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A New Standard for Wound Care

Digital strategies for relieving the
burden of wounds

Presenters

Margaret Kitching
Margaret Kitching MBE

Chief Nurse, NHS England & Improvement

Dr Una Adderley
Dr Una Adderley

National Wound Care Strategy Programme Director, AHSN Network

Professor Julian Guest
Professor Julian Guest

Principal, Catalyst Consultants

Laura Browne
Laura Browne

Lead TVN, Leicestershire Partnership NHS Trust

Jenni MacDonald
Jenni MacDonald

Lead TVN, NHS Lothian

Overview

Chronic wounds dominate the lives of almost four million people in the United Kingdom. The wound burden is also borne by their family and friends—and by the nurses, doctors and other caregivers who tend to them. Unfortunately, that burden is growing fast. A new report indicates a 71% increase in the prevalence of wounds managed by the NHS within a few short years, resulting in an annual cost of £8.3 billion. Despite clinicians’ hard work, those numbers are sure to increase without innovative change designed to expedite wound healing.

To explore the challenges facing wound patients and clinicians—and to map out digital solutions—Healthy.io partnered with NHS clinicians and Govconnect for a special webinar. Below you’ll find many of the questions asked by the audience, followed by responses from the presenters.

In case you didn’t catch the webinar or just want to view it again, click here for the full recording.

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"One of the things that's become very obvious, is digital technology helps release time for care, and moves us away from what often is double counting or erroneous methods of measuring and assessing wounds. I can say it's a key area that we will be focusing on."
Margaret Kitching
Margaret Kitching, MBE
Chief Nurse, NHS England & Improvement
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Questions & Answers

Julian Guest, on the Economic Impact of Wounds:

I think anything that will give us reproducible diagnosis in terms of wound type wound size can only be a good thing. Digitisation can certainly help with that. 

This estimate is not available at the current time and I would not want to speculate.

According to our analysis, the cost of wound care was £8.3 billion. That does not include the cost of resources required to manage heart disease or diabetes or any other comorbidity, but the possibility that there’s been some conflation can’t be excluded. But we try to focus exclusively on the cost of resources required to manage wounds. 

Table 10 in our 2020 publication provides the cost per healed and unhealed wound for each wound type. The average NHS cost of managing a wound in 2017/2018 was estimated to be £3,910 per chronic wound and £780 per acute wound.

Yes, it did. The analysis was performed using 2017/2018 costs and all previous cost estimates were uprated to 2017/2018 values as described in our 2020 publication.

The cost per wound was remarkably similar between 2012/2013 and 2017/2018 even though unit resource costs had increased. This was due to a shift away from secondary care towards greater utilisation of community-based resources (which are cheaper). In 2012/2013, 48% and 78% of the total annual NHS cost of managing acute and chronic wounds, respectively, was incurred in the community and the remainder in secondary care. In 2017/2018, 68% and 85% of the total annual NHS cost of managing acute and chronic wounds, respectively, was incurred in the community and the remainder in secondary care. Consequently, much of the increased cost was due to the increased number of wounds being managed in 2017/2018.

There seemed to be minimal clinical involvement of tissue viability nurses and other specialist nurses in direct patient management. Hence, the biggest lost opportunity in terms of reducing costs is the potential difficulties experienced by non-specialist healthcare professionals in the community managing wounds without necessarily establishing a working diagnosis. This was compounded by dressing and bandage types having been continually switched at successive wound dressing changes for the majority of patients, which may indicate confusion and conflict within the treatment plan.

The surgical wounds in our study reflect the number of wounds that remained unhealed four weeks after the surgical procedure. The reasons for the increase in this wound type are likely to be multifactorial, but patients being managed by non-specialist healthcare professionals in the community who continually switch dressing and bandage types at successive wound dressing changes – and not suspecting an infection – probably contribute to this. 

The rate of increase varied according to wound type. The annual number of lower limb wounds increased by ≥100%, whereas pressure ulcers increased by only 32%. We consider this difference is due in part to the ongoing pressure ulcer prevention campaign and CCGs having been restricting referral of varicose veins to a vascular service – this is the consequence.

If wounds were prevented, and resource use associated with wound management was decreased accordingly, it should have the effect of reducing costs and freeing up resources for alternative use.

Una Adderley and Margaret Kitching, on the National Wound Care Strategy:

Una: The need is very similar for both acute trusts and community providers. Wound management digital systems that will be used in situations without access to the internet need certain attributes, such as the capability to store entered clinical data until internet access is available.  However, this can be just as much a problem within some buildings as in very rural areas. 

Margaret: Yes, it’s important that digital solutions span patient pathways, including acute care.

