Wounds: patient care, clinical evidence or simply costs?

There is a large number of highly skilled clinicians working within the ‘discipline’ of wound care and a clear need for the development of a national wound care strategy. Such a strategy should go a long way towards resolving the wide variation in UK wound care services, confronting the lack of differential diagnoses and improving wound care product selection, resulting in improvement in outcomes and a reduction in costs. A confounding element pertinent to efficient and effective wound management is a clear understanding of the role that wound dressings have to play.

Different initiatives, to rationalise the availability of ‘suitable’ and ‘appropriate’ wound dressing products, have commenced in recent years. The backdrop to these schemes is the understandable need to contain costs bearing in mind that the NHS does not have recourse to unlimited finances. There is also a need to alert Government and the NHS to the reality of wounds as a burden on the population, health professionals and on budgets. Legally, wound dressings and bandages etc are classified as Medical Devices and bear the CE mark, signifying ‘they meet the essential requirements’ of the directives. This has resulted is a vast array of products listed in part IX of the Drug Tariff. As far as we are aware the first concerted attempt to rationalise—a euphemism for reduce—wound dressings started in 2015 with the creation of the NHS Supply Chain Generic Specification Project. Within this project, a national formulary was mooted that would contain a limited list of dressings that would be ‘clinically acceptable to 80% of patients'. This arbitrary identification of potential non-responders (20%) threatened to introduce a new selective principle into the NHS. Additionally, the ‘clinical acceptability’ or otherwise has not been defined, nor established by empirical research.