A Facebook Live Question Time event was held in February 2020 to address several key issues concerning the future of wound care service provision in England. The event can be viewed or read. Here, the industry group who supported the event, thank all stakeholders for participating in this very important discussion, and provide further comment.
The advanced wound care industry group is made up of member companies from the two main trade associations, the Association of British HealthTech Industries (ABHI) and Surgical Dressings Manufacturers Association (SDMA), who are both aligned to improving outcomes for people with wounds. Existing evidence such as Guest et al (2016) indicates that both improved clinical and economic outcomes are achievable if the right strategies are implemented across the healthcare system.
We support the overarching aims of the National Wound Care Strategy Programme (NWCSP) to improve wound care pathways and look forward to presenting the voice of industry further during the development of the NWCSP.
We believe it is important that the NHS, including local healthcare providers look end to end across the healthcare system, at the overall cost of wound care. Once the cost of delivering wound care to a local population is transparently understood, then the focus can shift to where changes can be made. Evidence from Guest et al (2015) has shown that up to 80% of the cost of wound care is generally associated with clinical time. The lowest cost dressing does not always result in a lower overall cost of wound care to the system and could in fact make it worse (Guest et al, 2017). Worse means that costs to the healthcare system increase. This can happen as a product bought solely for low price may not be effective. For example, a low cost dressing may need to be changed more often or not perform as effectively, thus increasing consumption and/or resulting in delayed healing. These factors combine to increase financial and clinical burden, as well as impacting negatively upon the patient’s quality of life (Guest et al, 2017).
NHS Supply Chain along with the Category Towers are tasked with defining a strategy which requires Supply Chain Coordination Limited (SCCL) approval. The agreed strategy defines the approach to market and the expected outcomes of the procurement process. For established technologies, the procurement strategy is usually heavily weighted toward price, with limited consideration given to elements such as the impact on the total cost of care, clinical and patient outcomes or supply chain resilience. For new, innovative technologies, additional consideration is sometimes given to these factors. Ultimately, there is a risk that clinicians will have to compromise on patients’ care as the products made available to them have been chosen using a limited set of criteria.
The NHS healthcare system also needs to give due consideration to what is both relevant and possible in terms of the evidence. Industry is concerned that procurement activity does not always take into account good quality evidence that comes below the preferred, gold standard randomized, controlled trial (RCT) in the evidence pyramid. The industry group feels that an evidence reset is required in this respect. While not dismissing the role of the RCT in evidence generation, we feel the practicalities and limitations of this type of evidence should be acknowledged, and more weight given to real-world evidence that is collected during product assessment. It seems the NWCSP calls for and sets a high a bar as possible for evidence, but procurement strategies do not always value this.
In recent feedback to the National Institute for Health and Care Excellence (NICE), ABHI proposed that established evidence hierarchies are considered routinely rather than the current situation, which seems to largely dismiss non-RCT evidence. We are currently awaiting a response.
Choice, specifically in relation to products, is also a subject of debate. The industry group supports the clinical view that choice is paramount for clinicians. Clinicians have the responsibility of making instant decisions, based upon individual patient needs. The panel discussion confirmed that clinicians believe this choice is being taken away from them by procurement activities.
We look forward to the opportunity to further and continually discuss these issues with all stakeholders.
The advanced wound care industry group is made up of member companies from the two main trade associations, the Association of British HealthTech Industries (ABHI) and Surgical Dressings Manufacturers Association (SDMA), who are both aligned to improving outcomes for people with wounds. Existing evidence such as Guest et al (2016) indicates that both improved clinical and economic outcomes are achievable if the right strategies are implemented across the healthcare system.
We support the overarching aims of the National Wound Care Strategy Programme (NWCSP) to improve wound care pathways and look forward to presenting the voice of industry further during the development of the NWCSP.
We believe it is important that the NHS, including local healthcare providers look end to end across the healthcare system, at the overall cost of wound care. Once the cost of delivering wound care to a local population is transparently understood, then the focus can shift to where changes can be made. Evidence from Guest et al (2015) has shown that up to 80% of the cost of wound care is generally associated with clinical time. The lowest cost dressing does not always result in a lower overall cost of wound care to the system and could in fact make it worse (Guest et al, 2017). Worse means that costs to the healthcare system increase. This can happen as a product bought solely for low price may not be effective. For example, a low cost dressing may need to be changed more often or not perform as effectively, thus increasing consumption and/or resulting in delayed healing. These factors combine to increase financial and clinical burden, as well as impacting negatively upon the patient’s quality of life (Guest et al, 2017).
NHS Supply Chain along with the Category Towers are tasked with defining a strategy which requires Supply Chain Coordination Limited (SCCL) approval. The agreed strategy defines the approach to market and the expected outcomes of the procurement process. For established technologies, the procurement strategy is usually heavily weighted toward price, with limited consideration given to elements such as the impact on the total cost of care, clinical and patient outcomes or supply chain resilience. For new, innovative technologies, additional consideration is sometimes given to these factors. Ultimately, there is a risk that clinicians will have to compromise on patients’ care as the products made available to them have been chosen using a limited set of criteria.
The NHS healthcare system also needs to give due consideration to what is both relevant and possible in terms of the evidence. Industry is concerned that procurement activity does not always take into account good quality evidence that comes below the preferred, gold standard randomized, controlled trial (RCT) in the evidence pyramid. The industry group feels that an evidence reset is required in this respect. While not dismissing the role of the RCT in evidence generation, we feel the practicalities and limitations of this type of evidence should be acknowledged, and more weight given to real-world evidence that is collected during product assessment. It seems the NWCSP calls for and sets a high a bar as possible for evidence, but procurement strategies do not always value this.
In recent feedback to the National Institute for Health and Care Excellence (NICE), ABHI proposed that established evidence hierarchies are considered routinely rather than the current situation, which seems to largely dismiss non-RCT evidence. We are currently awaiting a response.
Choice, specifically in relation to products, is also a subject of debate. The industry group supports the clinical view that choice is paramount for clinicians. Clinicians have the responsibility of making instant decisions, based upon individual patient needs. The panel discussion confirmed that clinicians believe this choice is being taken away from them by procurement activities.
We look forward to the opportunity to further and continually discuss these issues with all stakeholders.
References
Guest JF, Ayoub N, McIlwraith T, et al (2015) Health economic burden that wounds impose on the National Health Service in the UK. BMJ Open 2015;5:e009283. doi: 10.1136/bmjopen-2015-009283
Guest JF, Ayoub N, McIlwraith T, et al (2016) Health economic burden that different wound types impose on the UK’s National Health Service. Int Wound J doi: 10.1111/iwj.12603
Guest JF, Vowden K, Vowden P (2017) The health economic burden that acute and chronic wounds impose on an average clinical commissioning group/health board in the UK. J Wound Care 26(6) https://doi.org/10.12968/jowc.2017.26.6.292
Guest JF, Ayoub N, McIlwraith T, et al (2016) Health economic burden that different wound types impose on the UK’s National Health Service. Int Wound J doi: 10.1111/iwj.12603
Guest JF, Vowden K, Vowden P (2017) The health economic burden that acute and chronic wounds impose on an average clinical commissioning group/health board in the UK. J Wound Care 26(6) https://doi.org/10.12968/jowc.2017.26.6.292
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