“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 is working with Derby Teaching Hospitals NHS Foundation Trust, Aranz Medical Ltd, Derbyshire Community Healthcare Services NHS Foundation Trust, Derbyshire CCGs and Entec Health 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 provides care for patients closer to home in the community reducing amount of travel on a weekly or fortnightly basis. 

Nationally there are more than 61,000 people with a diabetic foot ulcer at any given time – and around 6,000 people with diabetes have leg, foot or toe amputations each year in England, many of which could be avoided. As well as the impact on patients, the financial cost is high, with NHS spending on ulceration and amputation estimated to be £651m every year.

What's the impact?
  • Projected savings if deployed across the East Midlands: £0.9m-£1.8m per annum
  • Improved capacity and reduced activities / costs in secondary care, with a reduction of up to 2,000 follow-up appointments per year during the Derbyshire demonstrator phase of the project
  • Moving 30% treatment sessions to community clinics is forecast to reduce the overall diabetic foot ulcer service costs by up to 20%
  • Opportunity to scale Silhouette® across and beyond the East Midlands
  • New business secured for both a UK SME and an international company
  • The 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
  • 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
  • 490 appointments took place in the community in year 1( a 7% shift from secondary care). This is forecast to increase to 14% in year 2
What's next?

The solution model is ready for replication in other parts of the NHS. Implementation is rapid and straightforward and the technology could be used for other chronic wound management pathways such as tissue viability. Secured transformation funding for additional 2 year pilot and roll-out across Derbyshire. Eastern AHSN also planning to adopt this innovation
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