Introduction

This quality standard covers the diagnosis and management of varicose veins in the legs in adults (aged 18 and over). For more information about the scope of this quality standard see the topic overview.

Why this quality standard is needed

Varicose veins are dilated, often visible and palpable subcutaneous veins with reversed blood flow. They are most commonly found in the legs and are estimated to affect at least a third of the population. Risk factors for developing varicose veins are unclear, although prevalence rises with age and they often develop during pregnancy.

In some people varicose veins cause no significant symptoms, but in others they cause pain, aching or itching and have an adverse impact on their quality of life. Varicose veins may become more severe over time and can lead to complications such as skin damage (eczema and pigmentation changes), bleeding and venous ulceration. It is not known which people will develop more severe disease, but it is estimated that 3–6% of people who have varicose veins in their lifetime will develop venous ulcers.

The quality standard is expected to contribute to improvements in the following outcomes:

  • quality of life for people with varicose veins

  • progression of venous leg disease, which includes complications from varicose veins (skin changes including pigmentation and eczema, bleeding superficial and deep vein thrombosis and venous leg ulcers)

  • varicose vein recurrence.

How this quality standard supports delivery of outcome frameworks

NICE quality standards are a concise set of prioritised statements designed to drive measurable quality improvements within a particular area of health or care. They are derived from high‑quality guidance, such as that from NICE or other sources accredited by NICE. This quality standard, in conjunction with the guidance on which it is based, should contribute to the improvements outlined in the following 2 outcomes frameworks published by the Department of Health:

Tables 1 and 2 show the outcomes, overarching indicators and improvement areas from the frameworks that the quality standard could contribute to achieving.

Table 1 NHS Outcomes Framework 2014–15

Domain

Overarching indicators and improvement areas

3 Helping people to recover from episodes of ill health or following injury

Overarching indicator

3b Emergency readmissions within 30 days of discharge from hospital* (PHOF 4.11)

Improvement areas

Improving outcomes from planned treatments

3.1 Total health gain as assessed by patients for elective procedures iv. Varicose veins

4 Ensuring that people have a positive experience of care

Overarching indicator

4a Patient experience of primary care

i GP services

4b Patient experience of hospital care

4c Friends and family test

Aligning across the health and care system

* Indicator shared with Public Health Outcomes Framework (PHOF)

Table 2 Public health outcomes framework for England, 2013–2016

Domain

Objectives and indicators

4 Healthcare public health and preventing premature mortality

Objective

Reduced numbers of people living with preventable ill health and people dying prematurely, while reducing the gap between communities

Indicators

4.11 Emergency readmissions within 30 days of discharge from hospital* (NHSOF 3b)

Alignment across the health and social care system

* Indicator shared with NHS Outcomes Framework (NHSOF)

Coordinated services

The quality standard for varicose veins in the legs specifies that services should be commissioned from and coordinated across all relevant agencies encompassing the whole varicose veins care pathway. A person-centred, integrated approach to providing services is fundamental to delivering high-quality care to people with varicose veins in their legs.

The Health and Social Care Act 2012 sets out a clear expectation that the care system should consider NICE quality standards in planning and delivering services, as part of a general duty to secure continuous improvement in quality. Commissioners and providers of health and social care should refer to the library of NICE quality standards when designing high-quality services. Other quality standards that should also be considered when choosing, commissioning or providing a high-quality varicose veins service are listed in Related quality standards.

Training and competencies

The quality standard should be read in the context of national and local guidelines on training and competencies. All healthcare professionals involved in assessing, caring for and treating people with varicose veins in their legs should have sufficient and appropriate training and competencies to deliver the actions and interventions described in the quality standard.

Role of families and carers

Quality standards recognise the important role families and carers have in supporting people with varicose veins in their legs. If appropriate, healthcare professionals should ensure that family members and carers are involved in the decision-making process about investigations, treatment and care.