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Wound care's role in the future NHS.

Wound care’s role in the future NHS The Five Year Forward View (NHS England et al, 2014) describes why the NHS needs to change if it is to accommodate new technologies and evolving patterns of disease. The document envisages the development of better ways to deliver care, conducting all of this within the financial constraints imposed upon today’s NHS. There is broad consensus that prevention, patient-directed control of their own care, and the breaking down of barriers between care providers are necessary if the end-user appreciation of the service quality is to be improved. The integration of social care with health-service provision will undoubtedly benefit patients, particularly those with wounds as a result of chronic diseases, who are often frail and immobile and who live in care homes. The document identifies the adoption of technological innovation as a key element in improving service efficiency. In wound care, the NIHR WoundTec Healthcare Technology Co-operative (Vowden, 2013; 2015) is working to identify innovative medical devices that may improve care; however, without appropriate systems of care, the introduction of new technologies can be patchy and ineffective. The Five Year Forward View (NHS England et al, 2014) attempts to address three key themes: the health and wellbeing gap, care and quality gap, and funding and efficiency gap. How are these themes likely to affect tissue viability or wound care services? There will be a focus on wound prevention, addressing not only pressure ulceration but all types of chronic wounds, including foot and leg ulceration, irrespective of the underlying cause. There will be a drive to reduce care and outcome variations, with a focus on safe care, harm reduction, and timely healing. This will inevitably increase accountability and may be linked to outcome audits and reporting. This will also be connected to reshaping care delivery and the better use of technology. There are ongoing cost reduction drivers within the NHS, and wound care is no exception. Costs can be reduced by efficient care systems optimising prevention, treatment, and healing. This can involve new care systems, such as a move toward pharmacy and self-directed care of uncomplicated wounds, the introduction of remote expert support of home care, and an improved diagnostic platform to help and direct treatment. Wound care, particularly chronic wound care, is an area that could benefit significantly from the proposed changes contained in the Five Year Forward View (NHS England et al, 2014). The concept of a multispecialty community provider fits well with the delivery of specialist wound care services within a community setting, as does the proposed closer working relationship between hospital and primary care providers. Change is frequently regarded a threat, but this is an opportunity to raise the profile of wound care and enhance our service delivery for the benefit of patients and the NHS. CWC