PPP’s inaugural Wound Care Conference sought to highlight unmet needs, benchmark best practice and debate approaches to reforming wound care services. During the conference, PPP’s report, Going further for wound healing, was launched and laid the foundation for the discussions that followed.
Wound care was estimated to cost the NHS £8.3 billion in 2017/18, but as was discussed at the conference, this figure is now likely to be more than £12 billion annually.
Despite the 2017/18 figure placing wound care as the third-highest cost to the NHS after cancer and diabetes, it remains absent from the national debate and most of England’s integrated care board (ICB) strategic priorities.
UK wound care transformation; benchmarking progress
Opening the conference, Dr Una Adderley, Director of the National Wound Care Strategy Programme, argued that to ensure evidence-based wound care is broadly available, top-down implementation is necessary. Adderley explained that ICBs ultimately get their instructions for setting their strategic priorities from NHSE, and that wound care must therefore be recognised as an issue requiring urgent attention by the Department of Health and Social Care (DHSC) to encourage NHSE to mandate its prioritisation at ICS level.
With up to 50 per cent of the district nurse workload being taken up by wound care, releasing this capacity is essential if the government wants community services to deliver more care.
Douglas Hunter, a patient who has lived with a wound for more than 30 years, and supported by his wife, described his first-hand experience navigating UK wound care services. In doing so, Hunter reminded the audience of the importance of centring the patient journey in conversations around service reform.
The necessity for a collaborative approach to transformation was emphasised by industry representatives Thariea Whisker and Kate Backshell. Whisker noted that digital solutions are a key pillar, but must be considered alongside other areas, such as education, to underpin and strengthen reform.
“It’s our responsibility [as industry] for research and development and to create great tech but also to get it to the right patient at the right time, and in a way that is relevant for integrated health care systems.”
Kate Backshell, Senior Business Unit Director, Smith+Nephew
“The new ICS structure provides the ideal framework for the implementation of the [NWCSP] recommendations. The challenge now is to secure prioritisation of wound care at system-level. We need top-down support from the DHSC and NHSE to set wound care as a national priority so that we can turn aspiration into delivery.”
Dr Una Adderley, Director, National Wound Care Strategy Programme, NHS England
- To achieve widescale adoption of evidence-based wound healing practices, wound care must be prioritised at the national level.
- 50 per cent of the case load for district nurses is wound care. Implementing better wound care practices would therefore lift significant burden from community services and allow them to deliver upon national priorities.
- A collaborative approach between health care providers, industry, patients, and clinicians is necessary to successfully transform wound care.
Prevention through innovation: the future of wound care
This panel discussed innovation with regard to the prevention of wounds. The chair, Michael Clark, Director of Services and Systems at the Welsh Wound Innovation Centre, began by explaining that it isn’t necessarily new technologies that are needed, but rather, that innovations in the workforce, systems and education are fundamental to improving practice.
Chief Executive of The Queen’s Nursing Institute, Dr Crystal Oldman CBE, explained that “we won’t have innovation if there is no data – we also won’t know that innovation is working”. She added that without data, it becomes difficult to demonstrate the harm caused by suboptimal care and the need for innovative solutions in the first place.
Geraldine Harkins, Vice President Europe North, Wound & Skin at Coloplast, spoke of the vital role of public sector and industry partnerships to achieve improvements in wound care. She argued there is huge opportunity for collaborating to improve care, but to enable this, it must be recognised that the NHS doesn’t have the resource to do it alone.
Dr Kirsi Isoherranen, President of the European Wound Management Association (EWMA), reiterated Harkins’ remarks, explaining that even with optimal care, some ulcers are hard to heal, making collaboration with industry to harness new innovations essential. She also discussed the potential of technological innovation to enable prevention. In Finland, the EWMA are investigating the possibility of using AI-based technology to detect at-risk patients in primary care and implement early interventions.
Louise Brady, an active general practice nurse (GPN) and the National Primary Care Nurse Lead for NHS England, brought the audience’s attention toward the role of GPNs in wound care, describing them as the “invisible warriors of primary care, delivering 84 million consultations every year”, and highlighted their potential to kickstart the prevention agenda for wound care in general practice.
“Not delivering appropriate [wound] care is a cause of harm. If we collected that data, [we would see the equivalent to] the Mid Staffs scandal, but in the community.”
