Lower Limb Wound Care

Ann Clwyd Excerpts

Tuesday 23rd July 2019 Commons Chamber

[Ann Clwyd (Cynon Valley) (Lab)]

As you know, Madam Deputy Speaker, I do not normally sit when I speak in this place, but half an hour ago I was in a hospital bed on the 12th floor of St Thomas’s when I heard that this debate was coming early, rather than later. There was a big rush to get me here, and there are very good doctors and nurses in the Gallery who helped me to get here, because I thought it was tremendously important to speak. I had secured this debate, for which I am very grateful, and I particularly wanted to talk on this subject. I was pleased to get it before the recess, and I was not going to miss it for anything. After we finish, I shall be returning, I hope, to the 12th floor of St Thomas’s and to very good care.

The subject of this debate was brought to my attention by Lord Hunt, our colleague in the House of Lords, where they had a debate not long ago about what plans the Government have to develop a strategy for improving the standards of wound care in the NHS. As somebody who needs wound care right at this moment, I know what a big subject it is. I did not know before—I was totally ignorant—but I have discovered what a challenging subject it is for so many people.

As a patient myself, I can talk about the subject with some feeling. I have to say that it is the most painful thing I have ever come across, and I had no idea that people suffered this kind of pain. A week ago, when I had to be taken to a local hospital in Merthyr Tydfil, I was asked by an ambulance driver what level of pain I was in, on a scale of one to 10, and I said, “Nine.” I do not usually exaggerate; it was that painful. I am grateful to everybody who has helped me, and I want to make sure that the service develops and people get all the help they need in such circumstances.

[Jim Shannon (Strangford) (DUP)]

I congratulate the right hon. Member for Cynon Valley (Ann Clwyd) on securing the debate. She often features in Adjournment debates in this House. We are very pleased to see her in her place, and we thank her for all that she does. Does she agree that many people fear that the NHS neglects leg ulcers and the required treatment is not being given? The latest statistics, according to Dr Adderley’s speech at the Health Service Journal patient safety congress, show that leg ulcers account for 40% of chronic wounds but only 7% of the chronic wounds that are treated. There is quite clearly an anomaly.

[Ann Clwyd]

I am grateful to the hon. Gentleman for making my speech for me. I am sure we will be in total agreement as my speech develops.

Some interesting points were made during the debate in the other place, including the point that wound care is a massive challenge to the NHS, but it currently lacks priority, investment and direction. I want to push the Government, if they need pushing, on the need for urgent action and the development of a strategy across care providers to improve the standard of wound care.

A staggering 2 million patients are treated for wounds every year, at a cost of more than £5 billion and rising. While 60% of all wounds heal within a year, a huge resource has to be committed to managing untreated wounds. The NHS response is very variable. Healing takes far too long; diagnosis is not good enough; and inadequate commissioning of services by clinical commissioning groups compounds the problem, with under-trained staff and a lack of suitable dressings and bandages.

There has also been a very worrying drop in the number of district nurses, whose role in ensuring safe and effective wound care in the community is crucial. I was shocked when I talked to a friend in Cardiff about the problem of putting on surgical stockings, and her experience highlights the need for district nurses. My friend had had a serious operation, and she could not bend to pull on the stockings. I asked her what she did, because she is a widow who lives on her own. She said, “I go out in the street and ask somebody to help me.” I am sure that people are very ready to help, but no one should be in that situation. I think we would all agree that the drop in the number of district nurses is very worrying.

I am told that, ideally, 70% of venous leg ulcerations should heal within 12 to 16 weeks, and 98% in 24 weeks. In reality, however, research shows that healing rates at six months have been reported as low as 9%, with infection rates as high as 58%. Patients suffer, and the cost of not healing wounds swiftly and effectively can lead to more serious health problems, such as sepsis, which is often the result of an infected injury. We also know that foot ulcers on diabetics can unfortunately lead to amputations if they are not dealt with properly.

In the other place they talked about the Bradford study, and there is a very good summary of it in the House of Lords Library. It underlines the importance of evidence-based care, with nearly one third of patients interviewed in the study failing to receive an accurate diagnosis for their wound. As the study puts it:

“Wound care should be seen as a specialist segment of healthcare that requires clinicians with specialist training to diagnose and manage…There is no doubt that better diagnosis and treatment and effective prevention of wound complications would help minimise treatment costs”.

We learn most of all from our own experience. My experience is that when I first developed a farthing-sized spot on my leg, I did not know what it was. I asked my chiropodist, who looked at it a few times and said, “I think you had better go and see your GP.” I went to see my GP—a very good GP—who did not know what it was either. Eventually, I was referred to a skin specialist—this is some weeks ago, now—who looked at it and said, “I don’t know what it is, but why don’t you try putting Vaseline on it?” Now, I do not think the experts up there in the Gallery would think that that was a very good idea, but I did put Vaseline on it and I do not know whether that did me any harm or not. You do worry a lot when something like that happens, whether you have knocked your leg or injured yourself in some other way, and you wonder what on earth it could be.

