Pressure ulcers are a frequent occurrence in healthcare worldwide and should be considered an adverse event – events that result in avoidable patient harm (WHO, 2023). In early January 2025, a study published in the BMC Nursing journal found that with appropriate care plans, 90% of pressure ulcers could be prevented,1 but worryingly, in the past two years, a Freedom of Information (FOI) request revealed that the NHS has paid out an eye-watering £35m in compensation from nearly 700 legal cases linked to preventable pressure ulcers. Allegedly the result of ‘staff neglect’, the Royal College Nursing (RCN) has warned that whilst pressure ulcers are preventable and can be ‘lifesaving’, staffing shortages are in part to blame.2
The data also revealed that East Suffolk and North Essex NHS Foundation Trust (ESNEFT) has seen an 81% reduction in the number of reported pressure ulcers in the past year, with the Trust attributing this, in part, to staff being educated and trained on how to prevent pressure ulcers.2
So how do we reverse this worrying trend in litigation claims?
From acute to long-term care, pressure ulcers remain a significant and persistent challenge right across the healthcare landscape. At a time when our NHS has never been under so much pressure logistically and financially, OSKA, the pressure care experts, believe building and embedding a prevention culture lies at the heart of all pressure ulcer strategies. Beginning at grass root level, prevention is fundamental to unlocking better pressure ulcer care across the piece, for patients, as well as nursing staff.
Any strategy needs a robust structure to ensure all aspects of prevention and management are included. One example is OSKA’s ‘3 Pillars’ Advanced Pressure Care Strategy™:
The Clinical element endorses the implementation of good pressure ulcer prevention and management policies, enabling staff knowledge and the ability to give high quality care, from prevention and treatment, right through to supporting complex care needs.
Fostering a preventative Culture and reducing Cost elements are complex challenges that require a collective, collaborative, and organisation-wide commitment to embracing, embedding, and sustaining change. To achieve this, staff must feel included and empowered to actively engage in quality improvement (QI) efforts. In turn, QI leads to better patient outcomes and cost reductions by enabling more accurate assessments and care planning, which help prevent pressure ulcers and promote the efficient use of equipment.
Understanding the true cost of pressure ulcers
Exploring beyond the immediate financial burden of point-of-need treatment and extended patient stays, striving for a reduction in hospital-acquired pressure ulcers (HAPUs) undoubtedly is multi-factorial. With litigation claims averaging anywhere between £50,000 – £66,000 in the last two years alone,1,3 the impact is felt much more widely across the NHS. The hidden emotional toll can be draining for healthcare teams, with one study revealing that the stress of being involved in a claim not only affects staff morale, more significantly it may result in sick leave, longer-term absence, or even cause staff to exit the profession altogether. 4
Importantly, any drive to reduce HAPUs will support patient dignity and improved clinical outcomes, as well as ease workloads, increase staff morale, motivation and retention, as well as boost patient and staff confidence. This in turn will reduce the likelihood of complaints, investigations, legal claims, and subsequent high value financial litigation awards.
In this article we explore how OSKA is working together in partnership with a number of NHS Trusts to reverse this worrying litigation trend.
OSKA’s five steps to preventive pressure care
With ‘prevention better than cure’ in mind, shifting to a more proactive prevention strategy may seem daunting, challenging, or even overwhelming, but small, bitesize steps can make a big difference. Here, we explore OSKA’s five practical steps to help support a more proactive and advanced pressure care strategy:
1. Identifying ‘at-risk’ patients
Potentially, all patients are at risk, but there are certain patient groups who are at higher risk and, when combined with other extrinsic factors, present a greater risk of pressure ulcers developing or worsening. These patient groups can include those with:
- Previous or existing pressure ulcer(s)
- Limited/reduced mobility
- Sensory loss/ impairment
- Cognitive impairment
- Compromised nutritional status5
- Frailty of old age
- Other co-morbidities or mechanical forces
When exposed to the cumulative effects of high pressure, patients with one or more of these risk factors are more likely to experience negative patient outcomes.6
2. Reviewing the 3Ps – protocols, processes and procedures
Take a closer look at current protocols, processes and procedures to ensure timely and effective interventions. Are care pathways as proactive as they could be?
Let’s consider patients identified as ‘at risk’, ‘high risk’ or ‘very high risk’ upon admission. Ask yourself:
- Do they have limited mobility, poor sensation, or other contributing factors?
- Would they benefit from being placed onto a higher-specification pressure-relieving mattress immediately?
Early interventions can play a crucial role in preventing pressure ulcers from developing or worsening, particularly for those who are vulnerable, such as an immobile patient following a fall and a long lie for several hours and admitted via the Emergency Department.
Proactive adjustments to care protocols, such as the automatic assessment of surface needs at key points along the patient journey can make a measurable difference. By integrating preventative measures into workflows/procedures, we are not only reducing the risk of pressure ulcers either developing or worsening, but we’re also improving patient outcomes, staff efficiency and boosting staff confidence.
