NHS: Wound Care

Baroness Jolly Excerpts

Wednesday 22nd November 2017 Lords Chamber

[Baroness Jolly (LD)]

My Lords, I join other noble Lords in thanking the noble Lord, Lord Hunt of Kings Heath, for calling this debate and the noble Baroness, Lady Wheeler, for being such an excellent substitute. It has been a fascinating debate, with much clinical and personal experience. There are many voices and players in this discussion: the clinicians, the commissioners, industry, those who are trying to improve performance and save money by rationalising systems and processes, and of course the patients, too.

I confess that I came to this subject completely cold and ill-informed. The debate covers: innovation and the management of wounds as a result of great British dressings with amazing technology, but, according to NICE, the need for a stronger evidence base; the escalating crisis in our nursing workforce; the need to share good practice in the NHS; decisions made by clinical commissioning groups; and, as ever, the money.

The cost of wound care—as others have said, around £5 billion each year—is the same as the nation’s bill for managing obesity. This came as quite a surprise to me. We have heard some really interesting numbers from both the noble Baroness, Lady Watkins, and the noble Lord, Lord Kakkar, and I have a few more. In 2012-13, there were 2.2 million wounds to be dressed and healed, 7.7 million GP visits and 3.4 million out-patient visits. The numbers suddenly become not surprising when it is patient-professional interactions and professional treatment that are increasing the costs, and not the dressings.

Much of the debate about wound care is about dressings and their cost. The Carter report talks about procurement but not the cost of treatment. If he had looked at total treatment costs, the story would have been very different. As a proportion of total cost, even some of the most advanced dressings are not hugely significant. What is required in this care—and I am sure that in most instances it is given—is a patient-centred decision, and I am sure the Minister would agree with that. I would like commissioners of such services to be mindful of this.

The area of innovation is quite a good British success story. We have interesting and new techniques that are used in dressings. Several noble Lords have spoken about AMR, and we need to be mindful of that. There are also smart dressings that will talk to your iPhone, or any other mobile phone of your choice. Also, the dressings are completely unlike those that I remember seeing my mother-in-law having to wear on her legs 10 or 15 years ago. The change in technology is huge. Hand-held technology can also be really important. All clinicians should have access to patient data from all NHS settings. Could the Minister tell us when this might really happen? How imminent is it? I think 2020 is the date we look for, and I would just like some clarification that this is still on track.

The noble Lord, Lord Kakkar, spoke about sharing good practice, which should reduce the variation in outcomes. There are clusters of really good practice, and one of the upsides of battlefield medicine is some of the treatments that have come from it for treating wounds. The noble Lord, Lord Colwyn, emphasised that. The use of communications technology assists with this, but we acknowledge that this will never replace the clinician-patient practice relationship.

Nurses are pivotal in delivering good care, and in the briefings that we have received there is considerable anxiety around the nursing workforce. Some 60% of NHS costs are in community settings—in our own homes or care homes—and we need to attract to the profession many more young men and women who are willing to take on this role. Careers advice and perceptions of careers in schools are not always absolutely as they might be—or indeed probably as they were 10 years ago. We need to examine the financial support given to nurses as undergraduates. We all know that nurses will not always be well paid—certainly not in the first instance—but bursaries should be part of the package. Professional development is also key to good practice, to retention and to making nurses feel valued and part of a team. What time is protected within clinical settings for nurse training and CPD?

Overseas nurses have always had a key role in the NHS—historically from the West Indies, south Asia and the Philippines, and more recently from EU states. Could the Minister confirm whether, to replace these nurses, there are any plans to recruit from third-world countries? I remember being at an NHS conference 19 years ago where the Health Minister of one of the southern African countries spoke very movingly about how much they invest in training their nurses, and we come along and offer better packages. We have sometimes to weigh up issues around third-world development and our own failure to train enough nurses here. The pay cap is hugely detrimental to nursing retention and the feeling of being valued. We have this perfect storm around the workforce, which gives us the loss of expertise of retiring nurses and the loss of EU nurses.

Finally, as noble Lords will know, I forgot that this debate was today—I thought it was tomorrow—so I was not as well prepared as I would like to have been. However, the House has really covered this issue well and at length. We have seen that there are huge advances in technology and in dressings, and that these are all moving faster than the regulators can deal with. From all that we have heard today and that I have read in the briefings, I endorse the call within the title of this debate for a strategy for dealing with wound care standards.