The Parliamentary Under-Secretary of State, Department of Health (Lord O'Shaughnessy) (Con)
My Lords, I join noble Lords in thanking in absentia the noble Lord, Lord Hunt of Kings Heath, for having tabled this debate. I thank the noble Baroness, Lady Wheeler, for introducing it so expertly, and I thank all noble Lords for, as ever, their wise and insightful contributions, which have raised the salience and the importance of this issue. As the noble Baroness, Lady Jolly, said, this has been covered both well and at length.
As all noble Lords have said tonight, wound care matters because it has such a big impact on people’s quality of life. In fact it matters more than ever because people are living longer, with greater comorbidities and health complexities, so the role of good wound care will only grow. The noble Baroness, Lady Masham, and the noble Lord, Lord Kakkar, pointed out that getting this wrong and not having the necessary standards of care will have not only health impacts but social impacts too, and the Government are very aware of that. It is a picture that we recognise and that we believe the wider public sector, and the health sector, recognises too.
A number of important areas of work are already making a difference. I should point out that both MRSA and C. difficile rates are down 50% in the last seven years. As we have discussed before in this House, a second sepsis plan was published in September this year to try to make some progress on sepsis. The noble Baroness, Lady Masham, pointed out the importance of hand hygiene, and I believe that the changing attitudes to hand hygiene have played a role in the reduction of hospital-acquired infections.
All noble Lords have asked whether there is a national strategy. I reassure them that from a health perspective NHS England is leading an overarching programme of work on wound care. The major landmark was the publication in 2015 of the burden of wound care study, which highlighted the need for improvement of the assessment and treatment of patients, their outcomes and the cost incurred in the care pathway. I reassure noble Lords that this is a priority for the NHS.
As a result of the study, a national programme of work on wound care was launched by Professor Jane Cummings, the Chief Nursing Officer for England, under the aegis of Leading Change, Adding Value, which is NHS England’s framework for nursing, midwifery and care staff. Within this national wound care programme there are a number of initiatives. These include a national education and competency framework for all clinicians regarding good wound care, while a new national pathway has been developed for people with lower leg wounds, which represents 41% of all wounds. As several noble Lords have pointed out, variation is one of the great curses here, and these programmes are specifically aimed at reducing variability.
A national financial quality incentive has been introduced to improve wound assessments in the community, using a recommended minimum wound assessment tool. Wound care makes up 40% of community nurses’ workload, and they are supported in those efforts by both GP nurses and specialist tissue viability nurses, whose important role the noble Lord, Lord MacKenzie, and the noble Baroness, Lady Watkins, pointed to.
I would like to dwell on nursing numbers because they have been the subject of debate tonight. We know from looking at the figures that there has been a reduction in both community nurses and district nurses. I assure noble Lords—particularly the noble Baroness, Lady Watkins, because I know it is a great passion of hers—that Health Education England is reviewing the role and training of community and district nurses. She was right to highlight the important role in improving nursing numbers that nursing apprentices and nursing associates can play; indeed, properly trained, they can play an important role in supporting good care, particularly in the community.
The noble Baroness, Lady Jolly, when asking about nursing numbers, asked where we might recruit extra nurses from. The intention is to grow more of our own, as it were. There is a plan to increase by 25% the number of nurse training places so that we do not engage in the kinds of activities that she is talking about, where nurses who are very much needed in developing countries find their way to the UK, so that instead they can focus on improving healthcare in their own countries. We will grow our own.
The pay cap was also mentioned. I hope noble Lords will have noted in the Budget, as we had an opportunity to discuss earlier, the support from the Chancellor for funding an Agenda for Change pay deal, which will be focused largely on nurses.
I mentioned the new quality incentive that we have introduced. It will help nurses to improve the quality of care through a more standardised assessment, enabling appropriate treatment and improvements in both outcomes and value for money. In order to raise the profile of good wound care among commissioners, a point that has also been raised by noble Lords, a story about “Betty” within the Right Care programme demonstrates the benefits of appropriate care and pathways to support improved commissioning. Central to the Right Care programme, as the noble Baroness, Lady Jolly, said, is the question of “patient-centred” and patient choice within care.
I should also mention the Getting It Right First Time programme. It is not specific to wound care but it is led by front-line clinicians to improve the quality of care within the NHS and reduce variations. It initially focused on orthopaedics but is now moving to over 30 specialities, with clinical leads appointed.
Pressure ulcers have been the focus of a number of noble Lords’ comments, including those of the noble Lord, Lord Kakkar, and the noble Baroness, Lady Watkins. I join them in stressing the importance of prevention. I reassure noble Lords that the NHS has set out its specific ambition to reduce pressure ulcers. The noble Lord, Lord Kakkar, mentioned the Stop the Pressure campaign, a national campaign that began in 2012 as a regional programme within the Midlands and the east and drove improvements across those regions, including a 50% reduction in the number of new ulcers within 12 months. That campaign was rolled out nationally last November and includes acute, community and mental health settings. The aims of the campaign are to eliminate avoidable pressure sores by creating a significant culture shift with regard to avoidable harm, harnessing the collective energy of the nursing workforce and providing focus and support to front-line staff. Another example of local-level work being rolled out nationally is a framework called React to Red, an education and competency framework initially designed specifically for staff working in care homes but now being used across all sectors with the aim of reducing the incidence of pressure ulcers.
