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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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Elaine Baxendale (Deputy Manager - Island D&A Service NHS PCT)

Henry Nii Oblie (Community LD Nurse - Surrey & Borders Foundation Trust)

Denise Potter (Assistant Director of Infection Prevention & Control - Barnsley Hospital NHS Foundation Trust)

Helen Robinson (Sister/Transplant Coordinator - Papworth Hospital NHS Foundation Trust)

Jacqui Stamper (Matron - Royal Liverpool Broadgreen University Hospitals NHS Trust)

Helen Burstow (DCE - Royal Bournemouth and Christchurch)

Julie Hodgkins (Sister - Kettering General Hospital NHS Foundation Trust)

susan low (Sexual Health Promotin Nurse - BUCKS HOSP TRUST)

Gillian Houghton (Matron & Midwife - Liverpool Womens NHS Foundation Trust)

Vanessa Stuckey (Deputy Director of Community Services - Solihull Care Trust)

Lorraine Hyde (Matron - Royal Marsden Foundation Trust)

Judy Gillow (Director of Nursing - Southampton University Hospitals NHS Trust)

Rowan Procter (General Manager Gastroenterology & General Surgery - Ipswich Hospital NHS Trust)

Christopher Ashcroft (Matron Emergency Care - Brighton & Sussex University Hospitals)

Jane Stevens (Clinical Matron - East Sussex NHS Hospitals Trust)

Suzanne Barber (Midwife - Milton Keynes Hospital)

Zeihab Mnyanzi (Registered Nurse - Newham University Hospitals NHS Trust)

Jill Yates (Advanced Neonatal Nurse Practitioner - Royal Berkshire Hospital NHS Foundation Trust)

Pauline Tarrant (Diabetic Specialist nurse - East Coast Kent PCT)

Geraldine Walters (Director of Nursing & Midwifery - Kings College Hospital Foundation Trust)

Dawn Harper (Matron - Guys & St Thomas NHS Foundation Trust)

Tracey Cooper (Head of Patient Experience & Safety - NHS Herefordshire)

Jennifer Barnes (Theatre Practitioner - Central Manchester NHS Trust)

Pam Chatfield (Head of Hospital - Berkshire West PCT)

Theresa Fitton (Ward Sister - West Sussex PCT)

Catherine Cavanagh (Clinical Lead - Community Services Bury)

Bianca Brown (Development Transplant Practitioner - Papworth Hospital NHS Foundation Trust)

Christine Walley (Ward Manager - Countess of Chester NHS Trust)

Emma Innes (Lead Diabetes Nurse - Worcestershire Acute NHS Trust)

simon runnett (team leader - nspct)

Helen Brown (Professional Development Nurse - Central London Community for Healthcare)

Frances Bolger (Midinfery Manager - Ipswich Hospital NHS Trust)

Kulvinder Hira (Equality & Diversity Lead - Wocestershire NHS)

Anneliese Weichart (Associate Director - Clinical Quality and Workforce - Tower Hamlets Community Health Services)

Samantha Minto (TAP Breast Care - Torbay Hospital)

Ruth Heyes (Advanced Nurse Practitioner - Stoke on Trent Community Health)

Nichola Seaman (Deputy Sister - James Paget University Hospital)

Catherine Murphy (LAC Health Advisor - Knowsley Primary Care Trust)

Yvonne Whitfield (Ward Manager/Team Leader - Powys)

Stuart Hemingway (Charge Nurse - Royal Berkshire Hospital NHS Foundation Trust)

Gail Tucker (Clinical Excellence Lead (South ICT) - BHT CIC)

Elizabeth Greenaway (Staff Nurse - Band 5 - South Warwickshire Foundation Trust)

Mee Lan Pandya (Clinical Transformation Change Manager - NHS Newham)

Amanda Reeves (Senior Sister - Addenbrookes NHS Trust)

Mo Smith (Senior Nurse MH and LD - IOW NHS)

Val Stronach (Head of PPI/Equality - North Staffs Combined Healthcare NHS Trust)

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

Martha Gyor (Staff Nurse - Hampshire Community Health Care)

Michelle Melling (Young People's Sexual Health Services Manager - NHS Blackpool)

Evelyn Fulford (Staff Nurse - Heart of England NHS Foundation Trust)