I think that maybe diagnosis is difficult, but rapid diagnosis is absolutely essential. I am sure the Government would agree that we need to get to grips with a nationally driven strategy. Without it, patients will receive worse care for their injuries and the financial burden on other parts of the NHS will continue to increase, because patients develop chronic wounds or catch an infection that could lead to life-threatening illness.

During the course of my journey, I have met many interesting people. For instance, I did not know there was an all-party group on vascular and venous disease. I just happened to see it in the all-party notices the day after I had been in St Thomas’s. I rang up the chair, the hon. Member for St Ives (Derek Thomas), and asked him if I could come along to a meeting. He said that I was welcome to. I went along and, apart from the chair, I think I was the only MP there. There was a fascinating mixture of people, who were all involved in this problem in some way.

There was somebody who runs a leg clinic, who had a lot of stories to tell. In fact, she sent me a whole pile of patient stories—there is not time to read them out today, but they are very interesting. I realised how difficult it is for patients to get the right diagnosis and the right treatment. I took a list of all the people—they are mainly consultants—and I know that some people in St Thomas’s would have come along if they had known of the existence of such a group. It introduced me to the Lindsay Leg Club Foundation, which is run by Ellie Lindsay OBE, who is the president. There are leg clubs in many towns and cities around the country. She was very encouraging—I say that as somebody who was a bit afraid when they realised what they had. She rang me up several times, and her patient stories were fascinating.

[Jamie Stone (Caithness, Sutherland and Easter Ross) (LD)]

I am listening with great interest to what the right hon. Lady is saying, not least because this is an important debate on something that we do not talk about as much as we should in this place. Am I picking up correctly what she is saying on patient experience? Is she saying that we should encourage patients who have been through this transition and experience to share that experience with others in order to make other potential patients more aware of what might be out there and what they could do?

[Ann Clwyd]

Yes. That is a very positive idea. People need to talk to one another, particularly in this House because of the age differences. A lot of people talk about this in the other House, because on the whole they are much older than we are—except for me in this place; I am pretty old. I am just surprised that I had never heard of this before. Talking encourages people when they have discovered that they have this problem to seek the right advice.

[Jamie Stone]

Can I make absolutely sure that I understand this? By age difference, the right hon. Lady means people of my age—I am considerably older than some hon. Members—sharing experiences with people who are younger and might need to know these things. Is that correct?

[Ann Clwyd]

Sorry; I did not hear the last part.

[Jamie Stone]

Is this about the older generation, who might have had some experience in this regard, sharing experiences so that the younger generation—considerably younger than I am—might know the potential of what they will look at or deal with in future?

[Ann Clwyd]

Yes. I am very glad that there is an all-party group, for example, because it is important that such groups exist. I have seen the work that has gone on there over several months. As the hon. Gentleman knows, there are dozens and dozens of all-party groups in this place—I am sure that we do not know of the existence of most of them, but it is good to draw attention to this one.

Another person I met was Professor Julian Guest, who is a health economics consultant. People are very good at sending information. He sent me a list of things that, as a health economist, he has been working on. He says that wound care requires

“a change in its service delivery model that could include…Enhanced support for safe self-care (possibly by integration with local pharmacy support and supervision)…Improved diagnostic support underpinned by increased training and education of non-specialist nurses in the fundamentals of wound management…Consistent and integrated progressive care pathway with agreed defined trigger points for senior involvement and onward referral for investigation and differential diagnosis and a shared management plan to be implemented regardless of care setting…Establishment of dedicated wound care clinics in the community, possibly in general practices.”

So there are several papers by people working in this area who are thinking deeply about it.

I heard from consultants at St Thomas’s about an excellent development called the Camden Health Improvement Practice pilot wound clinic. Dr Geraghty, who runs it, is working on wound care for people who are sleeping rough—for the homeless. I think everybody would applaud that as a very necessary and useful thing to do, and we look forward to hearing more about it. I am looking at the clock, and there is not much time left, but I hope the Minister will respond on this issue, because when I think of the pain inflicted on people—luckily, my pain is managed, but the pain of the homeless, for example, who are sleeping rough on the streets, is not generally being managed—it is clear that this Camden project is a very welcome development.

I had a new knee about a year ago, which is not a pleasant thing to have done. However, I have known nothing as painful as this leg wound, and I am grateful that so many good people are working in this area and highlighting its importance. It is probably not as glamorous as others in the health service, but it is absolutely necessary for people’s wellbeing, comfort and health, and I hope we can do a lot more to support people in this area, to support new initiatives and to assist the doctors, nurses and other practitioners who do such an excellent job.

I am out on parole, Madam Deputy Speaker. I will, I hope, be returning to my bed in St Thomas’s before too long, and I hope to come back after the recess with very positive views and a continuing interest in the whole subject of wound care in the NHS.

[The Minister for Care (Caroline Dinenage)]

It has sometimes been said that MPs in this House speak about things they do not know about, and sometimes MPs speak about things about which they have only a little experience, but I do not think I have ever had the honour of responding to a debate where a Member has spoken with so much current, relevant experience. I must congratulate the right hon. Member for Cynon Valley (Ann Clwyd)—

[Ann Clwyd]

It is pronounced “Cun-on”