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The NHS Plan: the implications for continence care

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VOL: 96, ISSUE: 40, PAGE NO: 16

Jenine Willis

Although there is no explicit reference to continence services in The NHS Plan, nurses and organisations involved in the promotion of continence have broadly welcomed the government's commitment to investing in facilities and staff to improve health care services.

Although there is no explicit reference to continence services in The NHS Plan, nurses and organisations involved in the promotion of continence have broadly welcomed the government's commitment to investing in facilities and staff to improve health care services.

Among the pledges outlined in the plan, which was published in July, is a commitment to the recruitment of an additional 20,000 nurses, 7,500 consultants, 2,000 GPs and 6,500 therapists. It also envisages the provision of 7,000 more beds, 100 new hospitals and 500 one-stop primary care centres, all supported by up-to-date information technology systems, within the next 10 years.

The conditions that affect the highest numbers of patients in the UK - cancer, heart disease and mental health problems - all come under scrutiny in the plan, although continence problems, which affect more than 4,000,000 people over the age of 40, do not.

But Veronica Haggar, professional development officer for the Association for Continence Advice, says the organisation is not disappointed that there is no mention of continence in The NHS Plan because the profile of the specialty was boosted earlier this year when the long-awaited NHS guidance on continence services (Department of Health, 2000) was issued in April.

'It's down to us now to apply the general principles of The NHS Plan and work to implement the guidance,' she says.

Nursing leadership
From a nursing perspective, the plan's focus on nursing leadership is a step forward. 'It is clear now that nursing is recognised as a profession in its own right, not just in support of the medical profession,' says Ms Haggar.

'But the bottom line is that we need to have a multidisciplinary approach in continence.

'We need to ensure that we work across primary, secondary and tertiary care boundaries and that we work effectively with different professional groups to achieve an integrated continence service as outlined in the guidance,' she explains.

Such integrated services will be run by directors of continence services, with a background either in specialist nursing or physiotherapy, who will have a clinical, educational and managerial remit.

The NHS Plan also promises to increase the number of nurse consultants to 1,000, creating promotional opportunities for more continence nurse specialists. And as nurse consultants they will spend 50% of their time working with patients.

Ms Haggar believes that these two key leadership roles will complement each other and provide a'two-pronged approach' to improving continence care.

Extended roles
According to the plan, there will be opportunities for all nurses to extend their roles. The government has set aside £280m over the next three years to develop the skills of NHS staff and a new leadership centre will help to train clinical leaders, including modern matrons who will ensure that basics such as cleanliness are once again a priority on the wards.

While welcoming the prospect of additional investment in staff education and training, most organisations involved in the promotion of continence are concerned about this money filtering through to front-line staff.

David Pollock, director of The Continence Foundation, suggests that there is also a need to upgrade the skills of doctors, practice nurses and other non-specialists who come into contact with people with continence problems so that patients are appropriately referred to specialist services.

'Luckily people don't die of continence problems,' he says, 'but staff who are rushed off their feet sometimes find it very difficult to give a lot of attention to continence problems.

Equity in services
Although Mr Pollock is disappointed that continence problems are not addressed directly in the plan, he feels that its focus on the rights of older people is a step in the right direction.

In particular, the plan promises that the nursing care provided in nursing homes will be free. As Mr Pollock points out, there is now no justification for charging the residents of nursing homes for continence pads.

The foundation is seeking clarification on this issue, but it hopes that the implementation of The NHS Plan will mean that the residents of nursing homes are no longer the only patients who do not receive free continence pads.

Postcode prescribing is referred to in the plan in relation to cancer drugs, but where patients live also affects the type of continence services they have access to. Although the plan gives a clear commitment to national standards of service, Mr Pollock is concerned that its emphasis on delegating spending decisions to local levels could lead to greater disparities as different services are forced to fight for local funding.

And now it is not only primary care groups or trusts that will decide local priorities and funding: The NHS Plan says patients will also have a say on local health services, including how much is spent on them.

Patient involvement
'Patient involvement always looks good on paper,' says Jolyon Rose, executive director of the patients' group Incontact.

Many patients are reluctant to admit to continence problems, let alone seek professional help, so it may be difficult for them to voice their needs. But this is where patient groups come in, says Mr Rose. 'It is up to us to make sure that The NHS Plan is implemented in a way that will be responsive to our needs:

For example, Incontact has ensured that NHS national benchmarks for continence care enshrine the importance of listening to patients. And locally, working in conjunction with health care professionals throughout the UK, the organisation has already set up patient support groups which Mr Rose hopes will provide representatives to sit on patient forums and commissioning groups.

So it appears that The NHS Plan has placed the ball firmly in the court of health care professionals and patients.

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