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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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Ian Siddall (Healthcare partnership Manager - Smith & Nephew)

Lucy Igbokwe (Midwife - Newham University Hospitals NHS Trust)

Eirlys Evans (Head of Quality & Board Nurse Advisor - NHS Waltham Forest)

Alison Smith (Assistant Director of Nursing (Childrens Champion) - South Tees NHS Foundation Trust)

Marian Hill (Staff Nurse - Hereford Hospitals NHS Trust)

Trina Dandy (Continence Advisor - NHS Central Lancashire)

Amandeep Basra (Staff Nurse - Royal Wolverhampton Hospital NHS Trust)

Karen Castille (Chief Nurse & Chief Operating Officer - Cambridge University Hospital NHSFoundation Trust)

Jessica Hargreaves (Transfustion Practitioner - Western Sussex Hospitals NHS Trust)

Eileen Mines (Health & Social Care Worker - Knowsley Primary Care Trust)

Jessica Stokes (Student Nurse - University of Wolverhampton (Walsall Manor))

Lesley Smith (Sister Critical Care - University Hospital of North Staffordshire)

Stephanie Rylands (Tissue Viability Nurse - University hospital of North Staffordshire)

Karen Coyle (Community MAtron Intermediate Care - NHS Sefton)

Stacey Peach (Staff Nurse - Wolverhampton PCT)

Sue Daw (Deputy Director of Nursing - West Middlesex University Hospital)

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

Lynne Barnes (Matron - Child Health - Lancashire Teaching Hospitals NHS Foundation Trust)

Stacy Dangare (Improvement Facilitator - SLAM)

Kamorydeen Tijandi (Health Care Assistant - Oxleas NHS Foundation Trust)

Bethan Hughes (Student Nurse - University of Glamorgan)

Andy Bates (Assistant Director of Infection Prevention and Control - west midlands Ambulance service)

Jean-Paul de Wet (Staff Nurse - Royal Free Hospital NHS Trust)

Patricia Lownds (Practice Educator - Stoke on Trent Community Health)

Ursula Gallegher (Director of Quality & Clinical Leadership - NHS Ealing)

Emma Noonan (District Nurse Team Leader - Knowsley Primary Care Trust)

Linda Katte (District Nurse Team Manager - NHS Haringey)

Vanessa Neve (Acute Pain Relief CNS - Hereford Hospitals NHS Trust)

Shirley Anderson (Locality Manager Intermediate Care - North Tees & Hartlepool NHS Trust)

Sarah Clements (Matron - Leicstershire County & Rutland Community Health Services)

Hakim Sobrany (Change Nurse - Luton and Dunstable NHS Foundation Trust)

Lasandra Thompson (Sister - The Royal Wolverhampton NHS Trust)

Mohamed Chabani (Ward Manager - Lewisham NHS Trust)

Anna Halfpenny (Community Staff Nurse - Worcestershie NHS PCT)

Joy Warren (Matron - Dorset Community Health Services)

Josie Rudman (Assistant Director of Nursing - Papworth Hospital NHS Foundation Trust)

Vanessa Hill (Staff Nurse - Heart of England NHS Foundation Trust)

Debra Panikkar (Matron - Buckinghamshire Hospital NHS Trust)

Helen Belk (Matron - Northampton General Hospital NHS Trust)

Judy Turland (Corporate Practice Development Nurse - Northampton General Hospital NHS Trust)

Alicia Waite (Lead Case Manager Funded Nursing - Manchester Community Health NHS)

Debra Neal (Sister - James Paget University Hospital)

Emily Roper (RGN Band 5 - Hereford Hospitals NHS Trust)

Dorret McLean (Health Visitor - Brent PCT)

Angela Cockram (Matron - York Hospital NHS Foundatin Trust)

Faye O''Reilly (Ward Manager - Royal Orthopeadic Hospital)

Liz Crockford (CNS Tissue Viability - Salisbury NHS Foundation Trust)

Jill Addis (Nurse Consultant/PW Lead - Oxford & Buckinghamshire Menta Health Trust)

Jane Rutter (Matron in Medicine - Worcestershire Acute Hospitals NHS Trust)

Lisa Coton (Sister - Heart of England NHS Foundation Trust)