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Ensuring patients get the right care at the outset is essential. It ensures the best outcomes and experiences for patients, and it avoids the NHS having to expend additional resource to remedy the consequences of inadequate care; whether this is the slow healing or worsening of wounds; the avoidable development of new wounds; or unnecessarily burdensome and inconvenient treatment to achieve healing that could have been attained more effectively. For example, the correct assessment and treatment of skin tears can achieve a 57% reduction in dressing changes, securing a better outcome for the patient and making effective use of NHS resources.32 Decisions about the best approach for each patient should be taken using both the healthcare professional’s expertise, and the patient’s knowledge of their wounds, their circumstances and their preferences for the outcome they wish to achieve. Further study is needed of whether this has been achieved, or continues to be achieved, during the pandemic period, with reference to both patient outcomes and the use of NHS resources. Patterns of wound care need and services changed substantially during the 2010s, but we do not have clear sight of where they currently stand. Overall NHS spending on wound care increased prior to the pandemic, but this appears to have been a product of growing patient numbers. As patient numbers grew by 71% from 2012/13 to 2017/18, overall NHS resources used for wound care rose only by 48% meaning that on a crude per-patient basis, the amount spent on wound care per patient has been falling.33 However, this headline picture masks complex developments for patients. The overall healing rate of wounds improved over the same period, by 13% for acute wounds and 14% for chronic wounds. This suggests that improvements in care are making a difference to patient outcomes, albeit to varying extents depending on the type of wound.34 Another development appears to have been a substantial shift of services out of secondary care and into the community. For acute wounds, 48% of treatment (by cost) was in the community in 2012/13, rising to 68% in 2017/18. For chronic wounds, 78% of treatment in the community at the start of the period became 85% by the end.35 The biggest drivers of cost in wound care are district or community nurse visits (29% of all costs in 2017/18) and GP office visits (16%).36 With services reduced or even shut down during the pandemic, headline resource allocation, and spending on wound care products may have fallen substantially. When surveyed, 88% of wound care nurses stated that they agreed that wound care products had been economised to save money in the five years prior to COVID-19,37 and 87% believed that this economising had compromised the quality of products that their service has been able to access.38 This suggests that the reduction in spending per patient has – at least in the view of wound care nurses – compromised the quality of care for patients. The changing characteristics of the wound care patient cohort add further complexity to this picture. Between 2012/13 and 2017/18 the proportion of diabetes patients in the overall wound care caseload increased from 29% to 57%,39 which may suggest that inadequate management of diabetes is a driver of rising case numbers. Possibly related to this, the proportion of wound care patients who were of working age rose from 35% to nearly 70% over the same period.40 Whether the pandemic has driven any similar shifts in patterns of patient need is unknown, but these developments offer some circumstantial hints of a health inequalities dimension to rising levels of wound care need, and would warrant further investigation. We can therefore say that wound care has had a complex decade. Patient numbers have grown substantially, the characteristics of the wound care patient population have changed markedly, and the picture for patient outcomes is mixed, with improved healing rates for some wounds but rapidly rising caseloads in others. Is the reduction in spending per patient over the five years to 2017/18 the result of the changing caseload, more effective care by the NHS, direct cost-cutting, or a mix of all three? It is imperative that we investigate the impact of this reduction in spending, to understand what is driving it, and how it is affecting case load, service provision, and most importantly, patient outcomes