>>Speaker: The NHS is large and complex, helping hundreds of thousands of people every day,
so it’s perhaps not surprising that not all care is the same everywhere. NHS RightCare
is helping the NHS seek out, adopt and share the best way to do things. We’ve been looking
into what good care looks like in a number of different areas.
One such area is wound care. Every year around 2.2 million adults in the UK will have a wound
that needs treatment, costing the NHS around £5.3 billion each year. So, we want to tell
you a story, a not unfamiliar scenario. It’s about Betty, a widow who lives by herself
in a village ten miles from town. Betty has a good social life: enjoying her walking club
despite a bad knee, and a weekly Aqua Fit class followed by a meal out with friends.
At her 70-year health check, Betty was overweight, but the nurse put it down to her age, so there
was no mention of changing Betty’s lifestyle or health advice.
Four years later. One day, while out walking, Betty grazed her ankle. She put a plaster
on it and then spoke to her local pharmacist, who suggested a dressing to try. Six weeks
of self-treatment weren’t helping, so Betty’s GP prescribed antibiotics, not realising that
they wouldn’t help Betty’s wound. Two weeks later, Betty’s practice nurse dressed
the wound. For the next six weeks, Betty struggled to the surgery every week to get the dressing
changed, but there was no improvement. Over the next six months, the general practice
nurse tried lots of different dressings but the wound got worse. The dermatology clinic
confirmed it was an ulcer, but the test results didn’t get to Betty’s GP practice. Although
the nurse was doing her best, her training was out of date so she didn’t feel confident
applying the type of dressing needed. The appointment slots were too short, and treatment
was delayed as equipment wasn’t working. Meanwhile, Betty couldn’t bathe with the
dressing so didn’t feel clean. She worried about the wound smelling, so didn’t want
friends to call round. She couldn’t go out with her walking club, nor go to Aqua Fit.
Because of her wound, she couldn’t have the knee operation that would have helped
her get more mobile and lose weight. So, Betty felt isolated and depressed; she was in pain
and housebound with a variety of district nurses visiting, all trying to help but making
slow progress due to lots of different reasons. To cut a long story short, it took two years
for the wound to heal. From a simple graze to her leg there were countless dressings,
many people involved, a stay in hospital to deal with a nasty case of cellulitis. Only
then did Betty’s wound finally get the correct treatment and the pain subside.
But how could things have been different? Let’s rewind the clock and take a look.
We’re back at Betty’s 70-year health check, where she was heavier than she should have
been. The healthcare assistant made a care and support plan for Betty, to keep her healthy.
Betty lost some weight but was worried about her tired and heavy legs. The general practice
nurse assessed Betty and prescribed compression stockings to reduce the risk of leg ulcers,
and arranged regular reviews. Four years later. One day, while out walking,
Betty grazed her ankle. She put a plaster on it so it wouldn’t stick to the compression
stockings she wore every day. She then asked the advice of her local pharmacist, who knew
just what to do. The local NHS had agreed a protocol for anyone who had a lower leg
wound, so she advised Betty to see the practice nurse at her GP surgery without delay. The
practice nurse dressed Betty’s wound, prescribed some cream to moisturise Betty’s skin and
some medicine for the pain. She referred Betty to the leg ulcer clinic for a full assessment,
and a couple of days later the clinic confirmed it was a venous leg ulcer. Treatment of the
wound started straight away, with specialist compression bandaging that had been proven
to work. The nurse also gave her an information leaflet all about it. The nurse prescribed
a wound cover, so Betty could have a shower, and encouraged her to keep as active as possible;
this made such a difference. Betty returned to the clinic the next day,
and again a week later, to have the ulcer checked and measured. Betty was pleased to
see it getting smaller; progress. After two weeks in bandages, the nurse gave Betty a
prescription for compression stockings to wear then and in the future, and advised Betty
to keep her leg moisturised. Eight weeks from visiting the practice nurse, the ulcer had
completely healed. Six months later, Betty was able to have her knee operation that meant
she could rejoin her rambling club and get back to her old self.
Let’s recap on how things were different. For Betty, early best practice treatment stopped
the ulcer in its tracks, and within a month the wound had healed. Betty’s active social
life that kept her healthy and in good spirits continued, and her knee operation would go
ahead without delay. And for the NHS? Providing care in this way cost around ten times less
than the first scenario. It’s a win-win for everyone; let’s make it happen everywhere.
Through NHS RightCare, we aim to improve healthcare for everyone, so that we all get the right
care, in the right place, at the right time.