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PATIENT CARE
Howandwhyweneedto improvecontinencecare
Around sixmillion people in theUK experience continence issues to some degree,making it an important factor for qualityoflifeandasignificanthealthissuefor the NHS. According to ChrisWhitehouse, chairman of theUrology Trade Association, failure to ‘get it right’would not only condemn patients to difficult circumstances and amiserable existence, but could also heap demands on the health service, at a time of acute pressure on resources.
For many people experiencing continence issues, these are just one part of their management of what can be chronic and degenerative conditions or injuries. Patients with spinal injuries, multiple sclerosis, and spina bifida, to name but a few, can experience continence issues as a frequent – sometimes persistent – but always unwelcome consequence of their conditions. Nevertheless, irrespective of the cause of the continence issues - if managed effectively – individuals may be able to go to work and about their daily lives with minimal inconvenience. If continence issues are not managed effectively they rob the individual of their dignity and can dramatically reduce their quality of life. People can be left effective prisoners in their own homes, unable to go to work or to socialise with friends and family for fear of embarrassing incidents. In the most severe cases, unmanaged continence issues can be become far more serious, requiring significant healthcare intervention and possibly even hospitalisation – which is both bad for the patient, and a potentially avoidable additional cost to the health service. Effective continence care is paramount, not only for patient experience and outcomes,
but also for managing the demands on NHS resources at a time of unprecedented public need and financial pressure.
This has been the situation for years, and the backdrop against which NHS England published Excellence in Continence Care guidance1
in December 2015, recognising
the importance of supporting patients experiencing continence issues and ensuring clear pathways to specialist support. In publishing its guidance, NHS England made the correct assessment that there was –and indeed still is – a need for better knowledge of continence issues amongst healthcare professionals, including knowledge of specialist support services to improve referral pathways. The guidance advocated the upskilling of healthcare practitioners across the piste on continence, in order to improve patient experience and patient outcomes.
NHS England’s motivations in publishing the guidance were laudable, and its recommendations pertinent. But, the question – more than two years on from the guidance’s publication – is to what extent change has been seen on the ground. Quite simply, have the intentions of NHS England translated into clear action that has benefitted
NHSEngland’s motivations in publishing the guidance were laudable, and its recommendations pertinent. But, the question… is to what extent change has been seen on the ground.
JUNE 2018
Chris Whitehouse, chairman of the Urology Trade Association
the millions of people experiencing continence issues?
The evidence available suggests that this is not the case, and it’s important to note that NHS England does not have a requirement or previous processes in place to assess the level of implementation of its guidance at the frontline. That means there’s no centralised mechanism to confirm improvements are being made. The Urology Trade Association (UTA), in late 2017, issued freedom of information requests to all clinical commissioning groups in England, asking for confirmation that Excellence in Continence Care guidance had been implemented since publication in 2015. Little more than half of the 103 CCGs that responded to the request were able to confirm implementation, with some highlighting their role in commissioning services rather than service delivery. That argument simply does not stand up. While CCGs are the commissioning organisations, they have every right to set expectations for service delivery from providers – as would be the case in any business supply chain. To defer the question to a provider can at best be seen as passing the buck, and the danger is that importance guidance – such as that on continence care – slips down the gap between commissioning and care provision. The UTA’s research strongly suggests that Excellence in Continence Care is unlikely to be having the level of impact of care quality that its authors envisaged. Indeed, it’s difficult, if not impossible, to attribute any improvements to that particular guidance. This offers a constructive lesson for NHS England ahead of the updating of continence guidance,
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