Recently I have met several delightful old ladies who are suffering from leg ulcers. These ladies have all been in their 80s, which means they have survived a world war and can remember what life was like before the NHS. Furthermore, these ladies (or their husbands) have paid national insurance contributions for a large part of their life so that they can have access to the healthcare they need. It seems so wrong that I am having such a struggle to help these people get the care they need.
Leg ulcers are very common in old age. They can be extremely painful and make life miserable by leaking and smelling. Treatment is complicated. It is difficult enough to make an accurate diagnosis of the cause of ulceration before trying to persuade the patient that they need to consider possible surgery or a lifetime in compression bandaging or hosiery. The good news is that most ulcers can be healed and further ulcers prevented if patients get the correct treatment. However, as with most chronic conditions, good results depend on the patient having access to a clinician who is allowed time to develop skills to deliver the appropriate care. It seems to be very difficult for practice nurses to protect sufficient time to fully assess and treat patients with leg ulcers when they are under such pressure to meet QOF targets.
This appears to be where the problem lies. Although money is undoubtedly flowing into the NHS, it only appears to flow for certain conditions. Conditions such as diabetes, cancer, drug user services and infection control rightly attract attention and subsequent funding. Unfortunately, this means that other conditions are left behind. The particular irony around leg ulceration is that although it is unlikely to kill its victims, if not treated correctly, it eats up NHS resources in terms of nursing time, dressings and medication and contributes to the MRSA problem in terms of wound infection.
I recently had a phone call from a practice nurse who told me (tongue firmly in cheek) that her leg ulcer patients were considering developing an illegal drug habit! When I asked her to explain she pointed out that our wound clinic for drug users had succeeded in attracting funding, but that we are still awaiting commissioning of leg ulcer clinics for non-drug users.
I can see the difficulties faced by PCTs (especially those with large deficits) when they are under such pressure to meet government targets around the specified targets. However, I can't help but feel that the government is missing a trick here. Thank goodness we are able to provide a wound service for the drug users, but surely the elderly ladies (and thousands more like them) also deserve the adequate funding of leg ulcer services?
Do you think more funding should be put towards leg ulcer care?
Your comments: (Terms and conditions apply)
"Yes, because it seems medical personell don't understand the amount of pain they cause. Doctors are reluctant to prescribe painkillers that actually work. It's easier to go to King's Cross and get them illegally than to sit in a waiting room for an hour, only to be prescribed paracetamol and ibuprofen, which don't work. It's seen as a nonemergency and disease of the old. I have just been diagnosed and it took me six weeks to have a scan. I still haven't had the results but I know the cause - it's venal. I had a triple bypass eight years ago and the ulcer is right on the scar. The NHS is OK, it's the BMA and the medical mafia that run the show who decide policy regarding treatments." - John Main, London
"Yes, certainly more funding is needed – more funding to educate nurses about leg ulcer management and also more funding for lymphoedema management, which is well catered for if you have cancer-related lymphoedema, but is poorly managed otherwise, and results in cellulitis, leg ulceration and social isolation in many cases." - Sylvia Stanway, Salford PCT
"Yes to the above. Hackney is known to have a poor socioeconomic status. The leg ulcers complicated by sickle cell anaemia is increasing in some young blacks. Without evidenced-based management. Their future looks frustating because their ulcers seem to recur quicker than the average venous leg ulcer." - Jemma Joseph-Crosby, East London
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