I am - at heart - a campaigner. One of the aspects of my role as vice president which I love is being loud and proud when helping APIL campaign against needless injury; it is after all one of the organisation’s core objectives.
The campaign we launched last year to highlight the issue of pressure ulcers really captured my imagination: When the cash strapped NHS is straining to cope, having to deal with a reported £2 billion funding shortfall, why does it not do all it can to prevent pressure ulcers, an ‘easy win’ which would save it millions of pounds in treatment for injuries that needn’t have occurred? In so doing, the NHS would also meet one of its core objectives – to improve the lives of its patients - as opposed to making them more ill in hospital than they were when they arrived.
When we rolled out the campaign some people couldn’t seem to get their heads around why the Association of Personal Injury Lawyers was campaigning to prevent injury: Surely (they said) our members benefit when people are injured, and we can successfully sue for damages on their behalf? What cynics some people can be! The press often likes to depict us either chasing ambulances for people injured outside hospital, or as bloodless vampires preying on those who are injured inside it. The truth is that actually we are decent human beings who do not wish to benefit from others’ misery but do want to fight their corner where we are needed, and right the wrongs done to them.
For those who do not know, pressure ulcers (also known perhaps more commonly as bed sores or pressure sores) develop when pressure is applied for long periods to an area of the skin. This in turn disrupts the blood supply and the skin breaks down, forming an ulcer. They are often seen in people with mobility problems, people who can’t move for long periods and are confined to a chair or a bed. The elderly are particularly prone because their skin becomes more fragile with age. If pressure ulcers are not treated appropriately and early enough they can deteriorate quickly to the point where muscle or even bone is exposed. They are – as one can imagine – very, very painful, and if left to fester, they can become incurable.
What we know from NHS England’s own figures is that the cost to the NHS of treating serious pressure ulcers could be as much as £186 million every year. But perhaps a more alarming statistic is that 95 per cent of pressure ulcers are completely preventable. So for our national health service to cause them, in turn causing increased pain to their patients, and an increased drain on NHS resources, is surely a national disgrace.
There is, however, a lot of good practice out there. APIL’s campaign draws inspiration from the excellent work of NHS Midlands & East and its determination to “stop the pressure”: Championing simple, old fashioned nursing techniques, it has devised a package of measures identifying firstly where the high risk areas on a given patient are (often their bony extremities), emphasising the importance of skin inspection, encouraging movement, identifying moisture and incontinence issues as risk factors, and ensuring good nutritional intake and hydration. Where followed, these initiatives have led to a 50% reduction in the prevalence of pressure ulcers, and they have recently been rolled out to all NHS Trusts in England. APIL argues for a wider take-up – nationwide, and in care homes across Britain.
We also call for mandatory training on the relevant NICE guidelines – prevention is the key here, and this depends on those caring for patients and residents knowing how to risk assess a patient, how to spot the early signs and treat them there and then. Tissue viability nurses are specialists in this field and should be on hand to advise and treat wounds that don’t heal as expected, or where a patient has complex needs.
Where a patient or care home resident has developed a pressure sore, or is at particular risk of doing so, one person on the care team should be given overall responsibility to ensure that appropriate advice is sought and treatment is given and that if a treatment plan is in place it is adhered to, with ultimate responsibility resting with this named person.
Further, there should also be a uniform system across the board to record the incidents of pressure ulcers, their stages, how they are treated and the outcomes. The Care Quality Commission should carry out spot-check inspections to ensure that proper data is being collected and there is no false or misleading reporting. This is particularly important because APIL has discovered a ‘postcode lottery’ when it comes to the standards in hospitals across the land, and even sometimes between hospitals in the same district. Patients and their loved ones need information they can rely on about how seriously a hospital – or a Trust – take the prevention and treatment of pressure ulcers, to enable them to take a view.
The soothsayer Richard Susskind, speaking at a lecture last year, addressed the hall on what he felt consumers wanted from the law. He said that people don’t want an ambulance at the bottom of the cliff; they want a fence at the top. He is right. I would prefer to live in a world where no one was needlessly injured, even if I had to retrain as a tax lawyer. This is why campaigning to prevent needless injury is perhaps APIL’s most important objective and one behind which we all can rally.