8
WOUND CARE TODAY
2014,Vol 1, No 1
DISCUSSION
›
H
ealth care is changing faster than ever before
— at least that’s what we are constantly being
told from above. The government’s agenda aims
to put patients first, with a renewed focus on quality
(particularly in the domains of safety, effectiveness and
patient experience), with clinicians delivering this quality
through innovation, productivity and prevention (QIPP).
Of course, you have to do all of this while also achieving
the best healthcare outcomes in the world (Department
of Health [DH], 2010) and working within tight financial
constraints. If this sounds like a lot to think about on top
of your everyday workload, that’s because it is.
So, where to start? With an aging population and
care being increasingly delivered in people’s own homes
rather than in hospital, it is becoming more important
for those delivering care to listen to what their patient’s
want as well as ensuring that they have a positive clinical
‘experience’. But what does all this policy actually mean
for nurses, healthcare assistants and other clinicians
working in wound care? Do you necessarily understand
what all these changes mean for you? And are you
equipped with the skills to actually carry out
the changes?
In this first Wound Care Today discussion, we
ask two expert wound care practitioners, Edwin
Chamanga and Jeanette Milne, for their views on
the state of wound care provision today, whether
clinicians have the right skills to deliver the
government’s vision and, if not, what they need in
the future. The results make for interesting reading...
The state of
wound care today
Edwin Chamanga,
tissue viability
service lead, Ipswich Hospital
NHS Trust
Jeanette Milne,
tissue viability
specialist, South Tyneside Foundation
Trust; Chair, North East Tissue
Viability Professional Forum
?
?
WHAT DO YOU THINK IS THE CURRENT STATE OF
WOUND CARE PROVISION IN THE COMMUNITY
Having worked for different community healthcare
providers, it is evident that the provision of community
wound care services varies from one trust to another.
Some offer better services than others, depending on
the patients they are serving, their level of affluence,
the trust’s demographics and local population
comorbidities. Better provision can be seen in those
communities where the integration of acute and
community services has been implemented successfully,
helping to facilitate patient follow-up. From my
experience of working in London, and reading reports
and discussions of what is happening across the
country, in general, the provision of wound care in the
community is fragmented.
EC
Like all aspects of the health service, there are areas/
localities and people that excel, those that provide
an adequate service, and services that are failing
to meet the required standards. The challenge is to
celebrate good practice, while encouraging continuous
improvement and balancing that with the ability to
challenge poor practice
JM
WHERE THERE ARE GAPS IN KNOWLEDGE/PROVISION,
WHAT DO YOU THINK HAS CAUSED THESE
In some places the gaps are a result of local healthcare
needs’ prioritisation, where wound care is not
considered to be on top of the service provider’s
agenda. This can be a direct result of changes in service
provision across the country, with some community
services being run or provided by security companies,
for example. In some local areas, this has impacted
hugely on the patient/community nurse ratio; yet, the
amount of time it takes to holistically assess a patient
with wound care needs has not changed. On the other
hand, it is also the lack of knowledge of frontline
staff. From a personal interview with frontline staff, it
was highlighted that their training or study days had
been cut back due to financial constraints within the
organisation. In addition, as nursing/care homes are
private entities, they are expected to provide their own
wound care expertise, which, in many cases, simply
does not happen.
EC
The gaps in knowledge and skills are variable and
depend on a multitude of factors, which can be as broad
as organisational restrictions on access to education
and training, staff motivation — be this from a personal
or cultural point of view — and/or time-constraints, due
to competing/conflicting interests and requirements.
Community teams responsible for wound care also
look after other aspects of care, e.g. palliative and other
long-term conditions, such as diabetes. In many areas,
while wound care represents the largest percentage in
