PATIENT CARE
an unaffordable luxury and a means of quick wins to bolster the bottom line. That would be far from the truth and short-term thinking of the worst order that would also run contrary to the demands and expectation of patients. When questioned by the UTA, 79% of respondents believed cost should not be a determining factor in access to appropriate medical devices, with 47% of its survey respondents (of a sample of more than 1700) claiming they would be disappointed if costs were a determining factor in their access to catheters and other medical devices used to manage their continence issues on a daily basis. Nearly a third (32%) claimed they would be outraged if cost was a determining factor in their access to products. The financial pressures on the NHS are well known, but patients certainly do not expect their quality of care and ability to self-manage their continence issues to be impaired as a result.
The second, but as important point in terms of NHS financial resources, is the inherent benefits to facilitating patients’ self- management, which have the potential to minimise demands on the health service – including the potential for admission to acute settings in the most severe cases. While the UTA’s research did not include patient instances of urinary tract infections, the use of products that are uncomfortable and do not meet individual needs could contribute to greater susceptibility requiring medical intervention. This could quickly erode any short-term savings made by reducing access to medical devices.
The future of continence care
NHS England is expected to update its continence guidance, hopefully during the summer, and it’s essential that updated guidance not only reiterates the core recommendations and requirements of the 2015 publication, but also recognises the importance of enabling and empowering patients to manage their own continence issues and needs.
In 2015, NHS England correctly noted
the importance for practitioners to develop their understanding of continence issues. While the pressures of health professionals are significant, the number of people experiencing continence issues means they are an essential area of treatment with which GPs and others must be familiar, and knowledgeable about, particularly in terms of the local specialist support available. Clinicians currently have access to an NHS e-learning programme on continence and catheterisation and it would be welcome if this is made relevant for a GP audience. Such improvements will support referral pathways needed by patients who regularly experience continence issues and require specialist help beyond what might reasonably be expected in a GP practice. NHS England must also put in place steps to require CCGs and Trusts to adopt its guidance, and must have the processes in
JUNE 2018
place to make sure implementation is taken forward. The UTA’s Freedom of Information research indicates significant gaps in implementation since 2015, and these gaps must be closed to ensure the value of NHS England’s work and to facilitate improvements in care.
Ensuring the implementation of the updated guidance will improve levels of knowledge among healthcare practitioners, and will in turn tackle any sense that there can be a ‘one size fits all approach’ to managing patients’ continence issues. There is simply no such thing, and anything but a bespoke approach will be irreconcilable with the principle of enabling patients to manage their conditions, thereby helping to maximise their independence and quality of life. This principle extends beyond any updated NHS England guidance, and it would be a mistake to think quality of care will be improved solely by the release of one document. There is also a need for education at a procurement level, and for practitioners to input into purchasing decisions to ensure the range on continence products currently available to patients remains in place and allows for further personalisation and innovation.
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. The NHS risks undermining patient safety, independence and quality of life if it fails to meet individual needs. The existence and availability of a range of products is out of necessity rather than luxury, and practitioners must remain alert for the risk of reduced access for their patients.
The positive for the NHS is that patients appear broadly, and in many cases very, happy with the quality of continence care they receive. But there are undoubtedly opportunities for further improvement. This will benefit patients, but can also deliver savings for the health service at a time of unprecedented financial pressures. The alternative is that patients may be forced to rely more on healthcare professionals and specialist services, potentially including costly admissions to acute care. That is a scenario that must be avoided. However, the first step is for NHS England to update its guidance. It can hopefully then ensure implementation and by meeting patients’ individual needs, improve quality of life and meet urgent NHS financial requirements for value for money.
References
1 Excellence in continence care - NHS England
https://www.england.nhs.uk/commissioning/ wp-content/uploads/sites/12/2015/11/ EICC-guidance-final-document.pdf
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