Dr Crystal Oldman CBE, Chief Executive, The Queen’s Nursing Institute
“We are pretty good at innovation, but not so good at adoption. There are lots of examples of great innovation out there in the system, but the ability to scale it up is a common and recurrent problem.”
David Lawson, Director, Medical Technology Directorate, DHSC
“We need to recognise the NHS doesn’t have the resources to do everything. We need to trust one another to do wound care in the most ethical way possible. Our objective is to do it the right way, to work in partnership, to support and help to deliver audit and prove what is happening out there and help patients to get great outcomes.”
Geraldine Harkins, Vice President Europe North, Wound & Skin, Coloplast
“Reducing health inequalities in wound care and wound care management starts with restoring relationships. We do need to bring some of those mandated standards at national level but at the local level it’s about ICB strategies and relationships.”
Louise Brady, National Primary Care Nurse Lead, NHS England
- Innovation in wound care should be around workforce, systems, and education as much as new technologies to improve patient outcomes.
- Education for nurses must be improved right from the beginning of training to embed knowledge and culture of best practice around wound prevention.
- Through identifying at-risk patients in the GP patient records and educating GPNs to identify the right symptoms, harnessing general practice could be key to wound prevention.
Establishing partnerships in wound care to improve patient outcomes
Industry representatives presented various examples of collaboration with healthcare practitioners to improve the delivery of wound care but cautioned that the NHS must have an openness to collaborate. They reiterated that their end goal is the same as that of the NHS – better outcomes for patients.
Adding a workforce perspective, Professor Jennie MacDonald discussed the role of tissue viability nurses (TVNs) from her experience as a consultant TVN. She highlighted the value that specialist nurses can bring across health and social care settings and their ability to be key change agents in wound care. She said: “it seems illogical that there are fewer than 2000 TVNs in the UK, yet wound care is the third-highest cost to the NHS”. To reverse this trend, their value must be better understood by senior ICS leadership.
“Our mission and vision as a company is to free patients from the burden of wounds, and that’s why it’s been so important for us to be part of the report because it aligns with our aims and visions of what we want to do in terms of going further with wound care, and complements what we do to facilitate outcome-focused care.”
Ali Hedley, Medical Affairs Manager UK, Mölnlycke
“We need to keep lobbying and fighting for our patients, working together as a whole system to open discussion, help solve the challenges and embed the recommendations from the NWCSP.”
Kirsty Hunt, Regional Business Manager, Hartmann
- The NHS workforce must have an openness and willingness to work with industry to harness collaboration in wound care service delivery.
- Specialist nurses such as TVNs have an invaluable role in wound healing but their numbers are currently low, contributing to the sub-optimal standard of wound care in the UK.
- The value of the TVN must be understood by ICS leadership to enable them to become properly remunerated, integral parts of wound care services.
Effectively commissioning wound care
Julie Hodson, Head of Community Commissioning at Sussex ICB, opened this panel by describing her experience as a commissioner securing funding for wound care programmes in her ICS. She provided a roadmap for others who seek to do so and highlighted the information that system leaders must have visibility of to enable funding allocation. Hodson recalled examining pertinent data, listening to expert clinicians, and analysing wound care costs in her system to create the case for change. Identifying the ‘hooks’ necessary to secure ICB approval, such as aligning the case to strategic priorities, was fundamental.
This approach was echoed by Naseer Ahmad, Vascular Surgeon and Clinical Director of the Manchester Amputation Reduction Strategy (MARS), who as part of the MARS programme, ensured that wound care was included in Greater Manchester ICS’s five-year system priorities. Tapping into inequalities and discussing amputation rates were the key arguments needed to convince the ICB.
Vic Townshend, Programme Director – Population Health Management at Lincolnshire ICS, discussed how population health management approaches can improve the decision quality for commissioners and providers. In the case of wound care, she said “it is where we start to surface the true impact of the variation in care for wounds and the opportunity to improve outcomes. Your system leaders have to look at it and will see there is a shared objective that they need to tackle.”
“A whole-systems approach is working across public health, community, hospital, digital, procurement, academia, using implementation sites to make sure we understand why people aren’t doing what they know they should be doing and overcoming those barriers.”
Naseer Ahmad, Vascular Surgeon and Clinical Director, Manchester Amputation Reduction Strategy
“Population health management is 10 per cent data and 90 per cent behaviours. But what it can do is create the Rosetta stone for a shared understanding of population need, opportunity for improvement and a framework for decision-making for how we allocate our resources and understand what our strategic priorities are as a system.”
