidence and variations in practice and fragmentation of services can occur (Gray et al, 2018). Julie Stanton, associate clinical director, Healogics Wound Healing and Lymphoedema Centres To effectively deal with complex wounds, the importance of oedema and that all oedemas are on a lymphoedema continuum needs to be understood. The efficiency of lymphatic drainage is paramount to oedema management and wound healing. Therefore, interventions to help prevent damage to lymphatic capillaries, and techniques to facilitate lymphatic drainage and lymphangiogenesis should be considered as part of wound management. This article highlights the importance of the lymphatic system in the treatment of leg ulceration and the emergence of a new ‘hybrid nurse’, who combines the specialisms of tissue viability and lymphoedema to improve patient outcomes, reduce waiting times, and improve efficiency within the NHS with the provision of a one-stop service. KEYWORDS:  Lymphoedema  Chronic oedema  Venous leg ulceration  Tissue viability nurses  Lymphoedema specialists The National Wound Care Strategy Programme (NWCSP) began its work in 2018 and aims to take a data-driven approach to developing national clinical standards of care, improving patient experience and outcomes, as well as working alongside industry to ensure that wound care products are reaching patients at the right time (King et al, 2018). However, in the author’s clinical opinion, there is an argument that the work undertaken does not go far enough to address one of the major problems related to chronic leg ulceration — which is the link to lymphatic disease. LEG ULCERATION AND CHRONIC OEDEMA/ LYMPHOEDEMA White et al (2016) described the care of patients with venous leg ulcers as ‘palliative in many cases meaning that little or no clinical improvement is achieved due to inadequate compression application in many cases and mere“management”of exudate’. The view that patients with leg ulcers do not always receive equitable, efficient and effective care, resulting in prolonged ulceration and poor quality of life, has been expressed by many (Posnett and Franks, 2008; Vowden et al, 2009; Ousey et al, 2013; O’Donnell et al, 2014; Day, 2015; Bishop and White, 2017; Guest et al, 2017; Dowsett and Taylor, 2018; Gray et al, 2018). Guest et al’s work (2016) showed healing rates to be in the order of 6–9% in routine clinical practice. However, there is evidence that specialist leg ulcer clinic provision results in higher healing rates (White et al, 2016; Stanton et al, 2016). ‘The view that patients with leg ulcers do not always receive equitable, efficient and effective care, resulting in prolonged ulceration and poor quality of life, has been expressed by many.’