Tissue viability: the QIPP challenge

In the new NHS the effectiveness of care provision needs be demonstrated, with healthcare practice being aligned to priorities for quality and true measurements of care recorded. The Department of Health (DH) and both the previous Labour and present coalition Government, have identified the need to maintain and develop quality in healthcare. One key area where efficiency savings can be made is within tissue viability services. For example, the DH1 set out its ambition to eliminate all avoidable pressure ulcers in NHSprovided care and the National Patient Safety Agency2 selected the prevention and treatment of pressure ulcers as one of its “10 for 2010” plans to reduce levels of harm in ten high risk patient safety areas. Efficiency savings and elements of the quality agenda, most noticeably Quality, Innovation, Productivity and Prevention (QIPP) have become synonymous with healthcare. Most recently the DH published the challenges and opportunities to health care providers and commissioners to meet the quality agenda, ensuring that efficiency savings are made to allow reinvestment.3,4 The DH operating framework clearly identifies the requirement for the involvement of patients and the public when planning services, allowing them to understand how and where their money is being spent and offering greater choice and control of services. The key is shared decision making, summed up by the phrase “no decision about me without me.” Integral to this, is how the quality and productivity challenge will be met; securing re-investment to meet the demand and improve quality and outcomes. The Government plans to allow patients to rate hospitals and clinical departments according to the quality of care they receive. In addition there will be a focus on personalised care that reflects individuals’ health and care needs, supports carers and encourages strong local partnerships. Patients will be in charge of making decisions about their care and will be able to choose which consultant-led team, GP and treatment they have.3 Empowering patients to become involved in choosing their treatment through integrated care can help them achieve greater control.5 The GP Consortia will look after an £80 billion budget and by 2012 will take over responsibilities from Primary Care Trusts (PCTs), including leadership of the existing QIPP initiative. This initiative will continue with even greater urgency, but with a stronger focus on general practice leadership.

A radical new approach

The DH proposed a radical new approach to healthcare that includes protecting the population from health threats; empowering local leadership encouraging responsibility across society to improve health and a focus on key outcomes.6 Healthcare providers and commissioners will be expected to meet the quality agenda through cost savings while not being detrimental to patient care. A major area of expenditure for the acute and primary care sectors is tissue viability, with costs being assessed by the DH in 19977 as being over £80 million, not including hosiery products, with that figure increasing to £95 m over a two year period.8 Posnett and Franks9 calculated that 200,000 people in the UK had a chronic wound with an estimated cost of treatment being between £2.3 bn and £3.1 bn per year. Additionally, wound dressings account for about £120 m of prescribing costs in primary care in England each year,10 with prescription costs for wound dressings in primary care in England being estimated at £116 m in the year to September 2009. Interestingly, the Patient Association11 presented results of a survey that sampled 79 Trusts and identified that there were three times more infection control nurses than tissue viability nurses employed by Acute Trusts. This was despite the fact that the Patient Association estimated the cost of treating healthcare associated infections in hospital to be approximately £1 bn compared to at least £1.4 bn to treat pressure ulcers. What was of more concern was that infection control nurses act in an advisory capacity, as opposed to the tissue viability nurse who has a more active clinical role. The National Tissue Viability Society defines the specialty as “A growing specialty that primarily considers all aspects of skin and soft tissue wounds including acute surgical wounds, pressure ulcers and all forms of leg ulceration. However, it is not just wound management, it also covers a wide range of organisational, political and socioeconomic issues as well as professional relationships and education.”