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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.




Contact the High Impact Actions team

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Nick Pym (Head of Governanace and Performance - NHS Newham)

Karen Cowley (Matron - York Hospital NHS Foundatin Trust)

Debra Neal (Sister - James Paget University Hospital)

Mary Aly (Matron Private Patients & Surgery - North West London NHS Trust)

Liz Haskins (Improvement Lead - Hertfordshire Partnership Foundation Trust)

Paula Tucker (Head of nursing for Surgery/Deputy Chief of Safety - Brighton Ans Sussex University Hospital Trust)

Clare Cardiner (Sister of Endoscopy - Royal Berkshire Hospital NHS Foundation Trust)

Kate Chaplin (Midwife - Leeds Teaching Hospitals Trust)

Carol Williams (RGN - Stoke on Trent PCT)

Joanne Taylor (Infection Prevention Nurse - George Eliot Hospital NHS Trust)

Comfort Okusanya (Community Matron - NHS Enfield)

Kim Gunn (Head of Infection Prevention & Control - Stoke on Trent PCT)

Lesley Heelbeck (Matron - County Durham & Darlington Foundation Trust)

Tina Long (Director Strategic Partnershios - NHS Wirral)

Teresa Moore (Clinical Lead Nurse - North Staffs PCT)

Sarah Sherwood (Sister - Royal Wolverhampton Hospital NHS Trust)

Angela Irving (Practice Educator Facilitator - East Lancashire Hospital NHS Trust)

Teresa Manders (Head of Midwifery - St George''s Healthcare NHS Trust)

Erika Calladine (Health Visitor - Stoke on Trent PCT)

sarah wemyss (Lead cancer nurse - Epsom & St Helier NHS Tust)

Amanda Kimpton (Service Manager - Worcestershire PCT)

Carol Alstrom (Chief Nurse - NHS Isle of Wight)

Althea Marles (Staff Nurse - Barnet & Chase Hospitals NHS Foundation Trust)

maxine Chong (Head of Midwifery & Nursing Women & Children''s Services - HEREFORD HOSPITAL NHS TRUST)

Belinda Burroughes (Senior Sister - James Paget University Hospital)

Christine John (Band 5 - Heart of England NHS Foundation Trust)

Sue Hardy (Directory of Nursing, Midwifery & Patients - Northampton General Hospital NHS Trust)

Edith Erivo (Health Visitor with Special Interest Parenting - City & Hackney PCT)

Jane Canavan (Head of Learning and Development - Camden Provider Services)

Inshani Bandoo (Senior Nurse - Barnet & Chase Hospitals NHS Foundation Trust)

Emily Lawrence (Student Nurse - Ipswich University)

Jane Fletcher (Health Visitor - Warrington PCT)

Varsha Shah (Sister in Paediatrics - EALING HOSPITAL NHS TRUST)

lo dadswell (staff nurse - brighton & sussex university hospital trust)

Sue Henshall (Nurse Manager - Stockport NHS Foundation Trust)

Sam Flynn (Student Nurse - Glyndwr University)

Stephanie Goodwin (Midwifery Matron/Supervisor of Midwives - Winchester & Eastleigh Healthcare NHS Trust)

Leanne Harvey (Team Leader - Lambeth Community Health)

Suzie Cro (LSAMO - LSAMO Forum UK)

Debbie Clifford (SSN - Mid Staffordshire NHS Foundation Trust)

Alan Dawson (Associate Director - Hereford Hospitals NHS Trust)

Carmel Streater (Divisional Lead Nurse - Cambridge University Hospital NHSFoundation Trust)

Rosemary Baker (Head of Nursing - The Royal Wolverhampton Hospitals NHS Trust)

Debbie Burrows (Head of Nursing Specialist Services - Lancashire Teaching Hospitals)

Florence Chariah (Sister - Barnet & Chase Hospitals NHS Foundation Trust)

Helena Leyden (Associate Director Governance & Clinical Leadership - Bury Community Services NHS)

Sue Malbon (Matron - university Hospital of North Staffordshire)

Trudi Massey (Rehabilitation/Brain Injury Co-ordinator - Stoke on Trent Community Health)

Diane Robson (Registered Nurse/Staff Nurse - WDGH - NHS Foundation Trust)

Carol Bradley (Matron - Northampton General Hospital NHS Trust)