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Protecting continence services as financial pressures loom


Frank Booth asks whether continence services will become pad providers as financial pressures increase

I’ve always been one for looking ‘outside the box’, around the box, under and over it, and inside it well. As a specialist it is your job to see everything from all angles. I believe that it also your duty and responsibility to lead your team in doing likewise, especially where patients are concerned.

As a very long term member of the Association for Continence Advice it is with regret that our regional secretary informed the membership of the untimely deaths of two of our colleagues. Both had developed life threatening long term illnesses and I would like and dare to hope that the specialists involved in their care both ‘did their duty’ and lead the specialist care that they needed in an exemplary manner.

Specialist generic care at our level, regardless of specialty, needs to be able to ‘hit the spot’, to ‘do what it says on the packet’ and reflect what patients should expect. Nothing but the best!

Yet I worry! Do we let people know what we do?

Will you use language that the patient can understand? Can you be sympathetic and empathic without being sycophantic?

I can promise you that what you say and do really does matter.

You know, you don’t have to be desperately ill or have a terminal illness to be frightened by your condition.

If you are told that you have a life threatening illness your emotional health as well as your physical health will be shattered but I’m sure that all professional continence nurse specialists will agree that you do not have to be dying to be emotionally destroyed by something many people see as ‘simply incontinence’.

Incontinence is anything but simple, it has the potential to be very complex and yet we still see it being treated as an everyday occurrence, no more important than a simple cough or cold.

Incontinence needs to be investigated using basic guidelines.

With spring in the air, this could be the time to renew the impetus for building a brighter future for incontinent people and continence services.

There is little point in grumbling about what the government or opposition parties may or may not be doing for health, that PCTs and hospital trusts just don’t care, and all that seems to matter is money. Well you know that it’s true to a greater or lesser extent.

The current financial climate is putting everyone under real pressure. There has always been only so much money available and cancer, heart services, children’s services, research and escalating drug budgets all seem to be higher up the pecking order than little cared-for continence services.

So it’s up to you and me to put down the markers. Let’s tell our organisations how important continence services are and how YOU can make a real difference.

You as leader of the continence service in your area might like to look at the financial books of your service.

My greatest worry would be that if money is withdrawn from the care elements of continence services we will slide back to a pad-providing service.

As care components are reduced, pad costs increase. It’s that never ending story and we’ve been there before.

Take a look at the books and then suggest to your managers that cutting staff, cutting clinics, cutting services WILL inevitably lead to increased pad costs.

Remember what we called it in the past, ‘throwing a pad at it’? How wrong it was. Are we back on that road again?

It doesn’t matter how excellent, professional and proficient you pad provider is, their profit margins cannot fall to zero percent and for some the profit margins are now already very low.

Welcome to the real world! It’s very close to now or never for trusts.


Readers' comments (5)

  • At least I am assured of a voice of reason when i review my service and ask my self what else can we throw out. i like you do not want to see continence become a pads free for all which it will do if we cannot get people to realsie that good continence care = less falls, prevention of pressure sores , increased dignity .
    30 years ago i was a good pad thrower now i promote best practice please lets not go back to the dark ages but get a grip and show how much difference we can make.

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  • Anonymous does say if she/he is a specialist but after 30 years from pad throwing to best practice suggests that a great deal of experience and obviously common sense abounds. So how about the rest of us where ever we work, what ever our grades will we ever be able to stand up and be counted or have we been dealt another death knell blow about, not exactly 'whistle blowing' but simply telling the truth to Trusts as we see it?
    Do have your say in the safety of an anonymous blog response if you feel that you cant say who you are. I do understand.

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  • Having now spent 19 years in the continence world on both sides of the fence (commercial and NHS) I am always hopeful that the value of continence services will be recognised at Government level. However since my move to London to set up a new service for the 2nd time in my career, I have experienced a strange phenomenon. That of in-fighting between professionals to hold on to patients and scaremongering in primary care to ensure that patients are directed to secondary care, so bypassing community based continence services. If we cannot stand together with one voice how the heck is the message to stay strong and credible!!

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  • Nice to hear from you Belinda, what can we say? Is it the way of all nurses to shoot ourselves in the foot?

    Setting up a Service twice! You have to be a glutton for punishment!

    We have no chance at all if we cannot stand as a profession and then as a specialist service with one voice. It's not hard to do this as you imply and if we ever want to get the government to comply with "Good practice..." from 2000 then Primary and Secondary Care must feel comfortable as one. It will not be easy as inherit in our make up seems to be mistrust. Surely it's time to grow up? I know it will not be easy, it wasn't when I was practising but the best things we achieve are not always easy. Difficult doesn't meant don't try, it should mean try harder. We can do it. I cannot believe, anonymous or named that Belinda and I are the only 2 Continence people to feel this way!Come on, have your say, for or against, your argument is valid because it is what you believe.

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  • I've only just come across this article. I find the comments "scaremongering in primary care to ensure that patients are directed to secondary care, so bypassing community based continence services" a little over exaggerated. As a Continence Specialist in primary and now secondary care I know that ward staff are very poor in assessing incontinence. I sit in meetings with the community and listen to how good the service is and all the tgraining they provide and yet this does not bear out with findings on the wards and in our clinics. I have found patients who are already in receipt of pads and therefore supposed to have had a continence assesment who when we have assessed we have found Vulva Ca, Ovarian Ca, Bladder Ca and shingles causing chronic urine retention. Ok these are rare but I never underestimate incontinence. Community staff are under pressure not to refer on to acute and the only reason is cost.

    Unfortunately due to cost cutting unqualified or inexperienced staff are being employed as specialsits or we are fooleds into believing that HCAs are best placed to perform certain "tasks" when we all know it is PCTs way of reducing costs. If advising that doing full assessments and referring patients who have failed conservative treatment is seen as "scaremongering" I do not apologise.

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