Improving healthcare practitioners’ understanding of continence issues could maximise the quality of continence care across the NHS, notes Chris Whitehouse

community services care worker elderly woman patient

In December 2015, NHS England published specialist guidance on how to ensure excellence in continence care. The guidance itself was positive, noting the importance of clear pathways to specialist care for the approximately six million people who experience continence issues.

And, crucially, highlighting the need for healthcare practitioners across the piste to have additional training and to improve their understanding of continence issues, thereby ensuring the best possible levels of care.

The challenge, of course, has been ensuring that these astute recommendations are implemented within the health service and translated into action. That has been made more difficult by the lack of any mechanism by NHS England to follow up on its published guidance and to confirm its implementation. This raises the question of what, if indeed any, impact Excellence in Continence Care has had in the last two years?

Implementation of guidance

Freedom of Information requests issued by the Urology Trade Association to every clinical commissioning group in England have shown that little more than half of the 103 responding CCGs are able to confirm they have implemented the guidance.

And while a number of them have made the point they are commissioners rather than care service providers, the question remains as to what assurance we can have that NHS England’s guidance is now standard practice.

Nearly seven in 10 patients (69.7 per cent) concluded the knowledge of their GP on continence issues had remained the same

The UTA additionally sought the views of patients, conducting an online survey of more than 1,700 users of specialist continence products such as catheters to assess their opinions of the quality of care they receive, but also to highlight any challenges in service delivery.

While a third of respondents (37.7 per cent) suggested they had seen improvements in care for continence issues over the last 18 months, a greater proportion (43.3 per cent) said they had not. But perhaps most revealingly, nearly seven in 10 patients (69.7 per cent) concluded the knowledge of their GP on continence issues had remained the same.

Given that a core recommendation of NHS England’s guidance was additional training for health practitioners to improve their knowledge of continence issues, the lack of discernible improvement in the eyes of patients, coupled with the number of CCGs unable to confirm they have implementation of the guidance, again raises the question of what impact NHS England’s recommendations have had.

NHS England is expected to update its guidance on continence care. But improvements in services, and consequently patient experience, will only be realised if the updated recommendations are implemented across the health service. That requires NHS England to ensure that if CCGs aren’t implementing the recommendations themselves, they are compelling service providers to do so.

This leaves a remaining question. Given NHS England’s very pertinent recommendations to date, what more can it expect of service providers to maximise the quality of continence care across the NHS?

Parameters for care

Based on the information from patients via an online survey, the UTA and members of the Urology User Group Coalition – charities working directly with individuals affected by continence issues (often as part of the management of a chronic or degenerative condition) – produced a manifesto setting out the parameters for high quality care.

Its five themes are based on two fundamental principles. First, that a “one size fits all” approach cannot deliver appropriate levels of care. Instead, patients need support to meet their individual needs, including access to medical devices such as catheters that suit their personal requirements and conditions.

The second principle is that high quality of care means having the resources in place to manage continence issues as independently as possible but ensuring access to specialist services when required. In practice, the UTA would suggest that means ensuring continuity of care is as robust as possible, and that the goal should be providing patients with single points of contact to manage their care.

 It is important to recognise that what suits the lifestyle of one patient will not automatically suit those of another – and so a range of products can help patients manage their needs with confidence

 But it also means understanding patients’ lifestyles and concerns for the management of their continence issues, making available to them the medical devices that allow them the greatest comfort, confidence and discreet management.

Making a broader range of medical devices is a challenge that must be reconciled with the financial demands on the NHS and the need for savings. But it is important to recognise that what suits the lifestyle and needs of one patient will not automatically suit those of another – and consequently a range of products can help patients manage their needs with confidence.

And it is also important to recognise patients’ expectations, highlighted in the UTA’s survey, that cost is not a barrier to them accessing the medical devices they are familiar and comfortable with. If the NHS is able to continue to meet patient needs, and assess the impact of its updated guidance, then it can hopefully improve and ensure excellence in continence care.