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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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Lynn Owens (Pharmacy Governance Manager - Kettering General Hospital NHS Foundation Trust)

Sue Hogston (Senior Lead: Governance and professional development - NHS Leeds)

Anne-Marie Rowlands (Assitant Director of Nursing - Betis Cadwaladr University Health Board)

Helen Meehan (Lead Nurse Palliative Care - Solihull Care Trust)

Jane Loftus (Community Nurse Team Leader - Berskshire West PCT)

Charlotte Wood (Productive Community Services Co-ordinator - Nottingham Community Health)

Sarah Shaylor (Sister - Heart of England NHS Foundation Trust)

Gillian Adamson (Divisional Nurse - UHNS)

Margaret Perry (SSM Mobility Centre - Nottingham University Hospitals Trust)

Daylyn Fara.on (Sister - Heart of England NHS Foundation Trust)

Melinda Howard (Matron - York Hospital NHS Foundatin Trust)

Michael Smith (Chair Staffside/Emergency Nurse practioner - Epsom & St Helier NHS Trust)

Kim Harding (Health Care Assistant - City of Hackney Community Health Services)

Lynne Ward (Senior Matron - Leicestershire Partnership NHS Trust)

Jacqueline Markland (Locality Manager - NHS Blackpool)

Yamu Njie (Ward Sister - Kings College Hospital Foundation Trust)

Susan Little (Clinical Governance - Hereford Hospitals NHS Trust)

Gemma Bird (Student Nurse - Royal Wolverhampton Hospital NHS Trust)

Sarah Webb (Martron/CSM - RNOH)

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

Mary-Jayne Bosley (Modern Matron - Bognor War Memorial Hospital)

Anna Shasha (Head of Midwifery - Cambridge University Hospital NHSFoundation Trust)

Kerry Stanley (Practice Nurse - Stourport H/C)

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

Annie Walton (Ward Sister - Nottingham Hospital Trust)

Clare Head (Senior Sister / Community Night & Twilight Service - Dorset Community Health Services)

Lynn Davies (CSM - Royal Orthopeadic Hospital)

Ann Stritter (Midwife - Barnet & Chase Hospitals NHS Foundation Trust)

Cheryl Liceon (Deputy Ward Manager - Rotherham General Hospital)

Karen Foster (Practice Nurse - Primary Care)

John Driver (Professional Lead - County Durham & Darlington Community Health Services)

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

Katy Dunn (Ward Sister - East Cheshire NHS Trust)

Angie Mason (Deputy Chief Executive & Director of Nursing - Humber NHS Foundation Trust)

Lorraine Sole (Matron for Gynaecology - Royal Cornwall Hospital NHS Trust)

Joanne Dilley (Modern Matron - Northampton General Hospital NHS Trust)

Margaretha Donnelly-Mitchell (Staff Nurse - Nottingham University Hospitals Trust)

Colette Saveal (Ward Sister - North East London NHS Foundation Trust)

Sally Farrow (Ward Manager - Kettering General Hospital NHS Foundation Trust)

Robyn Bowman (CNS Gynaeoncology - Leeds Teaching Hospitals Trust)

Amanda Adkins (IPCN - Buckinghamshire Hospital NHS Trust)

Hilary Maxwell (Sister - Stockport NHS Foundation Trust)

Josephine Darvill (CNP - NHAS)

maggie bisset (head of nursing - NHS Camden Provider Services)

Rebecca Morris (S. Staff Nurse - Prison Healthcare Directorate)

Rachael Corser (Divisional Lead Nurse - Buckinghamshire Hospital NHS Trust)

Karen Stackhouse (Acting Matron - Lancashire teaching NHS trust)

Gladys Andrews (Ward Manager - Nottingham University Hospitals NHS Trust)

Neil Powell (Community Matron - Knowsley Primary Care Trust)

Catherine George (Community Matron - Camden Provider Service)