FOCUS: Treating the unseen costs of medical dressings

Friday 16 August 2019

Prohibitive costs of dressing anything from a simple cut to chronic sores have emerged as a “vast problem” for Jersey’s healthcare.

As Jersey doesn’t follow the NHS-style system of offering dressings and bandages, some patients are having to pay out thousands of pounds just to get the correct protection for their wounds.

But others, meanwhile, find themselves forced to opt for less costly treatments that could put their health at risk by potentially drawing out recovery times or even worsen their wounds.

The issue was revealed at an inquest this week, which detailed the tragic case of an elderly man facing weekly bills upwards of £160 to dress his leg ulcers, who, in his desperation to keep costs down, resorted to using nappies.

Pictured: The elderly man's inquest exposed the issue of self-funding medical dressings.

So what is being done to help islanders struggling in this situation? 

Express spoke to Family Nursing and Home Care's tissue viability nurse Gilly Glendewar and Operational Lead for Adult Nursing Services Tia Hall about the conundrum faced by Jersey's healthcare system…

Mrs Glendewar said that, in the first instance, healthcare professionals “will always initially recommend the most appropriate dressing” for the type of wound they’re looking at, emphasising that each is unique and requires different combinations of dressings to heal. 

The most expensive dressings aren’t necessarily the most effective for all conditions, she explained, but each product is designed to do different things to address the patient’s symptoms.

Pictured: Gilly Glendewar (left) and Tia Hall (right).

Cost doesn’t factor into the initial assessment of which dressings are required for a particular condition, however, meaning that “complication may arise” if the patient cannot afford what is prescribed. 

It is possible to seek charitable funding or support from Social Security to pay for medical dressings, but Mrs Glendewar admits the products are “not something that is routinely covered in the Jersey healthcare system as it currently stands at the moment.”

The wound management specialist said that dressings cost the same regardless of patients’ means. 

“It doesn’t matter what walk of life you’re from in Jersey. Whether you’re in receipt of benefits or whether you are fairly wealthy, everybody pays for all of their dressing products regardless of where you sit.” 

However, self-funding medical dressings poses a cost to more than just the bank balance: it could also affect patients’ wellbeing, coming in the context of an already difficult situation if they have been diagnosed with a chronic health condition.

Pictured: It's possible to apply to Social Security to pay for dressings, but they're "not something that is routinely covered."

“When you have a chronic health problem… that’s always going to have an impact on your emotional wellbeing,” Ms Hall explained.

Her colleague echoed this sentiment, commenting that these types of conditions and the problem of medical dressing can result in wider impacts “emotionally, psychologically and financially.”

Bringing a clinical perspective to this, Mrs Glendewar used the example of a condition called ‘pilonidal sinuses’, which particularly affects the coccyx area of young men. Due to the affected area, those in professions where they have to sit down for large portions of the day – drivers and office workers, for example – might be forced to take time off work. 

In her experience, Mrs Glendewar spoke of a ‘vicious cycle’ with patients like this, because, if they haven’t yet accrued enough Social Security contributions to claim sickness benefit, “they then have no income because they’re off work; they can’t go back to work because they can’t do their job because of the wound, they then can’t afford the dressings so they can’t get healed.” 

Of this, Mrs Glendewar, who has been working in this area in Jersey for around 20 years, remarked: “Sometimes the tiniest of wounds can have a huge impact.”

Pictured: The pressure of self-funding dressings can have more than just a financial impact.

With Ms Hall characterising the challenge of funding medical dressings as “a vast problem” for Jersey – what is the solution?

The Health Minister is teaming up with Family Nursing to launch a pilot project later this year to fund dressings for some patients with particular financial and medical needs. 

A Government spokesperson said: “Health and Community Services is working with colleagues from Family Nursing and Home Care to establish a pilot project with the aim of potentially introducing a scheme to provide free dressings to some patients in the future. 

“The aim of the pilot is to evaluate the impact of providing dressings for free in the community to an as yet to be identified group of patients. Work on the pilot project is still in its early stages and its scope is not yet determined. As such, the budget for this project is not yet known. We hope to roll out the pilot scheme during the last quarter of this year.”

Pictured: The Health Minister Deputy Richard Renouf is working with Family Nursing to look at funding some patients' dressings.

It comes at a time when the NHS and Jersey’s Health department are overhauling the approach to wound and ulcer management.

It's not yet clear exactly how the Minister plans to tackle this issue, but, for Ms Hall, the solution doesn’t simply lie in following the NHS system of prescription subsidies, which produces “wastage”.

 “[It’s] not a perfect system because people end up with boxes and boxes of dressings that have been prescribed… and once they’ve been delivered to a person they can’t be used on anyone else… We’ve got two different systems which we’ve got to find a middle ground for.”  

The solution, she says, lies in joined-up working with Health, pharmacies and procurement to avoid waste while ensuring “patients can access what they need.”

Amid the many pressures thrown up by the funding issue, one message was resounding from Mrs Glendewar: “We need to make a more equitable system.”