Nursing staff are all too aware of the significant challenge wound care poses but it is only in recent years that this burden is becoming more apparent to the wider healthcare system, explains Jacqui Fletcher.
Data now suggest that approximately 2.2 million patients have a chronic wound (Guest et al 2016) with the annual NHS cost of managing these wounds and associated comorbidities being £5.3 billion (Guest et al 2015).
It’s clear that wound care is a significant burden – one that will likely continue to increase. Yet, it can often lack priority, investment and direction, meaning there is now a real need for a coordinated national wound care strategy.
“A clear national strategy to address these challenges is needed which focusses on streamlining processes and/or removing those that serve little or no purpose”
There are multiple factors at play when looking at this issue. However, much of the burden is attributed to lapses in care, for example failure to assess, resulting in delayed healing and associated pain for patients.
Vowden and Vowden (2016) looked at the clinical implications of these factors, focussing on the inconsistencies in care, lack of appropriate care plans or specialist involvement in constantly changing dressing use.
They state: “It was difficult to define who has responsibility for care of the individual patient’s wound and the management of any associated comorbidities … clinical experience suggests that communication between practitioners is often poor and there is no clear role allocation”.
These can be challenging assertions for clinical staff to hear, especially as many already feel they are stretched to their limits, budgets for education have been withdrawn and once again the NHS is undergoing a major reorganisation to deliver place-based care.
A clear national strategy to address these challenges is needed which focusses on streamlining processes and/or removing those that serve little or no purpose. Every clinical team works with local nuances, some with more sophisticated processes. However, there is always room for improvement - too often their current systems confuse, obfuscate and delay.
“It is clear that there’s overwhelming support for such an approach so let’s hope that the conversation continues”
Community systems do not always communicate with hospital systems, nursing systems do not always integrate with GPs, meaning so much clinical time is spent navigating these issues, for example the inconsistency in SystmOne Wound assessment charts.
The new Wound Assessment CQUIN was launched for year 2017/2018 but the exemplar recommended tool was only sent out in December 2017 when much of the work had already been completed.
It feels that a time-stretched NHS is often drowning in the things that make less of difference; focussing on the process/task, taking valuable time away from patient care, and arguing about cost prices of dressings.
Many new technologies, often more expensive, stall because of this focus on the cost when in fact they can make real differences to patients.
A recent debate at the House of Lords, ‘Improving the standard of wound care in the NHS’, (November 2017), discussed the burden of wound management in the UK and suggested strategies on how to improve the standard of wound care across the NHS.
It is clear that there’s overwhelming support for such an approach so let’s hope that the conversation continues and the data are used in making decisions so we can unite in a coordinated response.
Jacqui Fletcher is an Independent Wound Care Consultant, Senior Nurse Advisor – Stop the Pressure Programme (NHS Improvement).
Guest JF et al. (2015) Health economic burden that wounds impose on the National Health Service in the UK. BMJ Open 5: e009283. doi:10.1136/bmjopen-2015-009283
Guest JF et al (2016) Health economic burden that different wound types impose on the UK’s National Health Service. International Wound Journal; 14: 2, 322-330.
Vowden P, Vowden K (2016) Clinical care implications of the ‘Burden of Wounds’ study. Wounds UK; 12: 3, 12 – 21.