The James Lind Alliance work is more focused on identifying priorities for research, but we agree that service users’ input into how wound care services are designed and delivered is very important.  The National Wound Care Strategy Programme has had a patient and public voice forum from the start and patients and carers are actively involved in the NWCSP Board, Stakeholder Council and workstreams to ensure that the NWCSP is informed by their views. In addition, one of the criteria for each NWCSP 1st Tranche Implementation Site is active engagement of service users

I don’t think it’s about digital innovation, standardising wound care. I think what we need to be doing, is working out what are the standards and how can we apply digitisation to that? That’s what we need to be doing, and then we apply the digital technology to help us do that. 

Una: This is a challenge, but good quality data and information does make a difference.  Political interest in wound care only really began when Professor Guest’s 1st ‘Burden of Wound’ care study was published. To paraphrase Mark Carney in one of his recent Reith Lectures, ‘If it doesn’t get measured, it doesn’t get managed’. Regarding community nursing, Sam Sherrington (Head of Community Nursing for NHS England and NHS Improvement) has recently begun a piece of work seeking to establish how to demonstrate the value of community nursing.  I hope the results of this will raise awareness of the essential importance of community nursing and District Nurses in particular.  

Margaret: The programme is primarily focused on community care and we have strong leadership around education and training and workforce including the issues affecting DN services, we are connected to DHSC so a strong political and national leadership group which is gaining momentum and support.

The National Wound Care Strategy Programme (NWCSP) is commissioned by the NHS England and NHS Improvement Nursing Directorate and already working very closely with other NHS policy teams such as the Healthy Ageing Directorate, Community Improvement Team, CQUIN team, NHS Digital, NHS Patient Safety Team and NHS X.   The NWCSP is also working closely with other partner organisations such as the Academic Health Science Network.

We are hopeful that the wound care CQUINs for 2020-21 will be reinstated for 221-22 but this rests on a decision about whether the CQUIN programme will run for this financial year.  Regarding the possibility of other incentive programmes, such decisions are outside the control of the NWCSP but given the high level of interest in the NWCSP, we are hopeful.

Jenni MacDonald, on the Patient Experience: 

Yeah, absolutely it is. Although it’s difficult to imagine having a wound, those who have cared for patients with wounds become quite intertwined in the patient’s life. I think certainly we’ve got some improvements to do as health care professionals in addressing the mental health concerns caused by wounds going forward. And I think at the moment, I think we’re relatively limited to signpost for mental health support, but we should be making that standard practice.

Questions About Healthy.io’s Digital Wound Management Service:

After a nurse uses the app on a smartphone to complete a wound assessment, imagery and information is uploaded to the cloud where it is turned into a 3D model of the wound.  This more accurate and detailed data helps to drive reporting and clinical decision making, and can be accessed through the app, the online portal, or the electronic patient record.  The digital wound management programme makes consistent and detailed records of wound assessments centrally accessible to the nursing team without duplicating any record keeping.   

It takes just a moment to capture consistent, high quality imagery of a wound using the app.  Accurate wound measurements are calculated from the information captured, helping to show wound progression from one visit to the next.  Nurses can add wound depth and other record keeping information and benefit from time saving features like auto-correct, speech-to-text inputting and auto-recognition of tissue types.

Feedback from early adopter sites is that implementing a digital wound management programme can reduce wound healing times by two weeks in around 25% of the caseload. Nurses report that digital tools make it quicker and easier to identify stagnating wounds which can then be moved onto more appropriate care plans sooner.  This is improving patient outcomes and releasing time to care by reducing nurse contacts. 

100% of patients surveyed at one early adopter site reported being shown imagery of their wound by the nurse during assessments.  They reported how this made them feel more involved in their care and improved their feeling of wellbeing.  

The app is CE marked as a medical device and is compliant with the NHS Digital standard for clinical risk management and its application in the manufacture of health IT systems.

The app provider Healthy.io is ISO27001 accredited, GDPR compliant and has a range of other global cyber security badges including HIPAA.  Deployments of digital wound management programmes are underpinned by a Data Protection Impact Assessment which is independently delivered by a Cyber Essentials Plus accredited health and care, information law and data governance specialist.  No data is stored on staff handsets and all cloud based activity is in line with NHS Digital recommendations.

We are hopeful that the wound care CQUINs for 2020-21 will be reinstated for 221-22 but this rests on a decision about whether the CQUIN programme will run for this financial year.  Regarding the possibility of other incentive programmes, such decisions are outside the control of the NWCSP but given the high level of interest in the NWCSP, we are hopeful.

Implementing a digital wound management programme would be a significant step towards digitising record keeping and a simple way to make records of assessments more consistent and easily accessible.

Early adopter programmes have been led by tissue viability specialists in both community and acute sites, joined by other practitioners like community nurses, district nurses and podiatrists.  The app can be used across a range of settings including clinics, wards and patient’s homes. 

Further Questions?

Curious to learn more about the digitisation of wound care? Fill out the form with your questions and we’ll get back to you soon. 

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