Impact case study database

Contributing to evidence-based policy change

The LNW has been developing innovative methods to support the management of chronic oedema within the community setting.

Our research showing the economic benefits of the OGEP and the WLP across the Cardiff and Vale University Health Board (CVUHB) [R4] underpinned a significant policy and economic decision by the WG. Based on the economic analysis outlined in [R3] and [R4], Humphreys was able to confirm for the LNW that the OGEP and WLP reduced health care resource use and costs and that HRQoL scores increased among the patients with whom the OGEP was trialled. The LNW employed the evidence from the research to successfully lobby the Welsh Health and Social Care department to fund the rollout of the WLP throughout Wales [C1, C2]. As a result, GBP1,4,000.00 has been permanently ring-fenced by the WG for rollout the OGEP programme across all seven HBs for the benefit of all community nurses and DNs. [C5, C6, C7] The ‘Wet Leg’ pathway is now taught as an Agored Cymru accredited unit to Health Care Support Worker (HCSW) and Qualified Nurses and allied health care professionals and have been taught to approximately 283 people from all over the UK. To date 21 healthcare professionals (ranging from allied healthcare professionals to national lymphoedema specialists) have been employed to teach and manage the OGEP pathway throughout Wales. Furthermore, as a direct result of working with Swansea University’s researcher Ioan Humphreys on the economic evaluations of the OGEP, the LNW moved part of their headquarters to the Health and Wellbeing Academy at Swansea University [C1]. This move has already increased the visibility of LNW’s research and has led to further collaboration between Humphreys and researchers within the Medical School. This pooling of resources now includes access to the Secure Anonymised Information Linkage (SAIL) databank.

Improving the management of chronic lymphoedema for patients and practitioners

Again, based on the economic analysis outlined in [R3] and [R4], it was evidenced that OGEP and WLP reduced health care resource use and costs and that HRQoL scores increased among the patients with whom the OGEP was trialled. The OGEP promotes the use of ‘wet leg’ treatment that is more clinically effective than previous treatments among DNs. The education on the WLP includes training on the appropriate use of compression bandaging, etc., and the resulting changes in practices have led to a significant reduction in the number of required DN visits [R4] [C4]. Chronic oedema can have a profound and long-term impact on patients and impact a range of health metrics, including HRQoL. A survey (currently being analysed and prepared for publication) of lymphoedema practitioners was conducted between January and March 2020 on the use of the WLP.

Below are two example quotes from participants in the survey:

“[The WLP] hugely reduced the need for dressings and Multi-Layer Lymphoedema Bandaging (MLLB), more normal body image, patients able to socialise without stigma, reduction in washing and care needs for carers” (clinical nurse specialist, Wales).

“[The WLP] reduces wet legs, improves healing, patients can return to work earlier, wounds heal quicker, improves mobility” (lymphoedema clinical lead, Wales).

The analysis and report produced by Humphreys on OGEP was also endorsed and supported by the Chief Nursing Officer of Wales (CNO). She noted, “ The report makes sobering reading on the debilitating and distressing effects of this condition and I believe it is therefore essential that community nurses take a leading role in delivering effective person-centred care (OGEP), which minimises the complications of the condition and eliminates hospital admissions as far as possible” [C3, C4]. In addition, the OGEP was supported by all Directors of Nurses in Wales, as the programme is being rolled out nationally across all seven WHBs [C5, C6, C7]. Our work was cited as the only economic analysis source in the updated clinical guidelines for the WLP created by the LNW [C3, C4].

Increasing the economic impact of improved clinical care

Our review of the direct costs associated with the OGEP showed that the largest differences between the outcomes at the baseline and the three-month follow-up review were in reduced frequency of DN home visits (53%). Furthermore, there was a large difference in dressings costs, with baseline of GBP52,419 being reduced to GBP9,667 (63%) once the OGEP was utilised [R4]. This evidence was then used by the Chief Nursing Officer to establish a discussion and funding relationship between LNW and NHS Wales [C4]. Based on the potential cost savings seen in the CVUHB alone, the total costs saved over all the WHBs implementing the WLP/OGEP are estimated to be approximately GBP24,460,000 (an avg. GBP1,223 per patient savings) [R4]. A DN at Hywel Dda University Health Board (HDUHB) noted the effectiveness and cost-efficiency of the WLP in a comment on Twitter (24/01/2019) replying to a LNW staff member): *“Introducing the ‘Wet Leg’ Pathway was one of the most clinically effective, cost-saving and labour-saving innovations I have ever seen in District Nursing!!”

The LNW recently secured more annual rolling funding of approximately GBP120,000 to deliver their LVA treatment for the management of lymphoedema in the Swansea Bay University Health Board. [ C8] The LNW secured this funding by citing the results of the report delivered by Humphreys [R7].