PATIENT CARE
hopefully this year, in that there must be the provisions and capacity for follow-up at primary and acute levels to ensure implementation is taking place. Otherwise, the likes of Excellence in Continence Care are effectively merely a set of good intentions.
Secondary research
The UTA’s conclusion that the guidance may be having minimal impact was reinforced by a secondary piece of research in the form of a survey of more than 1700 patients who experience continence issues and who use products such as catheters as an intrinsic part of their daily routines. The purpose of the survey was to assess patients’ view of the quality of care they receive, and also what they perceive quality of care to look like.
While a third of respondents (37%) suggested they had seen improvements in the quality of continence care they’ve received in the last 18 months, more than two in five (43%) claimed to have seen no improvement. Perhaps most discouragingly, nearly 70% suggested the level of knowledge of their GP on issues relating to continence care had not improved during the same period. Encouragingly for NHS England, more
than a fifth of patients were happy to describe the quality of care they received as excellent – as opposed to only 5% who would describe it as very poor. However, the indication of a lack of discernible improvement in either GP knowledge of service deliver suggests a
significant disconnect between the ambitions and recommendations of Excellence in Continence Care and what is happening at the front line.
General practitioners face a huge range of healthcare issues and pressures on their time and resources. However, the number of patients experiencing continence problems in the UK should hopefully translate to greater awareness, potentially borne out of greater exposure to patient need. But the static nature of GP knowledge – from the perspective of patients – may continue to hinder much needed improvements in adoption of referral pathways to specialist continence services. That can present barriers to patients receiving the support they need and being able to access the continence products, such as catheters, they need. This, in turn, presents the potential for significant issues, given nearly 60% of patients participating in the survey confirmed they has requested or been referred to specialist continence services in the past 18 months. While patients appear generally satisfied with the quality of care they receive from the NHS in managing their continence issues, there remains room for improvement – which could be to the health service’s benefit if it leads to patients being able to live with greater independence and reduced need for specialist and even intensive interventions. The importance of that access to both specialist support and appropriate products was demonstrated by patients’ response to
questioning on the impact of continence issues on their independence and quality of life. More than 45% of respondents confirmed continence issues have had significant impact over the last 18 months, and less than 10% percent (7.7%) said they had no impact at all.
What should quality continence care look like?
The NHS must ensure value for money, but simply salami slicing at the medical devices used by patients and wrongly assuming that similar products are completely interchangeable is a false economy.
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WWW.CLINICALSERVICESJOURNAL.COM
Based on its research findings, the UTA published a manifesto setting out fundamental principles to realise improvements in quality of continence care, and recognising the importance of high quality service delivery to maximising patients’ quality of life. The manifesto focused particularly on ensuring continuity of care, enabling patients to manage their continence issues with as much autonomy as possible, and on ensuring patient access to the continence products and medical devices to meet their individual needs. The latter is a particularly pertinent point. A risk for patients experiencing continence issues is an assumption – whether made by health practitioners, NHS budget holders or procurement managers – that there is a ‘one size fits all’ approach to continence care; that the product or medical device that meets the needs of an individual, will necessarily meet the needs of all others. That fallacy has the potential to undermine care quality and the goals of NHS England’s guidance. There are a range of catheters and other continence products available to patients, but it would be entirely wrong to consider the number of products available to be a luxury. The purpose of providing patients with options is to enable them to use the catheter or other medical device that best meets their individual needs. By ensuring some products are more discreet than others or can be more comfortable for the individual, patients can be better empowered to manage their needs with greater autonomy, which in turn impacts positively and significantly on their quality of life. Quite simply, patients with the products meeting their individual needs and daily routines are more likely to be able to function within their families and communities, rather than being unable to go to work and even being stripped of their dignity and quality of life. This situation, however, must be reconciled with the financial situation facing the NHS. The health service faces greater demands on its resources than at any point in its 70 year history. A growing and ageing population, along with the rapid growth in medical treatments (some of which incur significant expense) mean the NHS budget is stretched to breaking point. The health service faced the Nicholson Challenge of £20 billion in savings earlier in the decade, and the push for efficiencies remains to this day and will continue to do so for the foreseeable future. In that context, it would be easy to consider a range of continence products to be
JUNE 2018
©Sherry Yates
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