As we approach another general election, there is always a feeling of worry for those working in the health service as to what might happen in the coming months. There is much talk of public sector job losses and reduction in service capacity in order to help reduce the national debt. Many health boards are considering changes to staff conditions in order to save money. Rather than see these changes as negative, there is an opportunity in tissue viability to demonstrate that high standards in wound care and prevention of pressure ulcers can contribute not only to improving patient care, but also to significant savings in terms of bed days and treatment costs. Recent attention on tissue viability has been negative particularly in relation to evidence surrounding wound dressings, however, this focus somewhat skews the real issues, which are about providing high quality cost effective care to every patient. For the past 5 years, there has been huge focus on Health Care Associated Infection (HAI), and rightly so. This has, however, eclipsed the need for improving tissue viability services across the UK, and, in addition, little has been made of the link between tissue viability and HAI. Better tissue viability provision and education would without doubt impact positively on the HAI rates. The time has come for tissue viability and all related specialities to push forward the agenda that will ensure that every patient in the UK should have thorough and accurate wound assessment, risk assessment at first contact and access to a tissue viability specialist within a reasonable time frame. Wound care and wound care education needs to be higher up the agenda, and with many community nurses spending the majority of their working day treating patients with wounds, we should not be relying solely on industry based education to see that this happens, although I must add, industry education is always welcome.

As I eluded to earlier, some of the negativity in relation to tissue viability has come from recent research which serves to highlight the lack of evidence to support wound care products. While, in an ideal world, every product would come to market with tomes of research support, there is a ground swell of opinion which suggests that the traditional randomised controlled trial is not suited to chronic wound care.

When considering an RCT for chronic wound treatments one may have to create an exclusion criteria which would rule out the very patients for which the treatment is intended. I have read some leg ulcer studies which included wounds which were smaller that 2cm in diameter. This bears no relation to the patients we see in practice, so how does this type of study help our practice? We must also think about all the conditions which impact on healing such as vascular disease, anaemia, diabetes and rheumatism to name but a few. Can we truly compare like with like, if our patients present with complex chronic conditions which are all likely to impact on healing?

The scientific community seem content to comment negatively on the lack of evidence in wound care, however, there is rarely any constructive direction from these quarters. I would suggest that instead of worthless meta -analyses which tell us nothing new about our field, that someone produces guidelines on what would be acceptable levels of evidence in wound care when the RCT is not appropriate.

John Timmons
Editor