I am in Vienna for wounds, suffering and it turns out;  incompetence and dissembling.  The kind of wounds old ladies (and gentlemen) get on their legs and seem beyond the wit of healthcare to clear up.  I heard tale of a (soon to come) study for the DH that followed 500 patients for 6 months.  The clear-up rate was 9% and the infection rate 60%.  Tell me that is great practice.

I listened to an erudite speaker reflect on 25yrs of wound care experience.   A teenager kicked by a horse who carried the wound for 67 years.  Another who spent 4yrs in bed with and ulcerated leg.  How, before the 90's ulcers were given a low priority and their aetiology hardly understood at all.  Patients were advised to urinate on their legs as a form of treatment.  1992, Doppler and duplex testing and compression bandages.

 Given the misery this condition wreaks it is a pitiful history.  A history of neglect, desertion and inattention.  We have NICE guidelines, Scottish guidelines, European guidelines and for all the good they do, probably intergalactic guidelines.  It is a shambles.  Why, in some places these wretched things, at 12 weeks are 20% healed and in others the figure is 95% defies intelligent explanation.  Why is it 20% of sufferers can't walk?  Why it is the casualties are left to social isolation, pain, depression, sleep deprivation and emotional torment?

And then there is the money.  The cost is huge.  In fact, beyond huge it is enormous, gigantic, mammoth.  In plain every day terms; half the community nursing budget and often over half their time.  Not just in the NHS; world-wide.  There are billions thrown at this horrible chronic problem.  Probably more than £400 million a year in the UK alone.  Speaker after speaker from every part of the world told the conference the same sorry tale.  In the end I wa annealed to the cost, deaf to the suffering and blind  to the pictures of the most awful, ugly, horrendous, harrowing, pitiful wounds. 

This is a fat industry.  The conference was made possible by a huge exhibition of lavish stands; chrome, graphics, samples, goody-bags and flat-screen tellies.  Companies are obese with the profits from products that don't work, scrambling for space in a lookey-likey, me-too market of the ineffective. 

The solution, it seems, is simple; compression dressings.  The problem; they are horribly uncomfortable for the victim, making compliance poor and the variations in nursing competence make their use and application, with the required gradient of pressure, a lottery.

 This is a mess of an industry and an embarrassment to health services world-wide.  Millions are spent on poorly arranged trials with tiny sample sizes and handpicked patients.  Careers have been built on failing therapies, houses paid for and kids put through school on the proceeds of ineffectiveness.  There is a poor understanding about when healing occurs and health economics seems to ignore the cost of the whole care pathway.  Support for the patient; rising services, meals on wheels, bathing, chiropody, shopping and cleaning.

 There has to be a solution to this disarray.  Get this right and in one go you could probably solve the NHS savings conundrum and settle the nation debts of some decent sized countries.  It's simple; stop people getting the shameful things in the first place.  Regard their appearance as a failure.  I am told there is a shed-load of indicators, predictors and heads-up on the patients most likely to be at risk of venous leg ulcers. 

 Give them all three sets of support stockings; one set on, one set in the wash and one set ready in the drawer.  Encourage compliance, send a HCA to help put them on if necessary and save enough money to buy Greece and Chelsea a replacement for Drogba.

 If we can put all middle aged blokes on a statin, fluoride in the water and screen for breast cancer - we can do this.  Where's public health when you need it?

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