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Continence care criticised


People with continence problems face a “life sentence” of suffering due to poorly organised NHS care, a report said claimed.

Bladder and bowel continence problems affect one in five people and causes poor health, depression and social isolation, while costing the NHS millions of pounds.

But the study found services are failing patients, in particular the elderly, who may not get treatments or a clear diagnosis.

An audit of services for more than 18,000 people in health trusts and care homes found “diagnosis and treatment of incontinence is often poor or non-existent”.

Only half of patients in mental health trusts and care homes had a treatment plan for urinary incontinence, according to the National Audit of Continence Care.

Many patients had no bowel history taken, despite being incontinent in that area, while many also suffered due to lack of diagnosis.

The report, commissioned by the Healthcare Quality Improvement Partnership and carried out by the Royal College of Physicians’ clinical effectiveness and evaluation unit, said continence services are poorly integrated across hospitals, care homes and services in the community, even though most claim to be integrated.

There is also a lack of leadership in the area and patients rarely have their voices heard.

Dr Adrian Wagg, clinical director of the audit, said: “Although these are treatable conditions, people of all ages and vulnerable groups in particular (frail older people and younger people with a learning disability) continue to suffer unnecessarily and often in silence, with a life sentence of bladder and/or bowel incontinence.”

The audit for England, Wales and Northern Ireland included 135 NHS acute trusts, 26 mental healthcare trusts, 86 primary care trusts, and 122 care homes.

A Department of Health spokesman said: “This audit shows a distressing lack of response to patients’ views and needs, a lack of expertise in commissioning continence care, and a lack of integrated care.

“The government’s white paper puts patients at the heart of the service, and will strengthen clinically-led commissioning. This audit will be a powerful spur, to enable patients and clinicians to deliver the quality of care patients have a right to expect.”


Readers' comments (4)

  • all the issues and rules that are being implemented, no one is actuall thinking.these so call management / white paper and everything else is in the interest of the ones doing a job and getting paid for showing...'oh i have a plan'...workers you deal with this and get the work going im a front line worker and the extent of paper work and bulling that is taking place at work, i wonder where is patient care. we all work many hours doing paper work, while the patient suffer in silent.the nurses are being taught to lie and do false documentation, because if things dont get done, we're called at home, an ir1 is done or we are told off by bulling staff. also fighting among ourself. i feel sorry for patients, the work of a nurse is no longer, its about hours of paper work, doing care plans and bringing folders up to date, whiles poor patients are left to wait, because we have other tasks to perforn.nurses love their job, but we are being cut down and, provide paper and record care, not patients care. i feel very sad and i wonder what next.

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  • This report was long overdue. Its been a long standing issue thats justs not given the level of exposure and level of diagnosis and treatment that IS available. I cant agree with previous poster that nurses are being taught to lie and do false documentation - outrageous that anyone would use this excuse .... don't you value your PIN? Why awould anyone compromise themselves to be lie and do false documentation?
    We're all under pressure, but come on!

    Getting patients through the maze of referrals is the first objective, then getting diagnosis and treatment plans in plans.... but of course, neither will happen if we dont complete documentation correctly (and truthfully): forgot to do bowel chart? whoops, I'll just take a guess shall I? Didn't complete urine output chart? Take a guess at that too shall we?
    Care homes are worst offenders withg continence care, we cant make changes if practices do not improve. Easier to leave a patient wearing pads than encourage bladder training and use of .... yes a toilet!

    Happens in hospitals too; getting old? Well, what do you expect then! I heard a consult. comment to patient that along with needing reading glasses, needing inco pads was a 'given'. Nearly go fired for reminding later reminding said Consult. that he was 5 years older than the patient and how was he he enjoying pissing himself then!

    Suffice to say, Consult. hates me, but is more overtly sensitive to patients on this matter.

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  • One very large PCT serving a population of 677900 has just reduced their Continence Nurse Specialists from 6 to 3. According to the figures that means they cover a population of over 33,600 patients with urinary incontience and 5,400 with faecal;that's how much this PCT cares about continence care for its population.
    The DNs, amongst all their other work, are supposed to perform specialised continence assessments.
    A professional and accurate continence assessment takes at least 1 hour and follow-ups are important for successful outcomes. All they care about is meeting the targets of "numbers seen", not the outcome of the consultation and if the patient is improved, even though in the long-term this is more cost effective.

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  • Incontinence costs money. Let people (both staff and patients) manage it better and we could save a bundle! And hey, we could even improve the dignity of people we are caring for and their / our environment.

    Throughout health provision in community and acute care settings, from community nursing homes and dementia facilities to acute wards, incontinence costs. It impacts across the whole sector but more prominently for Elderly, Mental Health, Learning Disability and Physical Disability patients.

    Perhaps some medical colleagues could shed light on some of the areas (i.e. the causes and volumes of people affected) that result in incontinence where if diagnosed the symptom could be easily reduced or eradicated. By understanding the causes we may be able to determine those for which there are treatment solutions, and where this is not possible management of the effects can normally be delivered better and more cost effectively.

    Savings can be made by
    - Decreasing risks to patients such as
    o Infection risks
    o Trips and falls risks

    - Focused use of resources
    o staff time – nurses, auxiliaries etc. taken away from other core duties
    o cleaning time
    o opportunity costs
    o Goods and services costs

    Effects of incontinence are obvious: patients discomfort; increased risks of infection; increased risk of injury through trips and falls; staff time taken up (stripping beds, changing clothes etc. not to mention increased hotel costs) – all puts pressure on valuable resources. These are all things taken for granted day and daily.

    Example of increased risk to patients in trips and falls - I was in a dedicated rehabilitation ward last week where 4 elderly gentlemen are working on returning home. One had a trip and fall in the bathroom. Another had a trip and fall trying to get back into bed (the nature of his condition is that he has a sudden loss of power in his legs at times). A third fell out of bed – and it is not known how this happened. All are now using catheters. (I'm not a fan of catheters, whilst practical and often necessary, they introduce an greatly increased risk of infection). All of these gentlemen have issues in speed of getting to the toilet, they know they need to go – they just can’t get there in time. Staff are under pressure and cannot respond in time. When they try to get there themselves, their risks increase.

    Methods to reduce costs include diagnosis and management.
    1) diagnosis to (i) determine a course of treatment to reduce incontinence, identify those for whom management is the best option; and
    2) Management of the symptoms using pads etc. is cost effective, simple and easy to implement reducing risks of infection, increasing patient dignity and reducing the frustration of staff who could be doing other things.
    Bottom line(er, sorry, excuse the pun). Incontinence costs money. A large amount of this cost can be saved through very little effort.

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