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Your skin matters - one of the High Impact Actions

Your skin mattersThe aim of the high impact action – Your skin matters is ‘no avoidable pressure ulcers in NHS provided care’ – but which ones are avoidable? We know that pressure ulcers represent a major burden of sickness and reduced quality of life for patients. They create significant difficulties for patients, carers and families, as well as increasing time in hospital and, therefore, cost to the NHS.

full print and download full chapter Your skin matters - full chapter from The Essential Collection (5.85 MB)

Case studies

Click on the small images, above, to access the video case studies.


Nursing homes were the focus for further improvement in reducing pressure ulcers in the community at Newham PCT, which recruited two specialist nurses to work with them on reducing the prevalence and impact of pressure ulcers among this vulnerable patient group.

Your skin matters case study 1 - Newham PCT (1.39 MB)

Kettering General Hospital NHS Foundation Trust

A programme of change focusing on continence care has helped reduce the incidence of skin damage by 80%. In the absence of a dedicated continence specialist, the tissue viability team worked differently to maximise the support they were able to give staff. A selection protocol for continence products was devised to ensure the right product is available and used.

Your skin matters case study 2 - Kettering General Hospital NHS Foundation Trust (1.39 MB)

East Kent Hospitals NHS Foundation Trust

Pressure relieving mattresses are considered to be an important tool in preventing and treating pressure ulcers – and this is why wards can be less then willing to part with them for fear of having a patient in need and no equipment to support them. East Kent introduced a range of measures to ensure they were available for those patients who were in most need.

Your skin matters case study 3 - East Kent Hospitals University NHS Foundation Trust(1.32 MB)

Abertawe Bro Morgannwy University Health Board

Nurses working in the plastic surgery unit were all too familiar with the dire consequences of pressure ulcers, so have developed a zero tolerance approach to hospital-acquired pressure ulcers. The practice has spread throughout the trust and pressure ulcers are now an extremely rare event.

Your skin matters case study 4 - Abertawe Bro Morgannwg University Health Board (1.18 MB)

Literature review

The literature review was commissioned by the NHS Institute to take forward previous work in assessing the costs and benefits of high impact actions by nurses and midwives.

This literature review updates the High Impact Actions for Nurses and Midwives: Rapid Review of Economic Data conducted by Pricewaterhouse Coopers in November 2009.

This report details the findings from the literature review and will be used to inform both the case studies and economic modelling.

Print or download literature review Literature review - Your Skin Matters (272.61 KB)

Additional information

Colchester Tiptree Box 2010 (291.74 KB)

Return on investment (ROI)

On field visits the NHS Institute team obtained a detailed understanding of the approach that has been taken by clinicians, who was involved, the impact (costs and benefits), and the data available to evidence this impact (pre and post implementation measures wherever possible).

Additional data have been secured through ongoing liaison with key informants including business managers, health informatics and audit staff. Modelling Modelling has been undertaken to generate a costs to benefits ratio.

The modelling utilises the following data:

  • Data from the literature review on the scale of the problem nationally, and the associated costs of the problem (i.e. potential savings);
  • Data from the literature review on impact;
  • Data from the sites on impact and the costs of implementation.

The first two bullet points are used as face validity checks for the data secured through field work and to provide proxy indicators where field data are unavailable. An excel workbook of their cost benefit calculation including all underpinning assumptions is provided.

Newham ROI summary (289.18 KB)

Newham (32.00 KB) 

Kettering ROI summary (232.90 KB)

Kettering (39.50 KB)

Opportunity Estimator

The opportunity estimator allows you to calculate the potential cost savings associated with making improvements in the High Impact Actions .  It utilises information from the literature reviews that are available in each High Impact Actions section.  The opportunity estimator will give you an indication of potential savings, if you want to carry out a more thorough  Return on Investment (ROI) analysis there are tools available at

Online tool - opportunity estimator The Opportunity Estimator 

Submissions received for Staying safe - preventing falls 

See all of the submissions that were received in this category.




