For Commissioners

Financial Burden

Wounds and their associated comorbidities cost the NHS £5.3 billion per annum; greater than 4.0% of total expenditure on public health in the UK. (Based on 2012/2013 patient data and on 2013/2014 unit costs.) J Guest et al 20 2015 BMJ

Of the £5.3 billion, over £3.0 billion a year is spent on managing chronic wounds (leg ulcers, diabetic foot ulcers and pressure sores) alone. The majority (74%) of this spend was on wounds that did not heal in the year. Healed wounds cost £800 million while unhealed wounds cost £2.2 billion a year; a cost that will be repeated year on year. J Guest et al 2016 IWJ

If nothing changes the burden is only going to increase. It is estimated that the annual prevalence of chronic wounds is growingat the rate of 12%; largely as a result of an average healing rate of 43%. At this growth rate, chronic wounds alone are expected to cost £5.3bn per annum by 2017/2018 and £9.4bn a year in another 5 years’ time. J Guest et al 2017 JWC

As a result, in 2012/13 an average CCG / health board (catchment population of 250,000 adults ≥ 18 years of age) treated 5,300 chronic wounds at a cost of £15.2m. By 2017/18 costs are expected to increase to £26.8m and, if nothing is done to improve healing rates,in another 5 years these costs are expected to rise to £47.2m and in 10 years to £83.3m (Fig 1). J Guest et al 2017 JWC

Burden on carers

Patients with chronic wounds are cared for at home and only admitted to hospital when complications arise. 78% of the total annual NHS cost of managing chronic wounds was incurred in the community with the remainder being incurred in secondary care. J Guest et al 2017 JWC

Chronic wounds put an enormous and growing burden on carers, particularly district and community nurses, at a time when the number of nurses is falling. “Annual NHS workforce statistics show a 48% drop in the number of district nurses between September 2000 and 2014 in England. Monthly workforce releases suggest that this decline is continuing: the number of district nurses fell by 13.6% between March 2014 and 2016.” The King’s Fund 2016

Numbers are dropping and the job is becoming more challenging. ‘As more and more highly complex care is delivered and managedin the community, the more important it is that highly skilled district nurses are managing community teams –which are often large and have a high degree of skill mix.’ Dr Oldman CEO The Queen's Nursing Institute September 2017

Staffordshire and Stoke-on-Trent Partnership NHS Trust district nurse manager Vicki Smith agrees the demands of the service are leaving nurses frustrated and demoralised. ‘They go in and complete tasks to keep patients safe, but they are not giving the extra they want to give.’ Nursing Standard September 2016

Better Wound Care

The NHS recognise the problem and recognise that the burden will be eased by innovation and technology. As a result,the NHS have implemented a number of initiatives to address the issue:

  • Sustainability and transformational partnerships (STP's)
  • NHS Right Care (Betty's Story)
  • Five Year Forward View
  • Accountable Care Organisation contracts

To address the ever increasing cost of wound care, in the Journal of Wound Care article of July 2017, Professor Julian Guest states ‘we recommend that each patient has a monitored care plan in line with national guidelines based on appropriate dressing selection, which may involve the use of advanced wound care products, targeting early cost-effective wound healing as the primary outcome.’ J Guest et al 2017 JWC

An advanced wound care product that is demonstrating early, cost-effective wound healing is Accel-Heal®.An independent study, written up by Professor Julian Guest in the Journal of Wound Care in December 2015, concluded that:

  • the treatment ‘was found to be a dominant treatment (i.e. improved outcome for less cost)’ and ‘affords the NHS a cost effective treatment for VLUs’.Applied to non-healing wounds, Accel-Heal® achieved a healing rate of 77%
  • Of a population of 30 wounds, 23 healed in an average of 2.5 months and the 7 that did not heal reduced in size, towards healing, by 42% in the study period. 100% of wounds less than 1 year old healed and the average age of the 7 wounds that did not heal was 6.1 years (one wound was over 20 years old)
  • The treatment resulted in a 34% reduction in nurse visits and a 26% reduction in the number of dressings. This resulted in an11% reduction in the NHS cost of VLU management over 12 months. J Guest et al 2015 JWC

As a result, instead of increasing at a rate of 12% per annum (J Guest et al 2017 JWC), the costs of treating chronic wounds would reduce by 11% per annum as healing rates increased. To an average CCG (catchment population of 250,000 adults ≥ 18 years of age)the costs would reduce from £26.8m a year to £15.0m a year within 5 years and to £8.4m in 10 years (Fig. 2).The average cost of managing the 77% of wounds that healed was reduced by 35% (J Guest et al 2015 JWC). Instead of a reduction of 11% per annum, the savings could be significant higher. Applying Accel‑Heal® at the optimal point in a care pathway, the annual saving to the NHS would be at least 35%.

Information for Commissioners

Accel-Heal product shot