Vic Townshend, Programme Director, Population Health Management, Lincolnshire Integrated Care System
“There is no magic bullet but I’d like to see ICSs combine intelligence with better knowledge management, a scientific approach to quality improvement and bring [them] together into a proper learning health system.”
Sue Lacey Bryant, Chief Knowledge Officer, NHS England
“Now we are five years on, I would lay a pound to a penny that the cost of wound care to the NHS is hitting double figures now and is in the range of 12 billion. We cannot just rest on our laurels; we must do something.”
Christine O’Connor, National Strategic Advisor, Coloplast
- The case for change in wound care will be different across ICSs and reflect the unique situation in each locality.
- Regardless, the case for change must be comprehensible to system leaders, who may not be clinicians, and should align with system priorities.
- Population health management can demonstrate the true impact of variation in care for wounds, highlighting opportunities for improvement and creating a framework for decision making.
Breaking silos to integrate wound care
This panel discussion set out to address the different silos of work existing across wound care services, from commissioning to clinical practice, and how to break them down to enable a more collaborative approach to service delivery. Diane Jones, Chief Nurse in North East London ICB, explained that establishing ICB wound care champions can help to break down silos and drive transformation in wound care. She also stressed the need to keep arguments local to motivate ICBs to make commitments on wound care.
Louise Patten, Strategic Advisor to the NHS Confederation, described how using GP data, systems should be able to support future wound care planning. She explains that the data is there, but systems must utilise the knowledge they have about their populations, echoing Vic Townshend, and highlighting the possibility for wound prevention to be harnessed in general practice.
Senior Professional Services Manager at the National Pharmacy Association, Matthew Peters, posed the question of whether pharmacy can play a more integral role in the wound care pathway. The audience discussed that pharmacists are well-positioned to support the prevention agenda, and that if pharmacists could identify those at risk or recognise abnormal healing, early interventions could be implemented in community settings. Peters noted that other countries are utilising pharmacists in wound care, emphasising that the UK should explore this.
“If there’s a compelling case that it will make a difference to the local population and close a gap in inequalities, there is a very good chance it will get commissioned going forward.”
Diane Jones, Chief Nurse, North East London ICB
- Identifying an ICB champion for wound care would help ensure that it is prioritised at system level and help develop more locally responsive commissioning practices for wound care.
- ICSs should use GP data for future wound care planning around workforce and budgets as well as to realise opportunities for preventative measures.
- The pharmacy sector offers huge potential in wound care as the most accessible point of healthcare in the UK, especially for wound prevention and basic care.
Geraline Harkins, Christine O’Connor, and Andrea Keady joined PPP Chair, Stephen Dorrell, in the closing discussion of the conference to sum up key takeaways and re-ignite the momentum required to bring about the changes needed in wound care highlighted throughout the day.
“Innovation is about going back to basics and getting it right first time. There are many patients out there suffering with wounds needlessly because the people who deal with them first and foremost in primary care don’t know what they don’t know. We can prevent chronicity and delays to healing if we get it right first time.”
Geraldine Harkins, Vice President Europe North, Wound & Skin, Coloplast
“Collaboration and partnership are only words. They are only meaningful when they come off the page, when they actually happen. Do you really want to work with industry? If you do, the door is open, you’ve just got to let industry in to work with you. Don’t use the hidden agenda that industry wants to sell products. Of course, they do, but at the heart of it is the desire to do what [healthcare practitioners] are trying to do, which is make a difference to people’s lives. Let’s not throw these words around, let’s mean it if we are going to do it.”
Christine O’Connor, National Strategic Advisor, Coloplast
“It’s amazing the momentum that has been created this year, culminating in today. But all the energy and excitement in this room needs to be taken forward to get wound care the priority it deserves.”
Andrea Keady, Market Access Lead, 3M
“We all have the same single objective, whether we are in the policy space, professional space, or the commercial space, single magic thread that needs to follow through and join us all up. If we are all on the same team, we have some chance of being able to deliver the objective.”
Rt Hon Stephen Dorrell, PPP Chair
Our thanks to our sponsors HARTMANN, Smith+Nephew, Healthy.io, Mölnlycke, L&R, 3M, Spirit Health and Coloplast, and our partner, The Queen’s Nursing Institute, for partnering with the PPP Wound Care Conference.
To find out more about partnering opportunities for the 2024 PPP programme on wound care, or other upcoming PPP programmes in the health and life sciences sector, email firstname.lastname@example.org.