I am sure that many of you, like me, would have watched the televised coverage of the death of HRH Queen Elizabeth II. What stood out for me in the commentary about her life, was the love she had for her family and the steadfast way she served her country. What was particularly impressive was the way she met challenges, both in public and in her private life by seeking solutions, instead of seeing them as insurmountable problems. This ultimately made me contemplate about how we approach challenges in our professional lives.
In my professional life, I have reviewed a great deal of research into wound care, specifically, where it relates to the management of chronic wounds in the community. The statistics on the burden of non-healing wounds to the NHS and to the individual patient and their carers makes for very grim reading. Fortunately in the UK, we have up-to-date information on the impact of this burden (Guest et al, 2020). Using a sample of 3000 patients' notes in the community between 2017 and 2018, resource use and wound-related clinical outcomes were used to model healing rates and total healthcare resource use (Guest et al, 2020). This analysis estimated the annual NHS cost of wound management to be £8.3 billion, with £5.6 billion (67%) associated with managing non-healing wounds (Guest et al, 2020). 81% of the total annual NHS cost was incurred in the community (Guest et al, 2020). What is even worse is that, when comparing previously collected data from 2012 with that from 2018, it showed a 71% increase in the annual prevalence of wounds from 2.2 million to 3.8 million, along with a parallel increase in resource use (Guest et al, 2017; 2020). In 2017/18 the annual level of resource use attributable to wound management included 54.4 million district or community nurse visits, a nearly 400% increase since 2012 (Guest et al, 2017; 2020). Of course, this problem is unlikely to improve, as the number of elderly people in the population continues to grow. For example, those aged 75 to 84 years in England are projected to increase by 33.9%, and those aged 85 years and over, by 22.8% (Office for National Statistics (ONS), 2018).
Having read about the scale of the problem in the course of my research, I was also pleased to find evidence on new initiatives that have been put in place to seek solutions to the growing burden of chronic wound care. I would like to highlight one of these in particular, which has taken a cross-regional and integrated approach to addressing the issues surrounding wound care in England. In September 2018, the National Wound Care Strategy Programme (NWCSP) was launched (NWCSP, 2022). As stated on their website: ‘The vision is to develop recommendations which support excellence in preventing, assessing, and treating people with wounds to optimise healing and minimise the burden of wounds for patients, carers and health and care providers’. They also state that ‘Success will depend on recognising and addressing the interdependencies between the different professional groups and services involved in wound care’.
At the core of what they are offering are the NWCSP lower limb recommendations, which they are working to implement with a first tranche of community and hospital trusts within each of the NHS England regions. The NWCSP also offer a range of online support for healthcare professionals, including: a Lower Limb Forum, online information sources (e.g. surgical wounds), webinars, access to relevant news items, and also a quarterly newsletter. For the first time, these resources are accessible in one place.
Time, of course, will tell if the NWCSP has the desired effect of bringing about much needed improvement in patient care and resource use. It certainly looks promising and as HRH Queen Elizabeth famously said ‘It is worth remembering that it is often the small steps, not the giant leaps, that bring about the most lasting change’.