The focus in the UK’s wound care program is on patient comfort and healing, rather than cost/benefit analysis or financial integrity. But from a practical standpoint, especially in a nation which offers socialized medicine, all citizens are sharing the burden of this cost. This begs the question: are the UK’s current wound practices… practical?
Professor Peter Vowden, former Head of the Department of Vascular Surgery at the Bradford Royal Infirmary, UK, recently led a study to find the answer.
"Burden of Wounds”
Professor Vowden analyzed NHS patient care over 2013 and 2104, and then extrapolated and applied his findings to the UK’s entire adult population. His research was limited to external and surgical wounds that require more than four weeks of follow-up care; internal wound care was not assessed.
What is Wound Treatment Actually Costing the UK?
The UK’s heavy price tag for wound care was £5.3 billion annually. For comparison’s sake, keep in mind that this is roughly the same cost for treating and managing depression across the UK. Surgical wounds and leg ulcers were found to be among the most costly to treat.
The predicted annual cost of British wound care incurred by average CCG (250,000) stands at an estimated £36.6 million currently, and is forecasted to increase steadily, reaching £55.7 million by 2020.
Bottom line: wound care costs in the UK are rising, and rising fast.
Health Impact
In addition to cost analysis, Prof. Vowden’s study also examined the kinds of wounds being treated as well as the method of care. The concerning piece here is that Prof. Vowden and his team discovered that a large percentage of wounds were not awarded any diagnosis at all. Wound status and size were generally not recorded, and, often, no treatment plans were established in order to foster efficient healing.
Certainly, this was disturbing news for a number of reasons. First, an accurate diagnosis is required in order to obtain proper treatment. If a patient retains no diagnosis, he or she cannot be referred to the right medical provider, which translates to nonspecialized care. Second, without meticulous documentation of the status of a wound, it becomes impossible to follow up with the patient methodically and monitor progress in healing. Third, in the absence of a systematic treatment plan, both dressing and care is inconsistent, leading to unstable and deficient recovery.
Financial Impact
In an environment of inconsistent or undocumented care, the significant piece here is that these wounds are simply not healing, requiring more curative care (more expensive) as compared to preventative care (less expensive).
The financial consequences are seen most clearly as related to leg ulcers and surgical wounds. A large portion of the wounds being treated in the UK’s adult population is diabetic foot ulcers. These complex (yet common) wounds are occurring at a greater rate than they are being healed, which means that there will be a year over year increase in health service provider costs. A wound that heals efficiently costs the NHS around £800 to treat, whereas a wound that doesn't heal efficiently costs over five times as much, with a price tag around £4,500.
Practical Changes are Coming
The paramount goal is that the patient receives the right treatment at the right time for the best possible outcome. Ideally, a marriage between patient optimal health and cost efficiency can be reached.
Toward this end, as a result of Prof. Vowden’s study, a proactive collaboration between researchers and the NHS will foster the positive changes needed to improve preventative and diagnostic patient care, ultimately increasing healing rates while simultaneously reducing costs.
The NHS: Leading Change and Adding Value in Wound Care
In 2017, the NHS launched the Improving Wound Care Project, which focuses on improving the quality and consistency of wound assessment. The key piece in the project is the newly established Wound Care CQUIN (Commissioning for Quality and Innovation) which identifies indicators to consistently improve patient outcomes.
In addition, RightCare economic analysis will encourage cost control while promoting the best possible health outcomes.
High priority will be assigned to improving treatment of the lower limbs in order to prevent foot ulcers.
An “Education and Competencies Framework” for wound care will be created, as exists in other areas of UK patient care. Community and Primary Commissioning guidance for wound care services will ensure that all local care providers across the UK have the knowledge and resources necessary for identifying and properly treating wounds, including the information required to refer patients to wound specialists when an elevated standard of care is appropriate.
Lastly, a new commercial campaign aimed at the general public, "React to Red", will help prevent the development of pressure ulcers by educating patients on early identification and detection.
Healing Wounds
Ultimately, wound care in the UK causes patients immeasurable hardship and distress, while costing the NHS billions every year.
This extensive study, which was ethically approved by the Health Improvement Network (THIN), brought to light the practices that are leading to high costs and low healing rates. If patient outcomes are not improved, the costs to NHS will continue to rise, and patients will continue to suffer.
A combination of proper prevention and treatment, already underway, will provide the sought-after benefits. A win-win solution is on the horizon for wound care.