The NHS Institute for Innovation and Improvement website is now being administered by NHS Improving Quality - the Productive Series and other products are still being provided by Delivery Partners and supported by NHSIQ, and all material relating to the Productive Series is still accessible.

The NHS Institute closed on 31 March 2013. If an item you are looking for is not available here, you'll be able to see all publicly available content on The National Archives website:*/
This site uses cookies to help performance and allow us to improve your browsing experience. You can click here to view the cookies we use on this website along with information on how to restrict cookies using your browser settings. By clicking on the Continue button, you accept the terms of our privacy policy on our website.

| | |

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

If you would like to get in touch, please contact
people have signed up to HIA

Sign-up to the rollcall

I am committed to High Impact Actions for Nursing and Midwifery

Lynn Davis (Tissue Viability Lead Nurse - Gloucestershire Hospitals NHS Foundation Trust)

Peter Blythin (Director Nursing and Workforce - West Midlands SHA)

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

Sarah Roberts (Head of Beurological & Tissue Viability Specialist Services - South West Essex Community Services)

Kate Anderson (Staff Nurse - Mid Yorks NHS Hospitals)

Linda Watson (Clinical Director - North Tees & Hartlepool NHS Trust)

Monique Pinks (health Visitor - Stoke on Trent PCT)

Alison Duffield (Community Midwife - Royal Berkshire Hospital NHS Foundation Trust)

Mary Shewell (Antenatal/Community Matron - Royal Surrey County Hospitals)

Julie Dawson (Student Nurse - Glundwr)

Maryse Mackenzie (Ward Sister - Robert Jones & Agnes Hunt NHS Trust)

Juliet Clarke (Midwife - Leeds Teaching Hospitals Trust)

Chika Aninga (Student Nurse - Middlesex University)

Emma Sneed (Lead Nurse Infection Prevention & Control - Herefordshire PCT)

Janet Davies (Staff Nurse - Papworth Hospital NHS Foundation Trust)

Sarah Harris (Neonatal Discharge Planning Co-Ordinator - Addenbrookes Cambridge)

Julie Escourt (Head of Midwifery - Stockport NHS Foundation Trust)

Katie Butterfield (Practice Development Nurse - Berkshire Healthcare Foundation Trust)

Gifty Ansong (Ward Manager - NHS Barnet)

Mary Stott (Senior Sister - Royal Wolverhampton Hospital NHS Trust)

James Syrad (Student Nurse - Greenwich Uninversity)

Elizabeth Withington-Cross (Clinical Lead Theatres - Royal Orthopeadic Hospital)

Siobhan Pender (Senior Diabetes Specialist Nurse - Guy's & St Thomas Hospitals)

Michelle Lazenby (Senior Sister - Leeds Teaching Hospitals Trust)

Lisa Marsh (Student Nurse 2nd Year - Nursing University of Greenwich)

Caroline Doherty (Trauma Co-ordinator - Stockport NHS Foundation Trust)

Rachel Thompson (Practice Development Nurse - Camden & Islington NHS Foundation Trust)

Belinda Burroughes (Senior Sister - James Paget University Hospital)

Julie Sobrattee (Deputy director of nursing - Epsom & St Helier hospital)

Jo-anne Ricketts (Special Nurse Learning Diabilities - Royal Wolverhampton Hospital NHS Trust)

Clare Hinwood (Sister - Royal Orthopeadic Hospital)

Lynn Lacey (Ward Matron - Ipswich Hospital NHS Trust)

Jenna Walters (Community Childrens Nurse - North Staffordshire PCT)

Pam Linton (Team Leader - Kirklees Community Health Care Services)

Rachel Nicalaon (Clinical Lead - North Staffs Combined Healthcare NHS Trust)

Imelda Vecino (Staff Nurse - Royal Wolverhampton Hospital NHS Trust)

Brenda Hargreaves (Head of Nursing - NHS Blackpool)

Janet Heppell (Ward Sister - York Hospital NHS Foundatin Trust)

Allison Johnson (Senior Nurse - leeds teaching hospitals nhs Trust)

Jolene Steel (HCA - University Hospitals Coventry & Warwickshire NHS Trust)

Neil Rymer (Physiotherapist - Barnet & Chase Hospitals NHS Foundation Trust)

Lucy Roberts (Preceptorship & PD Nurse - Westerb Sussex Hospital NHS Trust)

Karen Harper (Matron - Heart of England NHS Foundation Trust)

Catherine Pelley (Deputy Director Nursing & Quality - NHS Herefordshire)

Amanda Rolland (Workstream Lead - Clincial Standards & Patient Experience - NHS EM)

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

Mary Smith (Ward Manager - St. Georges NHS Trust)

Michael Fanning (Communication Manager - CNO - Department of Health)

Carole Chapman (Ward Sister - Hull & East Yorkshire Hospitals NHS TRust)

Caroline Erskine (RN - Heart of England NHS Foundation Trust)