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Continence care blog: When cuts lead to complaints

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Do you find yourself a target of complaints for problems caused by budget cuts? If so, you're in good company. Continence care blogger Frank Booth has seen it all before

Calling all clinical nurse specialists in the field of continence. Actually I believe this will apply to all specialists, regardless of your field of expertise.

Have you noticed whether your service is stable, or in decline?

Have you asked yourself why? Why is it in decline? Why is it stable?

If I were to ask you where there is waste within your service, I can hazard a guess that you are best placed to tell us. But in reality, who decides where the axe will fall and which part of the service will be reduced next?

Passing the buck

Probably your line manager will deliver the message, but this is likely to be because a more senior manager has made that decision, and even more likely this decision will have come from the trust finance directorate or chief executive.

When budgets are cut (or whatever words you choose to describe it) there will inevitably be some complaints from service users. These often land on your doorstep, and you are tasked with investigatign and identifying why YOUR service has let the trust and the public down.

Often the answer is simple - you are required to provide the same high level and volume of service with significantly less money or less staff.

So it’s YOUR fault.

What becomes worrying is the inevitable way that we seem to accept fault and start to give people what they want if it will save a complaint. You’ve experienced this as well have you/

What happens is that you respond to the desires of patients, and not to what all specialists strive for - care that meets ‘clinical need’.

Once we respond to the desire of one patient to avoid trouble, then the risk will be that more desires will follow and that will bring added costs. So you are now trying to avoid a complaint and are still expected to manage a budget over which you have ultimately no control.

Lessons from history

Thirty years ago we had a pad culture - if someone is incontinent throw a pad at them.

Twenty years ago we found, you guessed it, that we had a pad culture and we must do better to try to cure people.

Then in 2001 the now legendary and almost biblical Good Practice in Continence Services’ was published and we were told, we should cure people, not throw pads at the problem and supply products and services ‘subject to clinical need’.

This is all very credible, but if we are to provide care subject to clinical need, then finance departments and senior managers should recognise that the continence clinical nurse specialist is a valuable resource - she can save money while maintaining quality.

Expert clinical assessment must lead to cost-effective continence care. Why? The provision of products unnecessarily is a financial waste for the trust and a waste of everyone’s time.

Common purpose

Cure must be the optimum goal. A little time and encouragement, combined with compassion and understanding, can often produce the easiest cures. But your time is expensive.

I wonder if trust managers or Department of Health officials read blogs or clinical journal articles. Do they listen to the voice of clinical experts who are at the sharp end? Perhaps the answer is obvious, because they don’t seem to learn.

In the last blog, I reflected on the DH consultation on part IX of the drug tariff. Why have reports, consultations and costly discussions if grass roots views are quickly side-tracked and staff who do the day-to-day care are ignored?

Why should we bother commenting and waving the banner for continence services? Its simple, we have to, because we care.

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