Rethinking leg ulcer care around the people who need it most
St. James's Hospital
- Design Research
- Service Design
- Co-Design
Rebuilding a vital service
For people living with leg ulcers, getting the right care at the right time can make all the difference. But when a specialist clinic at St James's Hospital in Dublin closed, patients were left navigating an increasingly fragmented system.
The impact was significant. Over 350 GP referrals were returned between August 2024 and mid-2025, while patients who could have received earlier treatment were instead arriving through Emergency Departments.
Big Motive partnered with St James's Hospital and HSE Spark to reimagine a new leg ulcer service. Our challenge was to understand the barriers facing patients and healthcare professionals, and co-design a more accessible, joined-up service with the ambition of becoming a national gold standard by 2030.
Seeing the whole person, not just the wound
Leg ulcers are painful, often recurring conditions that disproportionately affect older adults. Beyond the physical impact, they can affect confidence, independence and quality of life.
We spoke with patients, carers, clinicians and healthcare specialists to understand their experiences, mapping a complex journey and multiple handovers between services.
Four challenges emerged: gaps in knowledge, disconnected care, lengthy delays and barriers to access.
For some patients, specialist appointments could take up to a year. Others faced significant costs for dressings, transport and ongoing treatment.
I was told it wasn't urgent and would have to wait a year, but I knew I could not wait a year.
Using the Age-Friendly Health Systems' 4Ms framework, we looked beyond clinical treatment to consider what matters most to patients, including their medication, mental wellbeing and mobility.
We also developed four patient stories grounded in real experiences, helping everyone involved see the challenges through the eyes of the people receiving care.
Co-designing a better way forward
Working closely with St James's clinicians and HSE Spark, we brought 12 healthcare professionals and specialists together to imagine a better future for leg ulcer care.
Through collaborative workshops, journey mapping and service design, we explored how patients could access support earlier, move more easily between services and feel more confident managing their condition.
Together, we developed ten recommendations, from practical improvements that could be introduced quickly to longer-term changes across the healthcare system.
These included a patient passport to keep important medical information in one place, hands-on training for families and carers, improved education for community nurses, and direct self-referral for patients experiencing recurring ulcers.
The ambition was simple: a service that works around people's lives, rather than expecting people to navigate the system themselves.
Turning ideas into tested solutions
To bring the recommendations to life, we created illustrated storyboards showing how four priority concepts could improve real patient experiences.
We tested these ideas with public health nurses and patients, using their feedback to refine the proposals and understand what would work in practice.
Patient self-referral received particularly strong support, offering people with recurring ulcers a faster route back to specialist care without restarting the referral process.
The patient passport also showed promise, giving patients and healthcare professionals a shared record of treatments, allergies and previous care.
Personally I find this absolutely necessary!
Testing helped turn early ideas into more practical, evidence-led opportunities for change, shaped by the people who would use them.
A clearer path to better care
The project gave St James's Hospital a shared vision and an actionable roadmap for rebuilding its leg ulcer service.
Together, we delivered a detailed picture of the existing patient journey, ten prioritised recommendations and four tested concepts to guide future development.
With leg ulcer and cellulitis admissions costing the hospital approximately €16.9 million annually, the opportunity for earlier intervention and more connected community care is significant.
More importantly, the work established a foundation for a service that puts patients back at the centre of their care, supporting greater independence, better access and a more joined-up experience.
By bringing patients, carers and healthcare professionals into the design process, we helped St James's move from a fragmented system towards a shared vision for the future of leg ulcer care.
