As a health economist working for the College of Human and Health Sciences at Swansea University, I have been helping Lymphoedema Network Wales (LNW) with several service evaluations for the past 5 years.
LNW is made up of a small but passionate team of people who are dedicated and committed to people in Wales living with lymphoedema and who are determined to look at inefficiencies and inequities in the care delivered.
Since 2014 LNW has, therefore, pursued the local university health board for monies to help evaluate its services. The network has done this to build up a body of evidence to support its innovative ideas and more effective—and cost-effective!—ways of approaching and treating lymphoedema.
Cost savings
This body of work started with a service evaluation of the entire Wales-wide network. The results of this study showed that the service had brought considerable cost savings and efficiencies across the network and this data formed the basis of LNW's raft of evaluations that have now taken place (Humphreys and Thomas, 2017).
Next came the evaluation of the On the Ground Education Programme (OGEP) that LNW ran in Cardiff and Vale University Health Board (Humphreys et al, 2017). Again, the results of this evaluation showed that there were considerable cost savings to be made in how lymphoedema care was delivered and managed. This work also led to the team developing the ‘wet leg pathway’ (Thomas et al, 2017) that LNW has been rolling out successfully ever since.
Last year, saw the evaluation of the lympho-venous anastomosis (LVA) service recently set up to treat patients across the whole of Wales. This evaluation looked at the first 50 patients through the service and, again, the results indicated that this surgery for lymphoedema could bring considerable cost savings and efficiencies.
Big ideas
Last month saw me making my way to the LNW Swansea base in Cimla Community Hospital for my regular catch-up visit and to hear the news that it had secured a small amount of funds for further evaluations. LNW may be small scale, but it has big ideas for the future of lymphoedema care.
In addition, anyone who has ever heard of or met Mel Thomas (National Clinical Lead for Lymphoedema, NHS Wales) and Karen Morgan (National Lymphoedema Education and Research Lead, NHS Wales) will know just how vocal they can be about the inequalities and inefficiencies in lymphoedema care across the UK and how fixing these problems can bring benefits not only for patients, but also for the NHS coffers. Thus, saying ‘no’ to them is invariably impossible.
They currently want my help with three evaluations. The first is a follow-up evaluation of the LVA service, which has now seen 90 patients over a 2-year period. The extension of the study will look at the longer term consequences of LVA treatment and the effect that it has had over these first 2 years.
Second, for the past year or so LNW has been investigating the differences in costs and quality of care for patients requiring compression garments, comparing standard prescription ready-to-wear versus prescription made-to-measure garments. They are looking at the process of acquiring compression hosiery garments and what difference possible prescription delays have on patients, as well as differences in costs for the NHS.
‘Fixing these problems can bring benefits not only for patients, but also for the NHS coffers’
Third, LNW has developed a one-page checklist for patients living in nursing and residential home settings, who have lymphoedema or are at risk of developing the condition. This simple checklist is helping carers to support patients with lymphoedema more effectively. It can also be used as a risk assessment tool for the signs and risks for lymphoedema.
It is envisaged that cost savings will be generated immediately, as well as by helping to avoid future comorbidities.
Master's initiative
Finally, LNW has agreed to put its support behind a KESS [Knowledge Economy Skills Scholarships] studentship (a Wales-wide scheme) that will support a research student to undertake a master's degree for one year. LNW wants to look at the extent of lymphoedema education in undergraduate teaching.
Mel and Karen's passion for their work is unwavering and is ultimately infectious. Their ability to ‘sell’ an idea is impressive and one wonders what profession they would be in if they did not work in LNW?
I will report back in later this year with the initial results of at least one of these exciting new evaluations. Watch this space.