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‘Why treat a problem when you can throw a pad at it?’

  • Comments (19)

In the NHS some patients are more equal than others.

That was a message I got from delegates at the Association for Continence Advice conference last week.

Why?

Because some commissioners think bowel and bladder care is important and others don’t.

We have discussed the outcome of rationing care on this website before. Remember the case of Elaine McDonald? Ms McDonald lost a supreme court appeal against the London Borough of Kensington and Chelsea’s decision to withdraw the night-time care that enabled her to use the toilet. Instead Ms McDonald was told to use incontinence pads – even though she has mobility problems rather than incontinence.

The indignity of passing urine into a pad when you know you could go to the toilet is unacceptable. Yet our continence services are under immense pressure and in some areas commissioners, looking to save money, may see continence as an easy target.

Why treat a problem when you can throw a pad at it – and, while you’re at, it ration the number of pads?

Those who have the money can top up their supplies, while everyone else has to make do. In a #NTtwitchat last week people talked about the human cost of rationing: drying pads so they can be used again or providing a pad that lasts 12 hours so less care is required for toileting.

It is nurses who inevitably have to deal with the consequences of offering different levels of service to their patients depending on who is commissioning care.

How do you explain to Mrs Smith at number 46 why she gets one service while Mr Green at number 72 – with a different GP – gets another?

How do we reconcile the compromise this inevitably entails? Is it just the new economic landscape of healthcare that we have to get used to?

The uncomfortable realities of competition care are beginning to bite. What is your experience?

  • Comments (19)

Readers' comments (19)

  • tinkerbell

    Really? Dry out and re-use an incontience pad. Surely not. Gonna end up smelling a bit. I have a bath at least once a year, even if i don't need one but that's taking the P***!

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  • as an ex continence nurse i saw this practice a lot, people trying to make do. I am ex as i was made redundant, i was thinking about going back but felt that continence services will always be under fire. i really cant face the uncertainity of the NHS again for the time being. Why should dignity suffer in a culture of privacy and dignity because pads are expensive, treatment is the option but that takes staff and services are having staff cut. i always think that when those who make the decissions get older and incontinant they are going to be hacked off with the services on offer.

    By the way when i get older catheterise me it will be cheaper!!!!!

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  • Anonymous

    Ms Shephard thanks for the topic.
    It is the basic human dignity that is put at risk here.
    The thingh that polititians love to dabble in when it comes to running down the nurses.
    This is nursing. Nurses should stand up to what is right and dignified. We not only know what the word means we try our best every day with short of staff to give patient the dignity they derserve.

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  • Anonymous

    wonderful employment and marketing opportunities and challenges to make more money!

    needs somebody to be innovative and produce new reusable pads which do not smell and do not damage the skin and cause the patients no other discomforts or inconvenience

    or bring back a service similar to the old post war door to door weekly nappy laundry service and create more jobs


    we have all noted the elderly or those who need pads who have a faint odour of urine or the devastating damage to the skin of those who have been exposed too long to a damp pad.

    that two patients, whose healthcare is paid for by taxpayers across the land and who may also have contributed themselves their working lives long, to receive different levels of treatment, care and rations of pads is inadmissible.

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  • Anonymous

    I currently work as a Continence Nurse Specialist for an organisation where the Continence service is so poorly resourced that we are sadly "almost throwing a pad at it" as no one has time to do a thorough assessment and actually promote continence!!! Think we may end up being like Sue Chadburn - what a pity and what a waste of her experience and passion!

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  • Anonymous

    A comprehensive continence assessment would almost certainly reduce incontinence - and this includes frail elderly people. Time & time again I see pads being offered first without assessing the cause - all that is seen is an age and therefore a premise that this person is old and therefore can not be cure of their incontinence.

    The DNs, in my experience as a Continence nurse specialist, do not have the relavant, knowledge, skills or time to perform a comprehensive Continence assessment. Many patients that I see have already undergone a "Continence assessment" by a DN without Bladder scan, bladder diary, vaginal examination, prostate assessment, rectal examination, abdomninal exmamination. The underlying cause of incontinence could have more sinister consequences which would be uncovered with a thorough assessment. For many nurses a continence assessment is a Pad assessment. You would be surprised at how many older patients do want to be cured but because they have been offered pads, this causes them to believe that incontinence is inevitable "at their age".


    Attitudes towards incontinence needs to change by nurses & their managers if we to stop "throwing pads" at the problem. If I have had to prescibe pads without first finding a cause or treatment, then I have failed.

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  • Anonymous

    "You would be surprised at how many older patients do want to be cured but because they have been offered pads, this causes them to believe that incontinence is inevitable "at their age"."

    fortunately some of us are nurses and hopefully when we need treatment of any kind are still cognitively alert enough to ask questions. Sadly though there are cases where nurses as patients are also ignored when they express their opinion or raise queries.

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  • michael stone

    I agree with Eileen and everyone else except for Anonymous | 6-Jun-2013 2:33 pm - I would probbaly agree with 2:33 pm, but the points raised are outside of my technical understanding to the point that I cannot comment on that post.

    I do suspect that this is part of a wider theme: incontinence tends to be a thing of old age, and older patients seem to be fairly routinely 'disciminated against/seen as soft targets' whenever people are looking to save money somewhere.

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  • tinkerbell

    what about re-using bandages and sharps, we are going backwards not forwards.

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  • Anonymous

    tinkerbell | 10-Jun-2013 5:49 pm

    don't Tinkerbell. In my last job we had to recap and reuse disposable i.d. needles and syringes for insulin injections for the same patient for the whole day in an old people's and nursing home. have you ever heard of that before? I had not but of course I had nothing to say. I eventually lost the job as I refused to systematically recatheterise elderly patients with 20 or higher gage urinary catheters whether they were the suitable size for them or not. I was informed in no uncertain terms by the director of nursing that it prevented leakage, when it is known that the contrary is the case! I was told that they had always used these catheters for everybody and had no narrower gage ones in the home and I said my practice was evidence based and I had just come from a university hospital and had recently been on a catheter course run by a well known manufacturer before starting this new job.

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