Implement continence care guidance to improve patient experience

This article was originally published on behalf of the UTA in the Health Service Journal here. It is authored by UTA Chairman, Chris Whitehouse

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 Carehas 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.

Department of Health consultation: Informing an update of the NHS Constitution

The proposed changes outlined to the NHS Constitution cover:

  • the changes recommended by Sir Robert Francis QC, in his Inquiry Report following the terrible failings at Mid-Staffordshire NHS Foundation Trust;
  • giving greater prominence to mental health;
  • weaving in some of the new Fundamental Standards;
  • making reference to a more transparent and accountable NHS; and
  • making reference to the Armed Forces Covenant.

Continue reading

Royal College of General Practitioners inquiry: Patient Centred Care in the 21st Century

Background and introduction

The Urology Trade Association (UTA) is the leading urology industry membership organisation in the UK, representing the majority of urology product manufacturers and suppliers to the urology appliance market. We welcome the opportunity to respond to this inquiry into patient centred care in the 21st Century.

An estimated 6 million people in the UK are affected by continence problems and many rely on urology appliances on a daily basis. High quality urology appliances allow users to effectively manage their conditions, maintaining their quality of life and independence and avoiding repeated medical consultations. Access to appropriate products is also important as poor long-term urological care often has a profound negative impact on a patient’s dignity and wellbeing.

The UTA believes that any future models of NHS care must consider that as the number of people with one or more long term conditions will increase, so will the number of people with continence problems. According to the World Health Organisation, longer life expectancies and an ageing population is likely to lead to an increased prevalence of neurological conditions, of which many will result in continence problems. As such, NHS England must consider making continence care a higher priority and providing clinicians with the support they need to ensure that continence care is provided at an adequate level.  The UTA also believes that patients with continence needs must be able to make informed choices about the management of these needs, and must have access to products that best suit their needs. These products can only be provided if NHS staff properly evaluate the long-term implications of procurement on health outcomes and NHS budgets, rather than simply looking to make short term savings. Continue reading

Labour Party consultation: One Nation manifesto

Introduction

The Urology Trade Association (UTA) is the leading urology industry membership organisation in the UK, representing 95% of urology product manufacturers and suppliers to the urology appliance market.

The UTA welcomes the opportunity to respond to Labour’s consultation on Health and Care and its pledge to ensure that communities are given a real say in shaping the future of their local services where the majority of continence care are delivered.  Continue reading

Welsh Assembly Health and Social Care Committee inquiry: Access to medical technologies in Wales

Executive summary

  • The Urology Trade Association wishes to highlight in its response its strong support for the Drug Tariff, which provides confidence to all parties that devices listed are effective, safe, cost-effective, with price certainty.
  • The UTA notes that it is essential that commissioning staff understand the differences in seemingly-similar products, which can impact on a user of such a medical device, ranging from mild discomfort to infection, leading to hospital admission.
  • We suggest the Committee should investigate the value of developing partnerships between continence advisers and commissioning staff, so commissioners always have access to expert advice.
  • We also believe the Committee should make a strong recommendation that especially in times of limited public resource, it is essential that patient choice is preserved, so that patients can remain independent and dignified and the health service does not have to deal with the consequences of short-term decision making.

Continue reading

Department of Health consultation: Refreshing the Mandate to NHS England

The Urology Trade Association welcomes the opportunity to respond to the Department of Health’s consultation Refreshing the Mandate to NHS England 2014 – 2015.

The Urology Trade Association (UTA) is the leading urology membership organisation, representing 95% of urology product manufacturers and suppliers to the urology appliance market.

An estimated six million people in the UK are affected by continence problems and many rely on urology appliances on a daily basis. High quality urology appliances allow users to manage their conditions, maintaining their quality of life and independence and avoiding repeated medical consultations. A majority of continence services are delivered in the community and this will be the main focus of our submission.

The UTA has become increasingly concerned about arrangements made previously by some PCTs and inherited by clinical commissioning groups (CCGs) which restrict patient and prescriber choice in the selection of urology appliances. We believe that choice in this area is vital to improving outcomes for patients who use urology products, and we hope that NHS England will act to promote choice in the interest of patients.

In urology care, the range and choice of appliances and associated care items that are available for prescription on the NHS is governed by the Drug Tariff, which also acts as a reimbursement framework for NHS providers. An important benefit of these arrangements is that it guarantees equality of access across the country. The Drug Tariff is a comprehensive list of products which have been assessed and approved at a national level as clinically effective and cost effective. However, we are aware that a number of NHS Trusts are introducing local formularies which narrow down the range of products approved for use at a national level into a reduced set of products for prescribers to recommend to patients. Continue reading

Care Quality Commission consultation: A new start: consultation on changes to the way CQC regulates, inspects and monitors care

The Urology Trade Association welcomes the opportunity to respond to the Care Quality Commission consultation A new start: consultation on changes to the way CQC regulates, inspects and monitors care.

The Urology Trade Association (UTA) is the leading urology industry membership organisation in the UK, representing 95% of urology product manufacturers and suppliers to the urology appliance market. An estimated six million people in the UK are affected by continence problems and many rely on urology appliances on a daily basis. High quality urology appliances allow users to manage their conditions, maintaining their quality of life and independence, and avoiding repeated medical consultations.

The UTA focuses on primary and community care and thus this response will particularly focus on questions in sections two and four. Continue reading

Health Select Committee inquiry – Management of long-term conditions

This is a response to the Health Select Committee inquiry into the management of long-term conditions.

Executive summary

  • Continence problems are an element in many long-term conditions, with many patients using urology devices such as catheters to help manage this issue. Clinicians need to be encouraged to consider associated issues, such as continence, which may arise from certain long-term conditions, and take proactive steps to assess their patients’ wellbeing in this area.
  • Patients need to be able to access specialist advice to help them manage their conditions and choose the right products, and need to be able to access those products – often there are local restrictions in place which prevent this from happening, despite the national processes in place such as Part IX of the Drug Tariff.
  • Both general clinical and procurement staff should be encouraged to improve their knowledge of continence care and the importance of patients being able to access appropriate levels of care, support and treatment products.
  • There is a need for greater coordination between hospital and community care, particularly for individuals with long-term conditions who may have repeated admissions to hospital.

Continue reading

Health Select Committee Inquiry – Implementation of the Health and Social Care Act 2012

This is a response to the Health Select Committee inquiry into the implementation of the Health and Social Care Act 2012.

Executive summary

  • A large number of patients, often with complex long-term conditions, use urology appliances such as catheters to help manage their continence needs. Ensuring that they are able to access the most appropriate product for their needs is important in ensuring the best clinical outcomes.
  • Previously, in many PCTs, there have been efforts to make savings in this area by restricting the choice available to patients, despite a national Drug Tariff which sets out the products which should be available. This means many patients have been directed towards cheaper products which do not meet their need as well.
  • Staff in clinical commissioning groups should be incentivised to consider the likely long-term impact of spending decisions across the whole health and social care budget, rather than looking to make short term savings from a smaller area such as the prescribing budget.
  • Choice of product also needs to be considered when implementing Any Qualified Provider for continence services.
  • NHS England also needs to provide some further clarify on particular areas, such as the arrangements for managing dispensing appliance contractors.

Continue reading