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Patient expectations of pressure ulcer prevention in the NHS, healthcare demands and national policy: a critical commentary

12 November 2020
Volume 29 · Issue 20


Preventive care was recently identified as a Government priority, which is likely to affect pressure ulcer (PU) preventive care in the NHS. Contemporary economic analyses of PU prevention interventions are undermined by factors including methodological challenges and poor inter-rater reliability of PU risk assessment tools. Healthcare demands on the NHS created by PU prevention remain unclear, although the burden is high, with litigation costs rising continuously. The poorly understood economics of PU prevention may create variation in practice. Patient expectations of PU prevention may be influenced by mainstream media, national awareness campaigns and the varied information and advice offered by professionals. Patient expectations and low levels of functional health literacy may create confusion and unrealistic expectations. This article critically examines the impact of recent changes in Government priorities related to PU prevention, considering the effects of healthcare demand, economics and patient expectations.

Hard-to-heal wounds create a significant burden on individuals and on the financial resources of healthcare organisations (Phillips et al, 2016). The management of hard-to-heal wounds, including pressure ulcers (PUs), is associated with annual costs of over £5 billion to the NHS, and mismanagement of these wounds has been an ongoing challenge (Greener, 2019). Confounding the economics of hard-to-heal wound care, significant public health reform in 2013 led to a real-terms reduction in spending power of 28.6% between 2010 and 2017 in the newly devolved healthcare budgets (Buck, 2020). The NHS Long Term Plan mentions the reversal of this funding deficit with a focus on increasing funding in areas including multi-morbidity and diabetes, as well as specific wound-related targets including the National Wound Care Strategy Programme and the development of a Commissioning for Quality and Innovation (CQUIN) for wound care, to help monitor the quality of care (NHS England and NHS Improvement, 2019). In addition to these responses to the growing demands of hard-to-heal wounds, the NHS Long Term Plan aims to reduce unjustifiable variation in care (NHS England and NHS Improvement, 2019). This issue is likely to impact the delivery of care and the experience of patients with chronic wounds, which is associated with significant variation in clinical practice (Adderley et al, 2017).

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