1000 lower limb amputations are performed annually in Greater Manchester (GM) of which half are preventable. The path to an amputation begins with an ulcer that is inadequately treated in people with diabetes, peripheral arterial disease (PAD), venous disease and lymphoedema. Wound treatment is the same regardless of aetiology e.g. foot ulcers are managed similarly in people with and without diabetes. There are approximately 330 000 with these conditions in GM – however, significant overlap exists.

There are inequalities surrounding amputations in GM with rates over 2.5 times higher in men than women and higher in black than white populations. These are most likely due to the diverse management and support that is available within localities. However, GM has nationally recognised areas of excellence of which Salford’s community vascular triage service has been highlighted by NICE. A similar program exists in North Manchester. These have been shown to be cost effective in reducing referrals to hospitals and treating claudication.

The cost of managing chronic wounds is rising as a result of rising prevalence, NHS inflation and population growth. The main costs associated with managing wounds are drug prescriptions, community nurse visits and hospital visits. The estimated cost of chronic wounds across GM in 2017/18 was £200m this is predicted to rise to £356m by 2021/22. This data suggests that reducing overall prevalence of chronic wounds by 15% within five years will result in an annual GM saving of £70m.

What is the MARS programme?

The Manchester Amputation Reduction Strategy (MARS) aims to reduce major limb amputations through the development and implementation of a MARS Commissioning Strategy designed to prevent, manage and heal chronic foot and leg ulcers faster. Existing resources will be redistributed to create a single community referral pathway, a coordinated lower limb management pathway and specialist wound care teams.

MARS incorporates Public Health, Health and Social Care as well as innovative IT platforms, including those already being used in Burn and Dermatology services. The MARS vision is to develop and be integral to a GM Wounds Strategy.

The key outputs from the implementation of the MARS Commissioning Strategy are:

1. Development of a MARS Public Health Framework –The 3-4-50 Strategy

2. Implementation of an integrated lower limb management pathway incorporating:

  • Creation of a community based single point of referral system that will triage and onward referral based on foot risk
  • Creation of community ‘wound care teams’ managed by non-medical consultants that
    incorporate existing district nurse, podiatry and tissue viability teams.
  • Integrated care protocols with public health, social care and hospital teams

3. GM wide IT system that facilitates referral across GM using images of wounds

What are the anticipated outcomes measures?

  1. Reduction in prevalence of chronic wounds by 15% within 5 years
  2. Reduce hospital AE attendances, admissions and outpatient referrals
  3. Reduce annual spending on chronic wounds by £70m within 5 years
  4. Reduce inequalities in service provision and access to services
  5. Put the patient experience first: https://goo.gl/j2t64k