The 19 November was International Pressure Ulcer Day. During this day many events took place all over the world in order to raise awareness about pressure ulcers and how they can be prevented. For Nottingham University Hospital Trust, it was the fourth time that we have been involved in activities with patients and staff to raise awareness. At our trust on the 19 November we set up stalls and approached nurses, patients and visitors over both our hospital campuses. One of the benefits of participating in this event was that it maintained the momentum of the original initiative instigated by NHS England to eliminate avoidable pressure ulcers. This initiative has resulted in our organisation not having an acquired stage 4 ulcer for over two and a half years. The original initiative began several years ago and has had a massive impact both on tissue viability services and those nurses delivering pressure ulcer prevention on the wards and in the community. If I had to explain my experience of this initiative so far I would say that I feel I have been part of an experiment in social engineering. What do I mean by this?
The news recently reported that China had reviewed and changed its ‘one child policy’, a policy aimed at reducing the population of the country. This policy was a very draconian form of what is called social engineering. Social engineering is not a popular concept in the West, but involves identifying a problem in society and undertaking radical measures to eliminate the problem. The NHS is not immune to social engineering. The establishment of the NHS in the 1940’s was an act of social engineering. After the Second World War, the health of the population was so dire that the government had no other option but to take the radical move of establishing a system of free healthcare. Since its inception the NHS has instigated numerous socially engineered initiatives to improve the health of the nation. The policy of immunisation is one example that has virtually eliminated many of the diseases that were all too common after the Second World War.
The initiative to eliminate pressure ulcers has been another radical project. Prior to its instigation I would see patients every single week with sacral pressure ulcers large enough that you could get your fist into them. The initiative to eliminate pressure ulcers has resulted in a situation where I no longer see patients with severe pressure damage. I will never forget the story of an 85 year old patient admitted to hospital following a fractured neck of femur, who then ended up in hospital for another 18 months because she developed a pressure ulcer. I do not want to return to this period of history, but at the same time, just like in China where they have relaxed their one child policy, I think we need to review and take stock of the initiative to eliminate pressure ulcers now that we have reduced our incidence of pressure ulcers nationally. We need to focus more of our attention on sustaining the enthusiasm for pressure ulcer elimination.