Continence care is going down the pan as costs are cut and prices rise
Patients are complaining and continence nurses are being forced to restrict types and quantities of products, regardless of need. June Rogers looks at the economy’s impact on care
We know the NHS will have to save £15-20bn over the next five years. Health secretary Andrew Lansley has said that this “implied something like 3-3.5%, probably about 3%, efficiency savings each year in the NHS… we may need to do more, because we have increases in demand”. However, the new coalition has also announced: “We guarantee health spending increases in real terms in each year of the parliament.”
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On the ground, we have all been told we need to make significant savings within our individual departments of approximately 10% of our budgets. This means that those of us working in continence services are under considerable pressure to save, on average, more than £100,000 per year. This is almost impossible when we are already struggling on limited budgets, while the cost of disposable products and the ageing population who need continence care are both increasing.
The cost of continence products produced in the Eurozone has been dramatically affected by the exchange rate. Between 2007 and 2009, costs rose over 30%. While the exchange rate has moved slightly this year, industry has still seen a cost increase of around 28% since 2007. Products produced outside the Eurozone are affected by fluctuating local currencies. In addition, raw material prices are increasing and, as those used in continence products are priced internationally in US dollars, there will be a double hit as the euro is weak against the dollar.
The figures do not add up. We want to provide the same level of service, balance the books and save 10% at a time when products are costing nearly 30% more.
Continence services can only realistically seek to cut costs via efficiency savings, rather than on product price. However, many of us are frustrated that our ideas to improve efficiency are often lost within the bureaucracy of the NHS and because continence is not anyone’s “target”, which means it sparks little interest.
Particularly frustrating is the snail’s pace at which services are being transferred from acute to primary care, where they could be better served. Many services, such as those for children with idiopathic constipation, should be transferred to the community yet many commissioners are slow on this. This seems an appalling waste of money.
‘Our hands are tied by commissioners who only pay for a certain level of service, regardless of need’
Yet it is disposable product provision that leaves many continence nurses in the line of fire. Calls to the PromoCon helpline, a charity that offers product advice, are increasing. Patients and families are complaining about the limited type and number of products for which they are eligible. The phrase “Don’t shoot the messenger!” often comes to mind as nurses are told by management to restrict the type and number of products they prescribe to save money. This means that many services are not able to provide products to meet patients’ needs.
The problem is illustrated by paediatric continence care. Many areas do not have specialist paediatric continence nurses and offer just a free nappy service, where all children are supplied with the same product and quantity of pads. This is not the best use of resources.
We have tried to address this but have been told that families should use their disability living allowance to top up supplies. This is very frustrating as we are well aware of families’ needs. Our hands are tied by commissioners who will only pay for a certain level of service. We have to supply that level of care regardless of need.
Continence services are essential and need to be protected from cuts as well as rising prices. With an ageing population, more people will need continence care and services need to be protected. Continence nurses need to work more collaboratively with manufacturers to maximise budget spend and protect the provision of continence products to those in our care.
JUNE ROGERS MBE is team director at PromoCon, Disabled Living, Manchester