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• W2188006345 abstract "he recent report from Lord Darzi (Darzi, 2009), ‘Transforming community services’ is the second to be authored by Ara Darzi and follows in the wake of his review of the NHS in England last year (Darzi, 2008). This latest report is to be welcomed by those who provide care in the community setting. For staff who are involved in tissue viability (including wound care) it has long been known that the predominant wound care workload is in primary care. However, little has been done to provide the necessary resources or acknowledge the vital role that community staff have to play. It is also important to emphasise that the commissioners of care (PCTs) should give due recognition to the fact that tissue viability care covers a broad spectrum of interventions from ‘basic/fundamental’ through to highly specialised care, including preventive measures to avoid skin and soft tissue damage, vascular assessment, diagnosis of wound infection, and sharp debridement, all of which require specialised clinical skills (White, 2008). The report stresses the importance of ‘getting the basics right — every time’. An admirable sentiment, but how does Darzi address this in his report? First, tissue viability does get a mention but sadly it amounts to no more than 100 words in this lengthy report. One might be forgiven for regarding this as disproportionate, especially as in community nursing wound care is one of the top 10 purposes for visits and accounts for 66% of the total available community nurse resource (Posnett et al, 2009). Second, Darzi does emphasise the need for clinical skills and competent care, highlighting the need for assessment, intervention and treatment. These components of quality care have been top of tissue viability collective priorities collective priorities for decades. Third, Darzi provides examples of ‘evidence-based practice’, but does this by mentioning two specific (and in one instance branded) therapies. It is perhaps pertinent to remember at this point that Darzi was made a Minister of Health, with a responsibility for health policy, by a Labour Government who wanted to promote trust and respectability and to deliver a market-based healthcare system. In such a system services are provided by a diverse range of independent providers who, in turn, compete for business in a market supposedly governed by consumer choice.It is, therefore, surprising if not downright controversial that specific therapies have been used as examples of so-called evidence-based practice, namely four-layer bandaging (4LB) and vacuum assisted closure (VAC therapy). The use of a specific trade name (VAC" @default.
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• W2188006345 date "2009-01-01" @default.
• W2188006345 modified "2023-09-26" @default.
• W2188006345 title "Second Darzi report: mixed messages for tissue viability" @default.
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