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Becky Mould (Clinical Manger Temporary Staffing Nurse Bank - Kettering General Hospital NHS Foundation Trust)

Jacqui Handley (Community Matron - Bournemouth & Poole PCT)

Debra Panikkar (Matron - Buckinghamshire Hospital NHS Trust)

Julie Carr (Sales Director - Activa Healthcare)

Tony Halton (Director of Nursing - Milton Keynes Hospital NHS Foundation Trust)

Jackie Ardley (Executive Director Quality & Chief Nurse - Leicestershire Partnership NHS Trust)

Mandy Lewis (Community Staff Nurse - Worcestershire PCT)

DEREK PAMMENT (MANAGING DIRECTOR - North Staffordshire Community Healthcare)

sandra Glynn (Community Matron - City & Hackney PCT)

Cecilia Edeh (Staff Nurse - Barnet & Chase Hospitals NHS Foundation Trust)

Claire Peacock (Staff Nurse - Worcestershire PCT)

Jonathan Maskell (Matron - Buckinghamshire Hospital NHS Trust)

Bendle Liz (Productive Co-ordinator - NHS Devon)

Louise Long (District Nurse Coordinator - Warrington PCT)

Gemma Wood (Staff Nurse - Heart of England NHS Foundation Trust)

Lindsey Pitt (Staff Nurse - The Royal Wolverhampton Hospital NHS Trust)

Louise Hembrough (Director of Clinical Services/ Executive Nurse - Community Healthcare NHS South East Essex)

Ann Clapham (Limphoedema Specialist Nurse - Worcestershie NHS PCT)

Karen Wild (Senior Lecturer. - University of Salford)

Antan Edet (Senior Sister - Ealing Hospital NHS Trust)

Cathy Poole (Senior Lecturer, Child Health - Birmingham City University)

Jane Aldridge (Junior Sister - Hereford Hospitals NHS Trust)

Kaye Dudley (Deputy Directorate Accountant - Royal Orthopeadic Hospital)

Trish Winn (Head of Nursing Emergency - North West London NHS Trust)

Jayne Talman (Project Lead - Releasing Time to Care - Leicester City Community Health Service)

Fiona Biwalkar (Student Nurse - UWE Bristol)

Paz Long (Nurse - NMC)

Christine Whitney (Cardiac Rehabilitation - Lancashire Teaching Hospitals NHS Foundation Trust)

Catherine George (Community Matron - Camden Provider Service)

Sue Atkins (Dignity in Car Clinical Educator - University Hospitals Birmingham NHS Foundation Trust)

Sarah Brown (Senior Sister - RWH NHS Trust )

Victoria Buchan (DSN - Papworth Hospital NHS Foundation Trust)

Helen Marsh (Sister - Royal Wolverhampton Hospital NHS Trust)

Vicki Poole (Care Co-ordinator - Stoke on Trent Community Health)

Kathryn Greenwood (Lead Nurse - Worcestershire PCT)

Amanda Bickle (Clinical Team Leader - North Staffordshire)

Jacqueline Andrew (Director, Qulatiy and Practice - Hotel Dieu Grace Hospital)

Louise Bebb (Staff Nurse - Royal Wolverhampton Hospital NHS Trust)

Marion Woolliss (RGN - Royal Bournemouth Hospital)

Jacqueline Markland (Locality Manager - NHS Blackpool)

Zoe Harris (CM Lead - Leicester City Community Health Service)

Leesanne Marsh (Community Staff Nurse - Dudley Community Services)

Lynn Fullerton (Project Lead Nurse - Nottingham University Hospitals NHS Trust)

Penny Foley (Staff Nurse - Oxford & Buckinghamshire Menta Health Trust)

Kim Grocott (Senior Nurse Clinical Standards and Quality - University Hospital of North Staffordshire)

Stephen Woodcock (Ward Matron - Leicestershire Partnership NHS Trust)

Sue Henshall (Nurse Manager - Stockport NHS Foundation Trust)

Mo Nowrung (MR - UEA)

Wendy Burton (Staff Nurse - Ipswich Hospital NHS Trust)

Suzie Cro (LSAMO - LSAMO Forum UK)