Keep calm and carry on: Wound care in the UK
Around 80,000 UK residents live with one or more chronic wounds. The cost of caring for all wound patients in the country is estimated between £4.5 billion and £5.1 billion a year. How does Great Britain deal with the topic and what can we learn from it?
The current situation
In the UK, there are basically no differences in access to health care. Nevertheless, health levels vary between social classes within the country, for example in England: the population in the north is more affected by health inequalities than those in the southern part. Moreover, these inequalities are more pronounced for women than for men.
Within the UK population, nearly 15 in 10,000 people have chronic wounds. This means that a total of about 80,000 of the country´s residents are living with one or more chronic wounds. Between 2017 and 2018, a total of 3.8 million people received care through the public health system for a wound. More than two-thirds of all wounds healed within one year, although this was the case for only about half of the chronic wounds. The cost of treating wound patients through the UK public health system (NHS) totaled £8.3 billion between 2017 and 2018. 5.6 billion went toward the care of unhealed wounds. The cost per patient for unhealed wounds is on average 135 percent higher than for healed wounds. Chronic wound care in the UK is provided in a variety of settings and is often not based on current evidence. Multiple healthcare professionals are involved in care. The level of expertise varies. All of this means that care can differ widely in practice.
Strategies for better wound care
National Wound Care Strategy Program: Improving a Widely Branched System
The care of wound patients in the UK is not optimally organized. There are also shortcomings in practical implementation. To address this situation and bring about long-term improvements, the National Wound Care Strategy Program (NWCSP) was launched in September 2018. It grew out of several previous initiatives that addressed challenges in wound care. The main goal of the program is to develop guidelines to help prevent wounds from occurring in the first place or to treat them optimally and effectively. A key starting point for these guidelines is that the care of chronic wounds is not viewed as a clinically isolated problem. Rather, throughout the process, the NWCSP focuses on including the treatment of co-morbidities. Conditions such as diabetes or chronic venous insufficiency can cause wounds to develop more rapidly, delay healing, or prevent healing. It will be critical to the success of the NWCSP that all professions and services involved in wound care collaborate effectively.
The MARS Project: Counteracting amputations and their causes on a regional level
Amputation of the lower extremities often becomes necessary when an ulcer is not adequately treated in diabetics. Peripheral arterial disease or lymphedema can also cause such ulcers and consequently lead to amputations. In Greater Manchester, the limb amputation rate is 36 percent higher than the UK average. In one year, one thousand lower limb amputations are performed in this part of the country alone. Half of these amputations could be prevented. The Manchester Amputation Reduction Strategy (MARS) is tackling this issue and aims to reduce the limb amputation rate to at least the national average. The project is developing a strategy to prevent, better treat and more rapidly heal chronic ulcers of the feet and legs. More than 40 national and regional stakeholders are involved in developing this strategy. The plan is to establish coordinated management for chronic ulcers of the feet and legs and a single referral pathway in care. Specialized wound care teams are also emerging. The strategy is based on a whole systems analysis. To ensure that care can be tailored precisely to the needs of those affected, the relevant services will be evaluated in advance. All these measures should lead to a reduction in the inequalities that exist in the treatment of patients and in the results of treatment. MARS aims to reduce the prevalence of chronic wounds by 15 percent within five years. Patients and their experiences should be at the center of the treatment process. In addition, communication between healthcare professionals and patients will be facilitated through technical applications.
Looking closely instead of looking away: Awareness and empowerment
“Legs Matter!” is both the title and the call of an initiative in the UK that aims to raise awareness for better health for legs and feet. From October 11 to 15, 2021, this alliance of eight nonprofit health organizations hosted Legs Matter Week. The topic of wounds and their prevention is of particular importance. With events and information material aimed at both patients and healthcare providers, they want to raise health awareness among the population and promote knowledge about high-quality wound care.
The Lindsay Leg Club Foundation wants to bring about a reduction in the suffering of patients with chronic leg wounds by motivating and empowering them to take an active role in wound care. Special emphasis is also placed on reducing the stigma associated with this condition. In Lindsay Leg Clubs, patients meet experts and each other to share experiences and gain new learnings. Raising awareness among caregivers, other health professionals and the general public is also part of the agenda.
What can we learn from the UK?
Compared to the UK, Austria is lacking a similarly well-founded scientific data base in the field of chronic wounds. This could form the basis for a nationwide strategy that would sustainably improve the current care situation.
The competencies of the respective treating healthcare personnel vary in comparison between the two countries. In the UK, for example, nurses can issue prescriptions for dressings. In Austria, with a few exceptions (such as the “Styrian wound case”), this can only be done by physicians. Nurses and physicians must therefore coordinate more closely with each other in order to ensure a high quality of care. The exact matter of this coordination has not been formally defined so far.
As in the UK, a coordinated approach to the management of chronic wounds is currently missing in the Austrian healthcare system. The regional differences in the care of patients that exist in the UK are also likely to apply to Austria. Specific data on this topic is not available, but each of the nine provinces is approaching the care of chronic wounds in a separate way.
A model such as the MARS Project, which targets at-risk groups, involves patients and focuses on prevention, would also be desirable for Austria. A stronger focus on awareness and information campaigns as well as networking among wound patients are additional aspects that we should copy from the UK.