SilhouetteConnect wound assessment software screen

There is a sea-change required to help improve wound outcomes and reduce the health economic burden of patients suffering with wounds in the UK. The pivotal publication by Guest et al is a stark reminder of the gaps and the opportunities for improvement in wound management in the UK health system (1,2).

NHS England has been researching and consulting on this matter and there is a clear case made now to have a strong focus on wound assessment and wound outcomes delivered by providers, as apposed to activity-based commissioning and contracting for wound care services.

Please read on for a summary of the National CQUIN Indicators and specific details on the wound assessment CQUIN goal set for 2017-2019 for community providers.

Overview - Headlines from NHS England CQUIN scheme announced for 2017-2019 (3)

The CQUIN scheme (The Commissioning for Quality and Innovation) is a payments framework for providers to deliver clinical quality improvements and drive transformational change.

A two year scheme has been announced for 2017-2019, to give certainty and stability on the CQUIN goals and enable health communities to focus on implementing the initiatives. (4)

The CQUIN scheme aims to support delivery of the Five Year Forward View and directly link to the NHS Mandate.

Two areas of focus are outlined in the NHS England CQUIN Guidance , extracted here (4):

“1. Clinical quality and transformational indicators - 13 indicators have been defined which aim to improve quality and outcomes for patients.

2. Supporting local areas:

• Sustainability and Transformation Plans – reinforcing the critical role providers have in developing and implementing local STPs.
• Local financial sustainability – encouraging providers and commissioners to work together to achieve financial balance and to complement the introduction of system control totals at STP level. “

The National CQUIN Indicators for 2017-2019 (4)

Details of Wound Assessment CQUIN for Community Providers (5)

Indicator name: Improving the assessment of wounds

Indicator weighting (% of CQUIN scheme available)         0.25%

Description of indicator: The indicator aims to increase the number of wounds which have failed to heal after 4 weeks that receive a full wound assessment.

Rationale for Wound Assessment CQUIN Indicator

Extract from Page 130 of NHS England CQUIN Indicator Specification (5):

“1/ Failure to complete a full assessment can contribute to ineffective treatment which therefore   delays the rate of wound healing for patients. This has significant consequences for patients in respect of their quality of life as failure to treat wounds correctly can lead to delays in healing or failure to heal.

2/ For providers and commissioners the delay in wound healing   relates to the resources being consumed inappropriately. Managing patients with wounds and their associated co-morbidities is estimated to cost the NHS £5.3 billion; the average cost of unhealed wounds is more than double that of healed wounds.  There is also significant variation in current practice.

3/ A recent economic evaluation of a  wound care pathway for chronic wounds demonstrates that the current pathway experienced by many patients  delivers poorer outcomes at greater cost to the commissioner – the study estimates this cost to be approximately  10 times greater.  “

Achieving Transformational Change for Wound Care Pathways

Entec Health is working with NHS Providers to develop and deliver transformation of wound care pathways, enabled with the innovative Silhouette (ARANZ Medical) digital wound assessment and information management solution. (6,7,8,9,10)

Find out more here: Download Silhouette Health Innovation Prospectus

Silhouette is developed and manufactured by ARANZ Medical. Entec Health is an appointed distributor for ARANZ Medical in the UK.

References and Resources  

1/ Health economic burden that wounds impose on the National Health Service in the UK: Guest JF, et al BMJ Open 2015:5:e009283. Doi:10.1136/bmjopen-2015-009283, View BMJ Open Article

2/ The True Cost of Wound Care, Kate Pym, Entec Health Guest Blog: See Blog

3/ NHS England CQUIN 2017-2019 Resources: See NHS England CQUIN Resources 2017-2019

4/ CQUIN 2017/19 Guidance – Publications Gateway Reference 06023 See NHS England CQUIN Resources 2017-2019

5/ CQUIN Indicator Specification – Publications Gateway Reference 06023 See NHS England CQUIN Resources 2017-2019

6/The use of electronic data capture devices in wound care settings. J.Fletcher, Wounds UK 2012, Vol 8, No 4 Download Publication

7/ EMAHSN Diabetes Foot Digital Solution  Care Closer to Home demonstrator, enabled by Silhouette. Read more EMAHSN website

8/ Going Digital, case study of early adopter experience with Silhouette, Kings College Hospital NHS Foundation Trust, Diabetic Foot Clinic, London, UK. M.Bates, March 2013. Download Case Study via this page

9/ Use of novel 3D digital technology for assessment of diabetic foot ulceration. J Lucas et al, Diabetes Foot Clinic, King’s College Hospital, London, SAWC Poster Presentation April 2015 (Please request copy via author)

10/ Pressure Ulcer Management case study, Barlow Respiratory Hospital, Long Term Acute Care Facility, Los Angeles, US, October 2013, See Case Study (ARANZ Medical web page)