22nd June 2023


Alison Hopkins who chaired the session has provided this summary.

“It was a very inspiring event for the panellists and the listeners. We delved into some of the tricky questions and we were open and honest about the simplicity and complexity of the solutions. You will hear an enthusiasm to create the change we are desperate to see. This is focussed on:

  • Changing our language around the portrayal of chronicity
  • Our need to understand how the system and lack of commissioning creates harm
  • Challenging the inequality around leg ulcer management. #LevelUpLegUlcers 😊
  • The need for education to develop confidence in compression and to ‘bring back the joy’.
  • The importance of compression in (nearly all) leg ulcers above the ankle.
  • The power of empowerment for our citizens.

We had an enormously enthusiastic audience. Here are a few quotes!

  • Chronic just suggests no way to heal
  • During Covid we upskilled our podiatry team to do reduced compression. This has carried on since, and has been very useful for patients.
  • A failure to treat leg ulcers appropriately has to be viewed as clinical inertia, and therefore contributing to patient harm
  • We have evidence in North Cumbria of healing ‘chronic’ leg ulcers, ulcers that the team did not think they could heal. Healing leg ulcers, reduces MSK issues in our staff, it creates time to care where time can be re-allocated each time a patient is discharged.”

About the round table talk

During Legs Matter Week 2023 we ran a round table discussion on the hidden harm crisis in leg ulcer management and the inadequate use of evidenced based compression therapy in the community. We discussed how the underuse of therapeutic compression in community services is harming people – and what we must do to tackle this. Around 50% of wound care activity every week is focussed on lower leg wounds within community nursing teams; this is less where there is an established leg ulcer service and a lymphoedema service.

If this was used from primary care, so much harm and distress could be prevented. A consistent and supported approach to using informed and well documented evidence and guidance would create a step change in community care, reducing health care costs and improving the working lives of nurses and the well being of patients. Healing rates would be starkly different and stop us using the phrase of chronic leg ulcers.

The event was chaired by Alison Hopkins MBE RN and, with leading experts drawn from the worlds of community nursing, vascular surgery, and the patient community, it’s set to be a lively and fascinating debate.


The event was chaired by Alison Hopkins MBE RN, CEO of Accelerate and, with leading experts drawn from the worlds of community nursing, vascular surgery, and the patient community, it was a very lively and fascinating debate. We thank all of our brilliant speakers for their time, thoughts and input during the session. And also a massive thank you to everyone who attended and shared their insights and feelings about harm and to those who’ll watch this later. Together we can stop harm.

  • Naseer Ahmed, Vascular Surgeon, Manchester University Foundation Trust
  • Manj Gohel, Consultant Vascular & Endovascular Surgeon, Cambridge University Hospitals
  • Zoe Larmour, Service Manager, Specialist Services, Community and ICC Care, Group for North Cumbria Integrated Care
  • Crystal Oldman, Chief Executive, QNI
  • Leanne Atkin, Vascular Nurse Consultant / Research Fellow, Mid Yorks NHS Trust/University of Huddersfield

How we think harm should be tackled – our ten-point plan to tackle harm

The current reality in the UK is that many people with leg and foot conditions are not being treated adequately or in time and, as a result, they are being harmed. This harm is unacceptable and avoidable.

We are calling on senior leaders, decision makers and clinicians within the NHS to radically rethink the way people with leg and foot conditions are treated in order to reduce their risk of being harmed.

Read the plan

Legs Matter’s position on harm

Insufficient action on leg and foot conditions is harming people. The current reality in the UK is that people with leg and foot conditions are not being treated adequately or in time and, as a result, are being harmed. Harm includes unnecessary pain, infection, amputation, hospitalisation, loss of livelihood, social isolation, anxiety, and depression. This harm is unacceptable and avoidable.

Harm is defined as unanticipated, unforeseen accidents (eg injuries, care complications, or death) which are a direct result of the care given rather than a patient’s underlying condition[1]. Harm can be both physical and psychological, and can be caused by delayed, inadequate, or incorrect care. This can include:

  • Delayed or inadequate assessment and referrals
  • Absent, delayed or inaccurate diagnosis
  • Lack of evidence-based care
  • Inappropriate dressing management, resulting in increased risk of infection and increased risk of attendance at A&E
  • No or sub-optimal compression, offloading or pressure redistribution
  • Lack of personalised care planning, including a patient not being given flexibility or choice about their appointments and treatment

[1] BMJ 2019;366:l4185

Learn more