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Practice comment

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

 

Readers' comments (11)

  • This also applies to the elderly not being referred to specialsist serviecs when treatments in the community have failed. Instead they are being offered pads.
    getting people dry should be the priority but the pressure is on in the community not to refer to cut costs.
    Older people are already under the impression that incontinence is ineveitable with age and that pads are the only answer.
    Numbers of pads are already an issue but dignity and the type of pads required on speciali order are also affected. When requesting pull up disposable pants for a patient being discharged as it was the only ones she would keep on, a continence nurse in the community actually said "They (meaning managment) will not be happy if I request those pants as they are too expensive; the carer will just have to manage".

    I have been to conferences where senior continence nurses proudly show their pathway where the "younger" adults are offered further treatments in secondary care but the frail elderly patients' pathway goes straight for containment. Specialised treatments are successful even with those with co morbidities. keeping patinets dry is more cost effective then using pads.

    Things will get worse with the cut backs and the pressure to save money or risk your job.

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  • The pressure is already on, there are limits on pull up pants and pads a client can have regardless of clinical need. The numbers vary from trust to trust, or county to county. The politiciatians have been very vocal pre and post all general elections. They continue to promise the electorate that they can have access to specialist care, nurses and doctors and prescribed equipment and products, but they don't tell them about the rationing which has been put in place as a way of saving money in order to remain within budget. Imagine doing a continence assessment, and telling a family that their mother is going on the waiting list for pad provision when she has bowel cancer and terminally ill.Everybody knows that when you are so ill, it is difficult to control your bladder and bowel. How is such a person to cope? Continence services are poorly funded, it has to change.

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  • In these days of fiscal difficulties is it so unreasonable to ask people NOT to expect an endless, free supply of continence products? After all, many of those receiving such products already receive DLA or Attendance Allowance - allowances from the public purse which are intended to pay for care which is not supplied by health and social care providers. So, in effect, by providing free continence aids, the taxpayer is, in many cases paying twice. I am all for sufferers being referred to specialist services and only those with a true, intractable continence problem being provided with aids (pads) when other avenues of treatment have been tried and failed. Healthcare (including continence care) will ALWAYS be rationed. I know I would far rather there were enough nurses to care for me either at home or in hospital than my mum or granny getting free pads ad infinitum when a pack of pads with the shopping from Tesco is not going to break the bank. Of course I realise that this is a fairly radical view but given the choice, what would be your preferred option? Pads or money in the budget for more nurses, new drugs etc

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  • Anonymous | 22-Jun-2010 8:07 pm the implication is that people with continence problems are in spome way less deserving than others. What if its not your granny with a weak bladder but a young person with MS- does the same principle apply. What if granny has continence problems related to parkinsons disease. How do you decide?

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  • I have a radical idea - don't use incontinence products in hospitals - nurse patients properly as we did before these became commonplace.
    Also, in the community, don't provide them free of charge - we could charge/sell them at cost to all the people who request them that's what DLA is for - not to boost income! This may also reduce stockpiling/inappropriate use!

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  • Always down to money! From my experience nurses 'encourage' incontinence by putting pads on patients (a cost to NHS) and then because they're under pressure due to staffing levels patients who request the toilet have to wait (causing an avoidable incontinence)

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  • Issuing continence products to manage incontinence should be the last resort following an assessment and should be based on the needs of the client.Unfortunately with lower resources, both within nursing and social services,there is going to be an increase in the need for continence products.
    Provision of pads and the type and amount given is not always based on client needs but on the knowledge of the nurse doing the assessment.
    If we are going to reduce costs perhaps we should be increasing education so that nurses have basic knowledge of continence promotion and management?
    Many clients with continence problems manage this themselves by buying their own products and don't ask for advice soon enough. By the time they do ask they are often already reliant on using pads and reluctant to stop using them.



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  • The sad truth is that in my experience on elderly wards, most patients are given pads as standard, even those who can walk to the toilet. Some patients request them as they "feel safer" but the majority are padded up, just because they're elderly.

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  • Soemtimes a more "expensive" pad can not only promote someone's independence but also ensure someone can stay at home cared for by their relative. Incontinence is second only to dementia as the reason for goung into care, usually because for carers find difficult physically & emotionally to keep on cleaning up after tehir loved one beciase pads are inadequate and leak. Looking at cost; the cost to society financially paying for someone in residentail care far outweighs the cost of those more "expensive" pads.
    That's not even touching upon the social cost to us as a society.

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  • Where i work the appropriate size of pad is retricted or refused due to expense. Also Continence support is lacking, hit and miss. Only some nurses receive continence training. Products change without warning Nurse consultants shout and scream blaming nurses not managers who are really to blame for the mess of nursing.

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  • I have since discovered that in some areas, manaufacturers of incontinence pads are performing the reviews of incontinence in residential homes instead of the nurses. not sure how ethical this is.
    Also if the home is requesting a higher absorbency, the manufatuerers are allowed to change the prescription without any further assessment performed as to why the resident may need a higher absorbency e.g. UTI, urinary retention, constipation; pathology. When questioned on this I was told "Well it's most probably their dementia".
    If I had a bladder problem which detriorated I would want to know why - having dementia or living in a care home should not change this.
    I find this shocking!!
    I find this shocking!

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