The acute sector of course has an important contribution to make to the establishment of good wound care across the NHS. Several noble Lords have mentioned the important work of the noble Lord, Lord Carter, for NHS Improvement. There is now a national Carter team that is working with an expert advisory group to understand what good practice looks like in relation to wound care and to support better ways of providing care in acute settings.
In addition to ensuring that we have the best trained and indeed the right number of staff, the Government are also working to simplify and improve product supply and distribution. Good wound care is not simply about medical skill and care; it is also about the availability and management of the most effective products. To support these efforts, a clinical evaluation team, currently based within the department, has been created. Its aim is to reduce unwarranted variation and to ensure that medical staff have access to high-quality products. It will achieve this by procuring fewer product lines and getting better value. I stress that this is happening under the guidance of clinical expertise. It is not simply, as the noble Baroness, Lady Watkins, pointed out, about reducing numbers and not simply a financially or accountant-driven programme; it is driven by a search for quality and ensuring that the NHS can procure at scale the clinically endorsed products that will help patients. This work is part of the overall reforms of the NHS supply chain known as the future operating model, and it is guided by NICE’s evidence base on wound care products that was published in January this year.
Speaking on the subject of wound care products, the noble Earl, Lord Liverpool, mentioned—as did my noble friend Lord Colwyn, rather elliptically—Surgihoney. I can tell them that it is in the British National Formulary. The clinical evaluation team has considered reviewing it but apparently it has a complex mode of action and more research is needed—there is a researcher’s answer—and the team wants to see the outcomes of clinical trials to understand its effectiveness better. I was particularly impressed by my noble friend Lord Liverpool’s exposition of how to treat a wound using sap and an old shirt; I think Bear Grylls would be incredibly impressed by those efforts.
Supporting good wound care and providing the best and most effective products in the health system are both essential parts of the strategy, but it is just as important to be able to track patients’ outcomes in order to inform best practice. That is why we asked NHS Digital to roll out the first nationally mandated community services dataset. It is currently being launched, with the first publication of data planned for February next year.
The dataset will provide national, comparable, standardised data about children, young people and adults in contact with community services in England. It is aimed to equip providers with the information they need to understand and compare the quality of care they are providing. In time, it will help build a much clearer picture nationally of the quality and impact of wound care, as well as other medical services. Further work will be undertaken over the next two or three years to refine the dataset to ensure that it is measuring patient outcomes and that it is as useful as possible for providers and patients in the provision of wound care.
I now touch on a few of the other issues that noble Lords raised. My noble friend Lord Colwyn talked about antimicrobial resistance. It is of course an incredibly important topic on which my noble friend Lord O’Neill has led the charge, and will continue to. We have an ambition to reduce gram-negative bloodstream infections acquired in the health setting by 50% by 2021. Of course, we will be fascinated to see whether reactive oxygen and other products have a contribution to make to that. I stress that the accelerated access review is now actively looking for transformative products that could fit its categories and be sped up into the NHS. There is specific support for SMEs to apply for that process, and I encourage the organisation that my noble friend mentioned to do so.
On the specific issue of research that the noble Lord, Lord Kakkar, mentioned, the NIHR is funding some research. I will write to him with more details, but I believe that a four-year award for a healthcare technology co-operative on wound care has just been made, and there may be other examples.
Finally, the noble Baroness, Lady Jolly, asked about patient data. She is absolutely right that having access to good quality data at patient and more aggregated level is critical to good wound care. Patients will begin to have universal access to their summary care record next year. That was a pledge that my right honourable friend the Secretary of State set out at NHS Expo this year, with the intention of having integrated local health records—which is where the joined-upness of all the detail and data on a patient comes—by 2020.
To conclude, I hope that I have gone some way to set out the work that is being undertaken in the NHS to improve wound care. Patient engagement is of course a large factor in wound management. Dressings are only one aspect of wound healing, because the patient has a critical role, as the noble Baroness, Lady Masham, pointed out, in supporting the healing process, and health professionals have a key role in providing the optimal environment, expertise and support to encourage healing. This requires a combination of access to products, clinical knowledge, measurement tools and patient education.
I end by saying how impressed I have been by the briefing received from the Lindsay Leg Club, which the noble Baroness, Lady Watkins, talked about and of which I know that the noble Baroness, Lady Masham, is patron. If noble Lords have not read it, I encourage them to do so. It provides just the kind of activity and intervention that we want to see. It is not just about good care; it is also about individual psychosocial needs and health beliefs. It is about getting good patients, as well as having good care and good products. I thoroughly commend the work that it is doing, and I would like to see more of it.
I hope that I have been able to reassure noble Lords that the NHS and the wider health system is engaged in a broad strategy to achieve better wound care, and that, as the issue becomes more pressing, we can expect to see significant improvements as a result of the actions being taken.