Wound Care

To understand the different types of wound care, you have to understand the four different types of wound:

1. Abrasion – Otherwise known as a graze, this is a scrape across the skin surface without explicitly breaking the skin, but the friction will be sore and there can be bleeding.
2. Puncture – There are different degrees of impact; some can be shallow and sore, others can be deep and more seriously damaging towards internal organs.
3. Laceration – Also known as a cut. Like punctures there are varying degrees of severity; some can be superficial and surface level, some can be deeper and cause heavier bleeding.
4. Avulsion – The medical term for a wound that has lost skin. Sometimes this can be a fall and skinning a kneecap, or it can be a bit more gruesome (which we’ll spare you the details).

Treatments such as the care of a wound after sutures have been removed, wound care for a burn, and wound care after surgery are each attached to one of these sections.

Once a wound has occurred and been assessed, appropriate treatment can be administered. Wound care types include different types of cloth, foam or film dressings, but also things such as gauze, antibiotics, hydrogels, and alginates (algae-based and good for stopping bleeding).

There are additional treatment methods beyond the usual bandaging process though. Some wounds need ‘debridement’, which is the process of manually removing callus, infected or dead skin, as well as any debris that would obstruct healing. There are also processes like hyperbaric oxygen therapy which can accelerate the healing process. This is done by saturating the plasma in the blood with more oxygen, the fuel for cellular growth and regeneration. The best contextual comparison would be that it's an acceleration process similar to using nitrous oxide in a race car.

The National Wound Care Strategy Programme (NWCSP) is a specific NHS England (NHSE) programme; launched in September 2018 with the aim of optimising care to improve outcomes, prevent harm, to make better use of staff, and to reduce costs – with Skills for Health citing a figure of £8.3 billion per annum spent on wound care in England alone.

The Health Innovation Network defines it as “a strategy that addresses variations in care. Implementing NWCSP recommendations will improve patients’ experience, reduce wound healing rates, lessen the impact of wound care on NHS resources and release time to care.”

The National Wound Care Strategy website serves as a hub for clinicians and patients alike, providing informative resources so that people can improve their knowledge of wounds, wound care, and the processes involved in delivering wound care. It also provides specific information on the strategy itself for partners. The point of the strategy, in their own words, is to address “the issue of sub-optimal wound care”.

The issues seen by the NWCSP are caused by the variation in UK wound care services; a mixture of using outdated or ineffective treatments and an underuse of more modern evidence-based practices. Much the same way as the NHS is going through a digital overhaul, so too is it in need of consistency; in this case in care across England, regardless of which NHS trust is treating a patient.

The NHS wound care guidelines are effectively a wound care handbook. They derive from the frameworks agreed by the NWCSP. The first was the Core Capabilities Framework in 2021, and more recently is the expanded National Wound Care Workforce Framework from 2023, which now includes a Career Framework.

The framework is a good 60 pages long but the key bits are the approach to staff competence and the grading of staff education – regardless of staffing grade, pay grade, or time within the NHS. The document lays out the foundations that it wants for assessing the staff in place within the NHS and how to track and support their development and their collaboration going forward. It is the view of those experts involved that by properly identifying the levels of knowledge and experience, gaps in knowledge or missing skills can be addressed, and opportunities for collaborative development between trusts become available, allowing for skills to be transferred or honed and best practice to become more utilised.

You can download the NWCSP framework in PDF format via the Skills for Health website.

In England, the NHS spends £8.3 billion per annum on wound care, making it the third most expensive care sector behind cancer and diabetes according to Public Policy Projects.

The British Medical Journal’s cohort study – evaluating the burden of wound care on the NHS – breaks this £8.3 billion down into a split of £2.7 billion for healed wounds and £5.6 billion for unhealed; a difference of £1,500 vs £3,700 per person per year in England. Their report also states that there was a 71% increase in wounds annually between 2012/13 and 2017/18, which in turn drove a 48% real terms increase in patient management costs. That’s both a large difference between care types and a large increase in treatment costs, so it’s no surprise that NHSE would want to address it quickly.

