The number of people with a wound in England continues to rise year-on-year (Guest et al, 2020). And so too does the frequency with which specialist teams and services who manage wounds are overwhelmed—with increasing referrals, mounting caseloads and the complexities of supporting people with multiple morbidities.
These challenges to service delivery in difficult conditions have been compounded by the COVID-19 pandemic, which has led to the redeployment of some of the specialist workforce, leading to a reduced number of wound-care clinics (Schofield, 2021).
I believe an over-reliance on specialist teams' skills by other health professionals has given rise to the de-skilling of some groups and has inhibited fundamental wound-care skills development in others. This conflux has increased the likelihood that many people with wounds will be seen by health and care staff who have little wound care-related knowledge and skill. The ensuing referral, to a person or team with the right expertise, then causes a delay in treatment, affecting healing time and, consequently, the person's quality of life.
Opportunities
Although COVID-19 has created challenges, it has also provided opportunities. There has been a growing focus on the need to support people to contribute to their own wound management. This has been accelerated during the pandemic and many specialist teams and services have been able to assist people to do just that. The set of skills this takes to employ is one which needs much cultivation across the wider health and care workforce. Being adept at enabling shared decision-making, through having the right conversations with people to develop a personalised wound management plan, while ascertaining someone's motivation and capacity to implement such self-care, and supporting them to do this, is no easy task.
‘This framework clearly defines the wound care-related knowledge and skills required by the whole patient-facing health and care workforce … in any healthcare setting where a person with a wound might be’
When I started as the Education Delivery Lead for the National Wound Care Strategy Programme (NWCSP), it rapidly became clear that addressing this knowledge and skills gap was a priority. A capability framework provides a means to assess the capabilities of an individual, team, or organisation, enabling a better understanding of where there are skills and where there are gaps. It also allows us to respond to any identified gaps.
Core knowledge and skills
Although there have been many pieces of work published in this area, many are for specific wound types or particular audiences. The National Wound Care Core Capabilities Framework for England (NWCSP and Skills for Health, 2021) does not negate the need for these resources, but rather builds on them. This framework clearly defines the wound care-related knowledge and skills required by the whole patient-facing health and care workforce, at all levels, in any healthcare setting where a person with a wound might be.
The project development, led by Skills for Health, brought together key individuals from across nursing, physiotherapy, paramedics, medicine and surgery, with experts by experience, and representatives from academia, Skills for Care, the Royal College of Nursing, the Royal College of Podiatry, the Queen's Nursing Institute and Health Education England.
Each core capability is described in three tiers, with an increasing level of knowledge and skill required in each. We have steered away from aligning these tiers to specific roles. Instead, they are designed to allow flexibility, so that individual practitioners, in partnership with their employers, can determine the tier of knowledge and skill they require for their specific role. They may require different tiers of knowledge and skill in the different capabilities.
Developing practitioners to enable a personalised approach to wound care is the golden thread running through the framework. This is a direct move away from defining a set of tasks to be undertaken or competencies to be achieved. Instead, it is shifting towards developing the knowledge, skills and behaviours that enable us all to work in partnership with people, creating care and treatment plans suited to the individual.
In addition to the expertise of those developing the framework, 585 health and care professionals and organisations contributed their feedback on the draft through an online consultation, providing strong levels of agreement with the content. In fact, 97% of respondents agreed in full or in part with each capability and felt that it offered clear standards to be met in service provision, which would improve safety in wound-care delivery.
Published on 9 June 2021, the National Wound Care Core Capabilities Framework for England is available free to download, on the Skills for Health info hub (https://tinyurl.com/cn6ksey8).
The initial aim is to develop the patient-facing workforce to have a minimum of tier 1 level knowledge and skill. However, having the framework is just the start of the journey to achieving this. We now need to promote its use, to encourage practitioners to use it as the means to assess and develop their own wound-care capabilities, and the capabilities of their colleagues and teams. We need to promote its use across organisations and systems and have a comprehensive wound-care data set that will allow us to measure its impact.
This will require all health and care practitioners with a patient-facing role to realise that wound care is within their scope of practice. This culture shift is not going to be easy, nor fixed by any one act. It will require buy-in and collaborative working from all professions, service providers, regulatory and professional bodies, coupled with supporting policy.
Education
The digital, immersive technology and simulation landscapes are rapidly evolving, with increasing applications seen in education and practice using virtual, augmented and mixed reality, as well as robotics, and artificial intelligence. The use of technology in wound-care practice has been accelerated by the COVID-19 pandemic, with an increase in remote consultations and use of digital wound assessment and monitoring systems.
The NWCSP will continue to develop high-quality educational resources that support the development of the requisite knowledge and skills. In addition to a suite of online wound-care resources, work is under way to develop more using ‘gamification’ technology and virtual reality. It is hoped that this will both enable the patient-facing health and care workforce to develop their wound-care knowledge and skills in diverse ways and to develop their own digital literacy. This in turn will support them to use technology in practice and to support people with wounds to use these technologies as part of a supportive self-management approach.
Reducing suffering
Over time, it is hoped that as the wound-care capabilities of the patient-facing workforce are developed, this will contribute to the NWCSP's aspirations of reducing the suffering of people who have a wound, improving healing rates and preventing wound occurrence.