“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 Health 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® technology, and others like it, means care for patients can be provided closer to home, their community, reducing the 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 £1.3bn every year.

What's the impact?
During the first 12 months of the project........
  • Outpatient waiting times have reduced. 3% of patients seen within 30 minutes in 2016 versus 72% in 2017
  • 71% of patients seen within 5 minutes in the community setting
  • Reduced administration - the number of letters typed up for GPs decreased by 76% from 2182 (May to August 2016) to 525 (May to August 2017)
  • 71% of patients reported that their confidence had increased in the care that they had received since the start of the deployment
  • Pathway cost savings (tariff costs) of £31,012 excluding Silhouette equipment/licence costs. The cost savings does not include administration efficiency savings which will be evident in the hospital
  • 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
  • Opportunity to scale Silhouette® across and beyond the East Midlands
  • New business secured for both a UK SME and an international company
  • A digital wound assessment system is now being considered across other chronic wound management pathways including Tissue Viability services to deliver further quality improvements and savings
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 extension and roll-out across Derbyshire. Eastern AHSN are also planning to adopt this innovation.

View a summary of Sihouette in 30 seconds here: