“This innovative service means patients can be seen and monitored much closer to home, outside of the often busy hospital environment. This is better for the patients and is also easing the pressure on our foot clinic at the hospital.  We are very happy to be collaborating with EMAHSN, the community health team in Derbyshire and Entec Health in order to put this technology into practice.”

Professor Fran Game, Consultant Diabetologist, Derby Teaching Hospitals NHS Foundation Trust


EMAHSN atlas 1Diabetes is a major health priority for the East Midlands and following an East Midlands Academic Health Science Network (EMAHSN) Innovation Exchange event focused on diabetes prevention and treatment, EMAHSN launched a call for proposals seeking solutions to issues healthcare professionals and commissioners were trying to tackle.

As a result, EMAHSN is working with Entec Health Ltd and Aranz Medical Ltd to implement a new 3D wound imaging and information system called Silhouette® in order to enable routine diabetic foot ulcer treatment to be delivered in the community rather than in the acute outpatient setting.

It is vital that all patients with diabetic foot ulcers receive regular treatment and check-ups. Currently, these all take place in acute hospital outpatient clinics placing a severe strain on this service and requiring patients to travel substantial distances for their appointments.

The Silhouette® project enables rapid escalation and de-escalation of patients with diabetic foot ulcers to and from secondary care, and increases accuracy and objectivity of assessments through use of 3D wound imaging and measuring technology and remote sharing of data. This will reduce the number of follow-up appointments taking place in hospitals outpatient clinics, by enabling remote monitoring of patients’ wounds in the community and improved digital health records.

Challenge/ problem identified

  • More than 61,000 people with a Diabetic Foot Ulcer (DFU) at any given time.
  • 6,000 people with diabetes have leg, foot or toe amputations each year in England – many avoidable.
  • Total NHS spending on ulceration and amputation is estimated at £1.3bn (Diabetes UK 2012).Atlas 2
  • Multidisciplinary team pathways based patients attending outpatient clinics at acute hospitals for all their DFU appointments is costly and in many regions the outpatient capacity cannot keep up with increases in demand.
  • Patients with DFUs are currently required to travel significant distances on a weekly or fortnightly basis to attend outpatient clinics at acute hospitals.
  • Providing access to correctly resourced multidisciplinary teams can improve DFU outcomes. This could result in avoided amputations and improved quality of life and mortality.

Actions taken

  • EMAHSN has supported the development and delivery of a demonstrator for a technology-enabled new model of care for DFU patients in South Derbyshire. The collaboration involves Derby Teaching Hospitals NHS Foundation Trust, Derbyshire Community Health Services NHS Foundation Trust and industry partners Entec Health Ltd and Aranz Medical Ltd. Together the innovation team has successfully implemented the Silhouette® 3D wound imaging system as part of an integrated pathway across both primary and secondary care in Southern Derbyshire.
  • EMAHSN assisted with ensuring that the system can be readily procured from a framework available to all NHS organisations and facilitated coordination with all partners to get the new pathway implemented in 10 settings.
  • EMAHSN is providing support with the implementation, communications, patient and public involvement, planning and procurement for wider adoption and spread across the region and nationally.
  • EMAHSN has established a health economic model and supporting evaluation to monitor and report on the impact of the demonstrator. A business case has been produced for the first year of deployment.

Impacts/ outcomes

  • silhouettePatient perception of outpatient waiting times at RDH have reduced. 3% of patients felt they were seen within 30 minutes in 2016 versus 72% in 2017.
  • Patient perception of community waiting times have also reduced. 71% of patients felt they were seen within 5 minutes in the community setting.
  • 71% of patients reported that their confidence had increased in the care that they had received since the start of the deployment.
  • Reduced administration – the number of letters typed up for GPs decreased by 76% from 2,182 (May to August 2016) to 525 (May to August 2017).
  • Over the four months from May-August 2017 this has saved 138 hours of band 4 admin time in comparison to the same four months in 2016.
  • 52% of hospital patients reported that they would prefer to have community located appointments. None of the patients seen in the community wanted their appointments moved to the hospital.
  • 790 appointments took place in the community in the first 19 months (an 8% shift from secondary care). This is forecast to increase to 14% in year 2.
  • Pathway cost savings (tariff costs) of £50,036 excluding Silhouette® equipment/licence costs.
  • A digital wound assessment system (Silhouette®) is now being considered across other chronic wound management pathways including Tissue Viability services to deliver further quality improvements and savings.
  • New business secured for both a UK SME and an international company.
  • Quality (healing times) of treatment maintained with opportunities for improvements.

 “Being able to have my check-ups at my local clinic is great. I have less distance to travel and it makes getting to appointments much easier. The process of being scanned using Silhouette® is also quick and I can see how my ulcer is progressing at each appointment.  I like the fact that this technology means I can get seen on my doorstep.”

David Hawkins, a patient from Ripley

Plans for the future

The solution model is ready for replication in other parts of the NHS.  After 12 months in operation in Southern Derbyshire, the Silhouette system is already being spread to North Derbyshire, Nottinghamshire as well as Cambridgeshire and Peterborough.

Which national clinical or policy priorities does this example address?

  • Generating economic growth – SBRI and supporting SMEs
  • Funding and efficiency gap, care and quality gap – Adoption and diffusion of innovation and research, Delivery of NHS England Enhanced MDfT Diabetes Foot Care and NICE Guidelines (NG19).

Start and end dates

Service came into effect in Southern Derbyshire from 1 September 2016, and since the end of the first 12-month demonstration supported by the EMAHSN, the service has been awarded National Diabetes Transformation funding for an additional two years for its expansion in South Derbyshire and implementation in North Derbyshire.

Contact for help and advice

Dara Coppel, Head of Implementation, Sustainability and Spread
T: 07917 220140
E: dara.coppel@nottingham.ac.uk

Chris Taylor, Associate Director of Communications and Engagement
T: 07738 151041
E: chris.taylor@nottingham.ac.uk

Find out more

The Silhouette project from EMAHSN on Vimeo.