In the National Wound Care Strategy Programme’s framework document, they agree that “poor healing rates increase the demand on scarce resources”, and list the following as a breakdown of what that money per patient equates to:

• 4 million district/community nurse visits
• 6 million healthcare assistant visits
• 1 million practice nurse visits

The BMJ breaks down the costing further too:

• District/community nursing visits = 29% of wound care spending
• GP office visits = 18% of wound care spending
• Healthcare assistant visits = 17% of wound care spending
• Practice nurse visits = 7% of wound care spending
• Wound care products = 6% of wound care spending

The eagle eyed amongst you might be able to calculate that these sums don’t add up to 100%, they add up to 77%. The remaining 23% accounts for the other aspects of wound care: ambulance attendance, diagnostics, podiatrist visits, A&E attendance… and so on.

What these figures do tell us though is that 81% of all the activity around wound care within the NHS takes place in community care settings, and the remainder is then specialist secondary care. This gives organisations like NHS England a starting point to focus their attention.

The foreword of the framework comes from Baroness Watkins of Tavistock, a non-executive director of the NHSE board and the chair of the National Wound Care Strategy Programme. She says: “Improving wound care offers major opportunities to improve the quality of chronic wound care through innovative solutions that will improve wound healing, improve patient experience and quality of life, prevent harm, increase productivity of staff and produce financial savings in line with the requirements of the recent NHS Long Term Plan.”

This is a nice, general statement about adhering to the Long Term Plan and the importance of optimisation, but the key wording is ‘through innovative solutions’. This is talking about healthcare software.

Wound care software could be a great option for meeting the NHS Long Term Plan’s goals for both improving wound care and digitisation across the public health sector.

Solutions like WoundMatrix, Woundsuite, Swift Skin and Wound, NetHealth Wound Expert, and Pixalere provide software solutions that support electronic patient records by providing the specialist criteria, tools, and metric required for wound care management.

There are also software products like Silhouette Wound Imaging which are designed for clinical use and the scanning/digital rendering of a wound site for evaluation and continued assessment.

WoundMatrix and Rio EPR

Here at The Access Group we are partnered with WoundMatrix, one of these companies.

WoundMatrix describes themselves as a digital platform for wound image measurement and assessment. In layman’s terms, their solution works on a website or in an app and allows photographs, measurements and notes about all different wounds. Even the patients can use the app and register their own regular updates of a wound’s condition.

Their wound management solution integrates via APIs with our own Rio EPR – electronic patient records. The collaboration allows for patient wound imagery and notes to be accessible through Rio EPR by clinicians, so they have the most accurate information possible about a patient’s condition. 

It also gives clinicians access to WoundMatrix’s own reporting tools, which are bespoke for the requirements of wound management and progress monitoring. For even greater convenience, their solution also has an Offline Mode, meaning it’s functional without internet signal and will update central records once an internet connection returns.

This brings us back to our point about wound care software: our experience from working with our partners in WoundMatrix is that there’s a lot of dedicated and bespoke support they can provide to the care process; support that could optimise the care process and alert clinicians to changes in condition faster, or avoid unnecessary wastage in cases where certain medications or dressings are having little impact.

Thus we come to our conclusion, and return to the premise of NHS wound care. The NHS (particularly in England) has to meet the targets of the Long Term Plan. This involves sweeping digitisation and greater consistency across treatment, with the overarching goal of joined-up care and a uniform system; a system where you can move from Teeside to Worcestershire and still receive the same care quality and approach to your treatment.

The obvious solution is to use a software solution, hence showcasing wound management tools, but there’s more to be onboarded than just that. We’ve written at length about the critical benefits of electronic records and patient record management systems. We’ve also talked about the NHS Digital Capabilities Framework, and how to meet its objectives.

The NHS can improve wound care with specific tools for improving wound care, and they will serve a purpose and have a positive impact, but if the NHS really wants to step up and ensure world-class care across the board rather than in isolated pockets, it has to continue to improve care as a whole, and it does that by implementing software solutions to help automate tasks and handle burden. Remove burden from clinicians and administrative staff and you’ll see more productivity, greater accuracy, better staff satisfaction, and better patient satisfaction – and they will steadily improve care quality and care outcomes and the NHS will transform once again into the ideal for public healthcare.