Don’t wait for a problem to occur – build preventative thinking into every step of the clinical process and patient journey.
3. Auditing equipment
Old or poorly maintained mattresses may significantly increase the risk of pressure ulcers. Regular, structured, and properly documented Mattress Audits are essential to ensure equipment meets the latest standards and continues to keep patients safe and comfortable.7
Equally, using the right equipment is essential. For immobile patients, consider placing them on a high-specification specialist lateral tilt surface, with micro-climate management and patient immersion and envelopment. This not only enhances patient care and comfort, but it also eases the burden on care givers.
Investing in the right equipment and maintaining it properly and regularly makes a big difference in delivering preventative, effective care.
4. Communication is king – empower patients through education
Take a more person-centred approach by fully involving patients in their care decisions. Taking time to educate them about their pressure ulcer risks can significantly improve compliance and clinical outcomes. Clear, simple communication is key – use jargon-free language, both spoken and in written resources, to make it easier for patients to understand the role they too can play in the prevention of pressure ulcers.
It is also important to make sure educational materials meet diverse needs by providing options such as:
- easy-to-read leaflets with images (where appropriate)
- foreign language versions catering to your local population
- signed or Braille content
- easy to understand short-form videos
Empowering patients not only enhances their understanding but also lightens staff workloads by fostering a more collaborative and proactive approach to patient care.
When patients are informed and engaged, everyone benefits due to better compliance, improved outcomes, and a smoother care journey/pathway for patient and clinician alike.
5. Exploring advanced solutions for better pressure ulcer prevention
Finally, investigate whether there are more advanced solutions available to help reduce pressure ulcer risks. For those patients at greater risk who may be unable to reposition themselves independently, a higher-specification lateral tilting mattress, can reduce the need for very frequent manual turning due to its advanced immersion and envelopment properties, providing more gentle and regular automatic offloading.
For NHS Trusts concerned about or tied into long-term procurement contracts, it is worth investigating whether specialist mattresses fall outside of any standard supplier contracts, thus making them highly accessible in both acute and community settings. The option to rent specialist equipment also offers the flexibility to bring in exactly what’s needed, when it’s needed, and without the commitment of long-term CapEx expenditure.
At OSKA, our Advanced Pressure Care Strategy combined with specialist mattresses is designed to make a real difference. With smarter rental options available, NHS Trusts across the UK are now providing tailored care that meets patient need, while working seamlessly within their existing procurement processes.
Behind every litigation claim, lies a patient
Behind every litigation case, there quite literally ‘lies’ a person who has suffered not only the physical impact, but also the emotional and psycho-social burden of a pressure ulcer(s). That’s why OSKA is committed to helping NHS Trusts prevent ulcers before they occur. It’s not just about saving money – it’s about improving lives, preserving dignity, optimising patient outcomes, and easing the strain on caregivers.
Working in partnership with NHS Trusts in both the acute and community setting, OSKA’s commitment to delivering innovative, cutting-edge equipment and technology, underpins our commitment to improving patient care and clinical outcomes.
Together, in partnership, we are driving pressure ulcer prevention as the standard, not the exception.
Contact us today to learn more about our Advanced Pressure Care Strategy and OSKA’s specialist pressure care mattresses.
Please cite as: OSKA Care Ltd. (January 2025). Avoiding Litigation: NHS pays out £35m in compensation linked to preventable pressure ulcers since 2023. Havant, Portsmouth: OSKA Care Ltd.
References
Care Quality Commission, 8 September 2023, Taking Action, https://www.cqc.org.uk/about-us/how-we-do-our-job/taking-action, accessed 17 January 2025.
Kandula, U.R. (2025), Impact of multifaceted interventions on pressure injury prevention: a systematic review. BMC Nursing 24, 11 (2025). https://doi.org/10.1186/s12912-024-02558-9
Chafer, L. 19 January 2025, NHS’s £35m compensation bill from bed sores caused by staff neglect – as figures reveal nearly 700 legal cases linked to preventable skin infections https://www.dailymail.co.uk/health/article-14301077/NHS-35m-compensation-bill-bed-sores-neglect.html, accessed 17 January 2025.
NHS Pressure Ulcer Productivity Calculator, NHS England,2018, https://www.england.nhs.uk/pressure-ulcers-productivity-calculator, accessed 17 January 2025.
Robertson, H., Thomson, A. M. (2016). An exploration of the effects of clinical negligence litigation on the practice of midwives in England: A phenomenological study. Midwifery. Vol 33, p55-63.
Pressure ulcer litigation: Prevention is better than cure – Medstrom
Miner, M. A. A (2022), Section 2.1 2023 Edition Guidelines for Perioperative Practice, AORN Inc. 2170 S. Parker Road, suite 400, Denver, Colorado 8023.
