Time to heal

Wound care – reducing variation, preventing complications and supporting care closer to home

In 2018, the yearly amount that wound care cost the NHS was estimated at £8.3 billion. That is worth ten years of the UK’s flood defences; it is the cost of running London’s police service, fire service and entire transport system combined.

It is equivalent to the whole of the UK’s foreign aid budget and its energy department. It is also, almost certainly, an underestimate.

Since 2018, pressure on the NHS has increased dramatically, with waiting lists remaining near record levels. For wound care in particular, this is a problem because chronic wound treatment relies on fast diagnoses to secure quick recovery.

If diagnosis takes longer than four weeks, the chance of a patient recovering within three months falls from 54% to just 17%. After twelve weeks, fewer than half of patients will recover within a year.

With the health burden therefore likely increasing, the true cost of wound care is probably in excess of £10 billion, and may even be well beyond that. Across Europe, an estimated 7.4 to 14.9 million people live with chronic wounds, consuming up to 4% of total healthcare expenditure.

This huge economic cost should not distract us from the human price that wounds exact on people’s lives. Roughly 3.8 million people in the UK live with some type of wound.

Up to a third may live with multiple comorbidities, compounding the mental and physical impact on their lives. And this impact is sobering.

At least 30% of those with chronic wounds experience symptoms of depression and anxiety, and limb amputations necessitated by wounds have five-year mortality rates of 40–70%. Wounds, like many health conditions, also harm an individual’s chance of staying in work.

For those suffering from leg ulcers alone, four working days are lost to managing and treating their condition. At a time when economic inactivity due to illness in the UK is near record levels, it matters to all of us that these individuals stay in the workforce.

But why are the economic and individual impacts of wounds so damaging? Partly because wound care too often exists in-between services rather than within a coordinated pathway.

It spans primary, secondary and social care settings. As patients move between these settings, healthcare professionals’ knowledge and skill does not always move with them.

Variation in the treatments provided to patients serves to further break up that pathway. While the UK does not lack standardised guidelines for wound treatments, the implementation of these across Trusts and ICBs varies, with significant local differences in available products like dressings.

Past analysis of community nursing has revealed that local practice is more often dictated by environmental and financial constraints than evidence base. With that variation, district nursing teams face delays procuring specific products, delaying patients’ healing and straining nursing resources.

And those nursing resources are already seriously stretched. Since 2009, the number of nurses working in the NHS has dropped by 43%.

With wound care accounting for the majority of community nursing time, it is best placed to suffer from this fall. This brings us to a second reason for the current state of wound care.

It is a clinical area overwhelmingly delivered by community nurses, district nurses, as well as those outside the NHS, like care home staff. But there are severe shortages in professionals able to treat wounds, and among those that can, there is large variation in skill and knowledge across the country.

Across the entire NHS, leaving rates for healthcare professionals averaged 10.1%. For district nurses, a staggering one in four left their role between 2023 and 2024.
Further, when adjusted for growing patient demand, the reduction in community nurses since 2009 becomes 55%. This long-term decline has left gaps in competency across the country.

One study conducted across Northern England found ‘marked variations in care’ in that region alone. The 2023 Wound Care Workforce Framework attempted to resolve this variation by providing a standardised, tiered system of competencies for those treating wounds.

Indeed, training for generalists can deliver significant benefits for patients. A Danish study found just six hours of training delivered a significant increase in wound care knowledge for nurses.

Nonetheless, without a targeted workforce plan and a significant increase in retention and training, staff shortages in wound care will likely exist for years.

This is why HealthTech can make such a huge difference to wound care. Innovations in advanced wound care products are mostly incremental rather than transformative, but can provide real benefits if measured by value across the whole patient pathway.

Increases in the wear time of dressings significantly reduce the frequency of mandatory dressing changes, alleviating the burden on district nursing teams.
Adopting AI and digital clinical decision-support tools could help reduce the variations in local workforce knowledge, standardising assessment, prompting earlier referral and supporting care closer to home.

Digitised record-keeping can allow the objective tracking of wound progression, ensuring that interventions are driven by clinical evidence rather than regional financial constraints or procurement delays. All these examples, and there are many more, contribute to the three shifts laid out in the Ten-Year Health Plan last year.

They prevent expensive complications, support the shift from analogue to digital and bolster community care badly affected by years of cuts.

For these products to reach the patients who need them, though, supply and reimbursement mechanisms, particularly through Part IX of the Drug Tariff, need to move beyond lowest acquisition cost towards a genuine assessment of whole-life system value.

Closer alignment is needed between the National Wound Care Strategy Programme, NHS Supply Chain, Integrated Care Boards and local procurement teams, so that national guidance translates into consistent local formularies rather than more variation.

Real-world evidence, alongside patient-reported outcomes, should be given equal standing to randomised trial data when innovations are assessed, recognising that randomised control trials are rarely well suited to the incremental product improvements common in wound care. And funding for the adoption and spread of innovation that has already proven its worth needs the same protection afforded to research funding, so that products are not lost at the point of scaling up.

None of this requires new money earmarked for wound care alone; it just requires a shift in how the system procures the innovation already available to it.
Wound care rarely attracts the headlines, yet the cost to the NHS and the impact on patients make it an area that deserves far greater recognition and focus.