“My father messed himself in his bed; he had to sit in that for a long time before he was cleaned up. That was the last thing that broke his spirit actually.”
The public inquiry into Stafford Hospital has commenced and will continue for at least six months.
The chair of the inquiry, Robert Francis QC, said he wanted to know why no government organisation charged with regulating the NHS had been made aware that serious problems existed at the hospital. Relatives affected by the appalling conditions are rightly angry and bitter and want answers as to what went wrong. They also want to make sure that the same poor quality of care does not happen in any other institution or to anyone else’s loved ones.
The independent inquiry published earlier, also chaired by Robert Francis, reported that of the 33 cases from which oral evidence was heard, 22 included significant concerns in the continence, bladder and bowel category. The report stated that requests for assistance to use a bedpan or to get to and from the toilet were not responded to. Patients were often left on commodes or in the toilet for far too long. They were also often left in sheets soiled with urine and faeces for considerable periods of time. Suffering, distress, embarrassment and loss of dignity were caused to patients - often in the final days of their lives.
The report also says there were accounts suggesting that the attitude of some nursing staff to these problems left much to be desired, with a small number appearing uncaring. However, more often there were inadequate numbers of staff on duty and it was suggested that there was also a lack of training in continence care. The findings of the recently published national audit on continence suggest it is not just at Mid Staffordshire that there is a lack of training of healthcare professionals in continence care. It is prolific within the NHS.
Basic continence care is a fundamental right of every patient, but unless there is an identifiable lead in continence within each care setting, no-one takes responsibility for implementation of good integrated continence services or for adequate training of staff at all levels.
Continence care, I would suggest, is not rocket science, it can, however, be time consuming and labour intensive. Attitudes, at all levels, need to change within many care settings. Clinicians must realise that incontinence is not an inevitable consequence of ageing. Often there are strategies that help regain or maintain continence, but education and translation into practice must take place. Proper assessment is fundamental and patients and their carers need to be included in the care plan. The maintenance of privacy and dignity are crucial to basic continence care.
The Nursing, Midwifery and Allied Health Professions Research Unit at Glasgow University, in conjunction with the Association for Continence Advice, is presently undertaking a survey of UK continence education in undergraduate health education, as well as seeking the views of recently qualified staff as to its effectiveness. The results of the former will be published in the spring and will hopefully identify if undergraduate continence education is adequate. Moreover, because there is no centrally held registry of post-registration courses, we do not know where validated and appropriate courses are being run, but we do know that as a consequence of the pressures within the NHS, staff are often unable to attend due to decreased funding and availability of study time.
Doreen McClurg, PhD MCSP, NMAHP, Research Unit, Glasgow Caledonian University
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