Improving pathways of care for patients with venous leg ulceration
File(s)
Author(s)
Bolton Saghdaoui, Layla
Type
Thesis or dissertation
Abstract
Venous ulcers (VUs) are a major cause of morbidity and place significant demands on healthcare services. The National Institute for Health and Care Excellence guidelines recommend that ulcers persisting longer than two weeks should receive comprehensive assessment and referral to vascular services for treatment of underlying venous incompetence. However, many patients continue to be managed in primary care without timely assessment or specialist referral. Previous pre-doctoral work identified organisational barriers to referral, but limited evidence exists regarding service availability and the experiences of patients, caregivers, and multidisciplinary teams.
This PhD aimed to understand the context of current VU referral pathways within the NHS and to identify strategies that could improve timely referral and management. Guided by the Medical Research Council Framework for Complex Interventions and the Person-Based Approach, the study combined systematic reviews, national surveys, Freedom of Information Requests to Integrated Care Boards in England, and qualitative interviews with healthcare professionals, patients, and caregivers.
Findings demonstrated that dedicated VU services improve access to timely and high-quality care, although demand and strict eligibility criteria limit availability. Interviews highlighted fragmented services, inconsistent treatment, poor continuity of care, and limited access to specialist expertise. Patients frequently reported inadequate understanding of VU management, reduced self-care confidence, and significant shortcoming in pain management. Pain often remained secondary to wound healing despite its substantial impact on quality of life.
Overall, the findings support earlier access to specialist VU services delivered by experienced clinicians, alongside improved multidisciplinary collaboration, patient education, preventative healthcare, and self-management support. Effective pain assessment and management should be central to future VU care pathways.
This PhD aimed to understand the context of current VU referral pathways within the NHS and to identify strategies that could improve timely referral and management. Guided by the Medical Research Council Framework for Complex Interventions and the Person-Based Approach, the study combined systematic reviews, national surveys, Freedom of Information Requests to Integrated Care Boards in England, and qualitative interviews with healthcare professionals, patients, and caregivers.
Findings demonstrated that dedicated VU services improve access to timely and high-quality care, although demand and strict eligibility criteria limit availability. Interviews highlighted fragmented services, inconsistent treatment, poor continuity of care, and limited access to specialist expertise. Patients frequently reported inadequate understanding of VU management, reduced self-care confidence, and significant shortcoming in pain management. Pain often remained secondary to wound healing despite its substantial impact on quality of life.
Overall, the findings support earlier access to specialist VU services delivered by experienced clinicians, alongside improved multidisciplinary collaboration, patient education, preventative healthcare, and self-management support. Effective pain assessment and management should be central to future VU care pathways.
Version
Open Access
Date Issued
2026-01-26
Date Awarded
2026-06-01
Copyright Statement
Attribution-NonCommercial 4.0 International Licence (CC BY-NC)
License URL
Advisor
Davies, Alun
Wells, Mary
Onida, Sarah
Chumbley, Gillian
Sponsor
National Institute for Health and Care Research
Grant Number
NIHR302917
Publisher Department
Department of Surgery & Cancer
Publisher Institution
Imperial College London
Qualification Level
Doctoral
Qualification Name
Doctor of Philosophy (PhD)