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D
emand for healthcare resources
continues to increase as
population demographics
change, long-term conditions become
more prevalent, patient expectations
rise and medical technology becomes
more sophisticated. The ageing
population — together with other
factors such as modern lifestyle
changes — are driving an upward trend in chronic conditions
like diabetes and cardiovascular disease. As the number of
older people increases, the prevalence of chronic wounds will
also continue to grow — so much so that by 2019 the number
of people with a wound is projected to rise by 9.8%, from
239,700 in 2014 to 263,200 (Dowsett et al, 2014).
Wounds represent a significant cost to patients as well
as to the health economy. Chronic wounds are often hard to
heal, resulting in a cycle of pain, anxiety and reduced quality
of life for the patients as well as considerable treatment costs.
The estimated cost of treating chronic wounds in the UK is
between £2.5–3.1 million per year, accounting for 2–3% of the
entire healthcare budget (Posnett et al, 2009). Further estimates
suggest that there are 3.37 people with one or more wounds
per 1,000 of the population, of which 74% are being treated in
community settings and 21% in acute care (Drew et al, 2007).
Although most patients are treated in the community,
the majority of wound care costs arise in hospitals — on any
given day, 27–50% of acute hospital beds are likely to be
occupied by patients with a wound (Posnett et al, 2009). Many
of these chronic wounds are longstanding — having lasted for
over six months — and as a result are more likely to develop
complications that result in hospital admission or delayed
discharge (Ousey et al, 2013). Additionally, patients themselves
are becoming more complex, with 76% of those with a chronic
wound having three or more comorbidities and up to 46%
having diabetes, making their wounds much harder to heal.
Data on health service expenditure suggests that funding
is unlikely to keep pace with demand and that fundamental
changes will need to be made in the way wound care is
delivered to reconcile supply with demand (Dowsett et al, 2014).
To balance the cost of services with the provision of high-quality
care, clinicians need to be more proactive in their approach,
adopting new and advanced technologies that increase healing,
involve patients in their own care, and create economic value.
A proactive approach to managing chronic wounds can reduce
cost and improve patient outcomes, as demonstrated by high
impact actions such as ‘Your skin matters’(Dowsett, 2010).
Strategies that focus on wound prevention not only lessen
the number of wounds requiring treatment, but also reduce the
burden of wound care in the future.There has been a strong
We need to reduce the future burden
of chronic wounds
JCN supplement
2015,Vol 29, No 5
3
EDITORIAL
focus on reducing harm from pressure ulcers in the UK as part
of the‘harm-free care’agenda, and most healthcare providers
are working towards the elimination of avoidable grade 3 and 4
pressure ulcers altogether. Another example of how the burden
of chronic wounds can be reduced is the focus on preventing
recurrence of venous leg ulcers through service redesign — for
instance, one nurse-led leg ulcer service that focused specifically
on patients with healed ulcers showed a reduction in recurrence
rates from 18–20% to 5.8% (Dowsett, 2011).
Treatment strategies can also improve the lives of patients
with a wound, particularly the adoption of new techniques
that enhance the efficiency of wound management and release
resources to be re-deployed elsewhere. Innovative wound
management products such as negative pressure wound therapy
(NPWT) can increase efficiency by reducing the number of
dressing changes and nurse visits required, as well as reducing
time to heal.The availability of NPWT in the community has
significantly improved the lives of patients with wounds by
allowing them to be cared for at home, releasing cost savings of
up to £4,814 per patient (based on an average treatment period
of 20.4 days) (Dowsett et al, 2012). As with most technologies,
NPWT devices have now become even smaller and are available
for single-use, meaning patients can continue with their normal
daily activities.This supplement includes some good examples
of the positive impact NPWT has had on the lives of patients
and on wound healing.
Unfortunately, the burden of chronic wounds will continue
to grow and service providers need to bridge the gap between
supply and demand to provide safe, effective and person-
centred care. In the future, we need to reassess the standard of
chronic wound treatment we provide and make the best use of
any available resources that will reduce the impact of chronic
wounds on patients, clinicians and the healthcare economy.
Caroline Dowsett, nurse consultant, tissue viability, East London FoundationTrust
REFERENCES
Dowsett C (2010) High impact actions and tissue viability.
Wounds UK
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14
Dowsett C (2011) Treatment and prevention of recurrence of venous leg ulcers.
Wounds UK
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115–19
Dowsett C, Davis L, Henderson H, Searle R (2012) The economic benefits of
negative pressure wound therapy in community-based wound care in the
NHS.
Int Wound J
9(5):
544–52
Dowsett C, Bielby A, Searle R (2014) Reconciling increasing wound care
demands with available resources.
J Wound Care
23(11):
552–62
Drew P, Posnett J, Rusling L (2007) The cost of wound care for a local population
in England.
Int Wound J
4(2):
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Ousey K, Stephenson J, Barret S, et al (2013) Wound care in five English NHS
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Posnett J, Gottrup F, Lundgren H, Saal G (2009) The resource impact of wounds
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