COMMENT XXXX
Highlighting the challenge of bowel management
Professor David Colin-Thomé, formerly the national clinical director for primary care at the Department for Health, and a member of NHE’s editorial board, argues that the quality of bowel management in the NHS could be greatly improved.
M
ost people are fortunate that bowel management is not something they have
to give much thought to. And this is true of many clinicians, managers and NHS professionals. But the fact is that one in 10 British people are affected by some form of bowel problem. Many patients with chronic neurological conditions are particularly at risk; bowel problems within this group are not only more common but more serious – potentially resulting in hospital admittance if not managed properly.
What does this mean for the NHS? Quite simply, there is a need to give this problem greater attention – doing so has the potential to not only improve patient outcomes but to make better use of NHS resources.
The potential for change was recently highlighted in analysis of Hospital Episode Statistic (HES) data by the organisation Neurological Commissioning Support. The research highlighted that the NHS spent £59m in 2012-13 on non-elective hospital admissions to treat constipation amongst patients with five neurological conditions – multiple sclerosis (MS), spinal cord injuries, Parkinson’s, spina bifida and stroke. Many of these admissions could have been avoided if bowel problems had been identified earlier and if patients had been provided with more effective management options.
A recent report published by the MS Trust and bladder and bowel specialist Coloplast highlighted that opportunities are being missed to identify and manage bowel problems in MS patients. The report surveyed people with MS as well as MS specialist nurses and found that 88% of patients were not given information on bowel management when first diagnosed, while
24 | national health executive Sep/Oct 14
almost half of people with MS had never had the issue of how the condition may impact on their bowel management proactively raised by a healthcare professional. For most of those with whom the issue was raised, it was by a specialist MS nurse.
What this data tells us is that the quality of bowel management in the NHS could be greatly improved by a culture of greater openness, in which healthcare professionals feel comfortable in raising often awkward issues such as the state of a patient’s bowels – and patients feel comfortable having an honest discussion on this matter. Given the link between chronic neurological conditions and problems with the bowels, these high-risk groups provide an excellent starting point, and clinicians should regularly be raising this question with them. Such openness would allow any problems experienced by a patient to be identified at an earlier stage, thereby avoiding the problems becoming intractable.
The next part of the solution is to ensure that healthcare professionals know where to refer patients for further advice. GPs see patients most often, but as we all know they are under significant pressures and have a wide variety of patients and ailments to deal with. Managers and clinical leads can be part of the solution by making sure that clinical commissioning groups have referral pathways and best practice guidance in place, so that clinicians can easily find where to refer patients for further advice and treatment from the local continence service or – for more complex cases – more specialist care. At the moment, such guidance and pathways are not in place in most clinical commissioning groups – so some focused work here could help to ensure that more patients
can access the care they need.
Once patients access continence services, there are a range of options which can help improve bowel management. These range from pelvic floor training and bowel training, to solutions such as trans-anal irrigation, and ultimately surgery further down the line if that is what is required. By providing patients with access to this range of solutions, we can reduce the number of non-elective hospital admissions.
Having recently undertaken work in this area, and having had access to case studies, stories from patients and the results of surveys, what is clear to me is that the NHS can do more on this issue, and would benefit from doing so. There’s a financial imperative, as highlighted by the work of Neurological Commissioning Support.
But there’s also a human imperative: to tackle an issue that affects clinical outcomes and quality of life for patients. There is a challenge here for professionals across the NHS, to encourage greater openness and to ensure that clinicians have the tools they need to provide patients with effective solutions. I hope that it is a challenge which the NHS will accept.
Professor David Colin- Thomé is an independent healthcare consultant. He was formerly the national clinical director for pri- mary care at the Depart- ment for Health, and for many years a GP.
Professor David Colin-Thomé
TELL US WHAT YOU THINK
opinion@nationalhealthexecutive.com
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60 |
Page 61 |
Page 62 |
Page 63 |
Page 64 |
Page 65 |
Page 66 |
Page 67 |
Page 68 |
Page 69 |
Page 70 |
Page 71 |
Page 72 |
Page 73 |
Page 74 |
Page 75 |
Page 76 |
Page 77 |
Page 78 |
Page 79 |
Page 80 |
Page 81 |
Page 82 |
Page 83 |
Page 84 |
Page 85 |
Page 86 |
Page 87 |
Page 88 |
Page 89 |
Page 90 |
Page 91 |
Page 92 |
Page 93 |
Page 94 |
Page 95 |
Page 96 |
Page 97 |
Page 98 |
Page 99 |
Page 100 |
Page 101 |
Page 102 |
Page 103 |
Page 104