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.
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?