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The problem costing us an arm and a leg

I spent an evening recently sitting in my local A&E department. There is not a lot to do when you are sitting there waiting, so inevitably I spent time watching the other people also sitting and waiting.

During the two hours I spent in the waiting room, I saw three older women with swollen, haemosiderin-stained legs – leg ulcers just waiting to happen.

Yet again it was brought home to me how little we do in terms of preventative care to try and help people look after their lower legs to avoid skin breakdown and leg ulceration.

This topic has bothered some of us a great deal. Problems with the lower leg are common but are too often ignored. Even when the skin breaks down and patients present with a leg ulcer, care is often sub-optimal.

A recent article found that over a third of wounds seen in primary care are some form of leg ulcer and over half of these did not have a working diagnosis.

It is impossible to safely treat a non-healing wound on the lower leg unless you know the underlying cause that explains why the wound is not healing as it should.

NHS England has also become concerned about this subject. A health economic study calculated that suboptimal care of a wound on the lower leg can end up costing up to ten times more than if the patient had received the right care.

Too many patients, GPs, practice nurses and nurses working in other services are either unaware of the need for early, accurate care or do not have access to services that can provide the expert care needed.

I had some personal experience of this when my father-in-law developed a leg ulcer but it took six months until he received the full assessment needed and he was started on compression therapy.

However, I also have an old school friend who is a GP working in a locality where if she spots someone with vulnerable legs she can quickly refer them to a team of nurses who have expertise in this field and thus prevent the situation getting worse. We need more services to work like this.

In April, a coalition of healthcare organisations and professionals, including myself, launched a campaign to try to help.

The Legs Matter campaign is aiming to provide an accessible and reliable source of information for patients and their front line clinicians. The Legs Matter website covers a range of skin problems on the lower leg and explains what good care should look like.

The good news is that if we could get our services better organised we could do a lot to help patients look after their legs and achieve faster healing when skin does break down.

Early diagnosis and appropriate treatment can make a real difference. That translates into less suffering for patients and savings for the NHS in terms of clinician time and spend on dressings and bandages.

We hope you and your patients will find the Legs Matter campaign useful and you will join us in standing up for legs.