A slowdown in referrals indicates that continence patients are being seen by district and practice nursing staff lacking specialist training, rather than urology services, a trade body has warned.
Urology Trade Association, which represents the manufacturers of catheters and other devices, has called for a review of NHS continence care guidance, warning patients could be struggling to access specialist urology support.
“The government must reconsider a frankly bizarre decision”
Figures obtained by the body via a Freedom of Information request show an overall 8% increase in referrals to acute specialist urology services in the three years between 2013-14 and 2015-16.
However, the figures also reveal a slight decrease between 2014-15 and 2015-16, which the association warned could mean patients were struggling to access specialist support.
National guidelines were published by NHS England in late 2015 to boost knowledge among healthcare professionals over continence issues and how to access specialist services.
But the association highlighted that ministers indicated before last Christmas that there were no plans to review the implementation of the guidance – titled Excellence in Continence Care.
As a result, it suggested the fall in referrals between 2014-15 and 2015-16 could mean patients were being seen by district and practice staff lacking specialist continence training, rather than specialist urology services.
Chris Whitehouse, chair of the Urology Trade Association, said: “On the face of it, a decrease in referral numbers between 2014-15 and 2015-16 should be good news.
Referrals drop ‘leaves continence patients struggling’
“But that’s only the case if patients are getting the support they need outside hospital trusts,” he said. “Given NHS England published guidance because of concerns over the lack of specialist urology and continence knowledge at local levels, we need to seriously question whether this is the case.
“Our members continue to be told by the patients they support, many of whom experience continence issues as part of living with a chronic or degenerative condition, that they continue to struggle to get the specialist help they need,” he said.
The association called on ministers to reconsider what it called a “frankly bizarre” decision not to evaluate the implementation of NHS England’s continence guidance.
A spokesman said the body had based its concerns on a series of parliamentary questions on the issue towards the end of last year.
Dr Sarah Wollaston
Sarah Wollaston, Conservative MP for Totnes and chair of the health select committee, asked the government in November “what steps” it had taken to promote the guidance and which clinical commissioning groups had put the guidelines “into practice”.
In response, health minister David Mowat said NHS England “did not currently hold information on which CCGs have put the guidance into practice”, but that it “anticipates auditing CCGs in future in order to capture this information”.
However, hopes of such an audit appeared to be dashed the following month, when another MP enquired about checks on the implementation of guidance on the quality of paediatric continence services, which are covered by Excellence in Continence Care.
Conservative MP for Southend West Sir David Amess asked whether the Department of Health had held discussions with NHS England on auditing the effect of the guidance.
On this occasion, Mr Mowat said: “The department has had no formal discussions with NHS England on auditing the effect of its guidance Excellence in Continence Care on the quality of paediatric continence services.”
Responding to the figures, Patricia McDermott, chair of the Association of Continence Advice and a consultant clinical nurse specialist in urology in Guernsey, said: “Continence care requires a higher priority than it currently receives.”
She highlighted that improving provision through better integration could improve outcomes and better quality of life, as well as increased independence by finding tailored solutions for individuals.
“The lack of timely access to high quality assessment, care, treatment and support in England has been well-documented over time,” Ms McDermott told Nursing Times.
Slowdown in urology referrals ‘leaves continence patients struggling’
“Poor continence care is not only distressing and degrading for individuals, it also contributes to unnecessary costs to the NHS through avoidable complications such as infections, pressures sores and falls, which can increase the amount of time spent in high cost hospital settings,” she said.
She added: “With effective community-based continence services can save valuable NHS resources whilst restoring dignity to people and improving quality of life.”
Meanwhile, the trade body’s FOI also revealed that average waiting times for referrals to specialist acute urology services fell from 44.39 days to 40.96 days – a decrease of 7.7% – between 2013-14 and 2015-16.
The number of male referrals rose by 5.6% between 2013-14 and 2015-16, from 462,073 to 489,578, and the number of female referrals increased by 15%, from 158,955 to 188,466.
The Urology Trade Association describes itself as the leading urology industry membership organisation in the UK, representing 95% of urology product manufacturers and suppliers.