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'District nurses hands are tied by poor procurement decisions'

Former nurse Laura Downes took over her husband's wound care because she was afraid that her community trust's cost-saving policy on dressings would compromise his recovery. 
Laura and Steve Downes

Former nurse Laura Downes took over her husband's wound care because she was afraid that her community trust's cost-saving policy on dressings would compromise his recovery

In March last year my husband Steve woke up in agony, with pain in his right foot and leg. His toes had turned blue, and after a dash to the local emergency department, we were quickly referred to the vascular team at a leading London hospital.

Despite their efforts to save his foot and leg, Steve had a below-knee amputation, returning home three months later.

Steve has antiphospholipid (sticky blood) syndrome, atrial fibrillation and type 2 diabetes. Under the hospital-based team, his care has been excellent. I wish the same could be said for care in the community.

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Former nurse Laura Downes took over her husband's wound care because she was afraid that her community trust's cost-saving policy on dressings would compromise his recovery 


Steve Downes, pictured with his wife Laura, required a specific dressing regime for his post-amputation wound. Picture: David Gee

In March last year my husband Steve woke up in agony, with pain in his right foot and leg. His toes had turned blue, and after a dash to the local emergency department, we were quickly referred to the vascular team at a leading London hospital.

Despite their efforts to save his foot and leg, Steve had a below-knee amputation, returning home three months later. 

Steve has antiphospholipid (sticky blood) syndrome, atrial fibrillation and type 2 diabetes. Under the hospital-based team, his care has been excellent. I wish the same could be said for care in the community.

Inadequate response 

After his amputation Steve had wound care problems, requiring dressing by a district nurse. The dressing regime was honey therapy and a pliable covering. One day while I was out, a nurse removed the dressing but had no replacement to apply, so used a non-absorbent square pad and tape that I had bought. 

When I questioned this on the next visit, I was told they had run out of Steve's usual dressings. The nurses used to obtain prescriptions for dressings from the GP, but this was deemed too expensive by the community trust. 

It is common practice now for a trust administrator to order dressings on a weekly basis, but the nurses almost always run out before the next batch arrives. If this happens, it is basically tough luck for the patient. 

When I complained to the trust about this, highlighting how ineffective it was as a cost-saving exercise, the response I eventually received was far from adequate, basically putting the onus on the nurses to order more dressings. 

Poor decisions 

The district nurses have my utmost sympathy. They are trying to do their best, but their hands are tied by poor procurement decisions from management.  

In 2015, the RCN launched a campaign aimed at driving nursing leadership in procurement. Through Small Changes, Big Differences, the college lobbied for nurses to have a say in the purchasing of products. 

Nurses are the ones delivering care on the front line. They know which products their patients need and in what volume, so why are they not more involved in these decisions? 

How does an administrator know what a district nurse's caseload for that week looks like, and whether they are ordering the right dressings in the right quantities? 

Problems spreading

To add to our anxiety, Steve's left leg and foot began to deteriorate 24 hours after he was discharged from hospital. He developed cellulitis, oedema, the toes were changing colour and the wound areas began to break down. 

A heavy dose of antibiotics cured the cellulitis, leg elevation helped the oedema, and as a foot pulse was palpable, he avoided going back to hospital. 

But the small wounds became high-grade leg ulcers, with the leg almost entirely ulcerated from below knee to ankle. 

As a former nurse, I took over the dressings at the suggestion of the hospital vascular team. We moved on to zinc bandaging, then silver, and finally to PVP-I non-adherent dressings, which were supplied by the hospital.

Sacrificing safe care

When we went back to see the consultant and clinical nurse specialist, they couldn't believe the improvement. Within five months, the ulcerations had completely healed. Treating Steve's ulcers with the correct dressings may just have saved him from having to undergo a second amputation. 

The NHS spends £9 billion a year on clinical supplies and services. I understand the need to save money given the financial pressures on the NHS, but this cannot be at the expense of delivering safe, effective patient care. 

This has been a stressful and life-changing experience for my family and I, but I will continue to push for what is right for Steve.

My concern is for the vulnerable patients who cannot fight for themselves, and don't have friends or relatives with a nursing background. What happens to them? 


Laura Downes is a freelance healthcare journalist 

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