Spinal charity highlights healthcare inequalities for people at increased risk of undiagnosed pressure ulcers

Today (21 November) Stop the Pressure Day, Spinal Injuries Association is highlighting the healthcare inequalities that exist for those who have an increased risk of undiagnosed pressure ulcers.

Lady-Marie Dawson-Malcolm from Balham sustained a spinal cord injury in 1992 as a result of domestic violence, leaving her paralysed from the chest down, meaning she is at risk of developing pressure ulcers.

This condition can start as a tiny mark on the skin and develop into serious skin damage that requires bed rest and consistent care from healthcare professionals that costs the NHS £22.4 million per day in 2024 according to projected figures.

Lady-Marie was admitted to hospital with pneumonia but when she returned home after eight days, her carers discovered five pressure ulcers across her back and heels that left her on bed rest for a month.

These pressure ulcers could have been prevented if staff had checked her skin with touch tests as she instructed them. Instead, they looked for signs of redness, following guidelines for white skin.

As a black woman, Lady-Marie’s skin did not present with the redness they expected and they missed the signs until it was too late.

As Lady-Marie cannot move or feel below the site of her injury in her neck, she relies on carers to check her skin for pressure ulcers.

Lady-Marie said: “Pressure ulcers are at bigger risk of going undiagnosed early for those with dark skin.

“I have to take it on faith that they’re actually physically using their hand to check because I can’t feel it.

“Having a light skin tone, of course, it’s much easier to actually see that there’s an issue because it presents as a red mark and then be able to rectify it before it gets really, really bad.

“This is not the case in dark skin.”

Lady-Marie was forced to go on bed rest for a month until the wounds had healed to prevent further complications that could lead to infection and even life-threatening sepsis.

As a result, her mental health seriously declined.

She said: “I’m not somebody that’s stressed very much, but being stuck in bed, that’s when I felt disabled.

“When I’m sitting up in my wheelchair, I’m fine.

“But being stuck in bed, no, not nice at all. It’s like you’re helpless, you feel helpless.”

Across the UK, there has been no formalised practice for identifying pressure ulcers in dark skin tones, resulting in a postcode lottery for patients needing care.

People like Lady-Marie face prolonged suffering because of a lack of training and understanding.

A spokesperson from Spinal Injuries Association said: “NHS trusts must ensure they do not discriminate and must take steps to promote equality of opportunity.

“Not providing training on identifying pressure ulcers in dark skin tones could lead to a disparity in care and non-compliance with the Equality Act 2010.”

Kumbi Kariwo, Health Inequalities Lead at Birmingham Community Healthcare NHS Foundation Trust, is keenly interested in developing training resources across the whole of the NHS to avoid complications for more patients.

She said: “I think consistency and uniformity of care are key.

“I think each trust has different approaches dependent on their population makeup.

“What safety nets can we put in place to ensure that consistency of practise?

“If you only have one patient, they need care. It is important to acknowledge, that in areas with less visible diversity, this approach might require more intentional effort.

“Even if there’s only one patient from a different cultural background, they deserve comprehensive, culturally sensitive healthcare that acknowledges their unique needs.”

Even for Lady-Marie who lives in an ethnically diverse area of the UK, knowing that something was wrong and instructing staff on how to fix it was not the simple solution it should have been.

She said: “I know sometimes they can be busy and they’re short staffed, but that’s no excuse. There’s no excuse.”

For more information on pressure ulcers, please visit Spinal Injury & Caring For Your Skin | SIA.