(2 days, 10 hours ago)
Commons ChamberRead Hansard Text Watch Debate Read Debate Ministerial Extracts
Sonia Kumar (Dudley) (Lab)
I beg to move,
That this House has considered the matter of incontinence.
I thank the Backbench Business Committee and its Chair, the hon. Member for Harrow East (Bob Blackman), who helped secure this debate. I am delighted that we are debating this vital but often ignored issue during World Continence Week.
The definition of a taboo is a subject so difficult, repulsive or offensive that it cannot be mentioned in polite conversation and can be articulated only in hushed, embarrassed tones. Once, menstruation was a taboo and we were not supposed to talk about it. Once, cancer was a taboo, and in some communities it still is. Once, mental health was a taboo and people covered it up. We can now discuss those things more openly without embarrassment, we can seek the right medical advice and treatment, and we can offer support to one another and fight for decent healthcare for every aspect of the human body.
How did I get here, in this Chamber, talking about human bodily functions? This has been a journey for me. I spoke in the Westminster Hall debate on women’s health in February. As a physiotherapist, I talked about pelvic health and the importance of rehabilitation and pelvic floor exercises. My words seemed to have struck a chord. Colleagues, residents and professionals all emailed me to thank me for speaking out and to share their experiences. It started to snowball, and I asked myself, “Why aren’t we talking about this more?” I am advised that this is the first ever general debate on this topic in the Chamber, so I congratulate the House.
What are we actually talking about? We are talking about the involuntary loss of faeces and urine, which can be caused by pregnancy, neurological conditions, multiple sclerosis, spinal cord surgery, musculoskeletal conditions, disabilities, menopause, prostrate-related conditions and many more reasons. The crippling fear for patients is that it might happen at work, in public or in social settings. Patients have told me that they feel like a prisoner in their own homes, caught by a condition that means people avoid others, do not go out, cannot go to work, do not have relationships and feel a crushing sense of shame. People’s mental health suffers to the point of serious illness.
Our language reflects society’s attitudes: “wetting your knickers”, “peeing your pants”, or ruder variants that I will not say. Yet we are talking about a range of conditions that affect millions of our residents. Did you know, Madam Deputy Speaker, that bladder and bowel incontinence is more common than hay fever? The NHS estimates that 14 million people live with bladder problems—one in five of the population—and it is men as well as women. The NHS says that 2 million men experience involuntary loss of urine. A third of women live with these conditions right now—that’s right: a third. Yet this is another aspect of health that is woefully unsupported and pushed off the agenda. It affects 1.5 million children and young people. One in 12 children across the UK battle these debilitating symptoms, including bed wetting, chronic constipation and soiling. Half a million adults have bowel conditions that lead to the involuntary loss of faeces.
We have a population that is getting older and surviving complex conditions, such as cancer, and that will increase the prevalence of bladder and bowel dysfunction. When it comes to bowel conditions, we are talking about the involuntary loss of faecal matter, which can be because of irritable bowel syndrome, Crohn’s disease or other conditions, such as bowel cancer. I have not even touched on what people suffer when they are doubly incontinent. Our NHS collects data on anything and everything. The number of patients with continence care needs to be routinely published, and it is not. My first ask of the Minister —and I have several—is, why not?
The House will note—notwithstanding the title of the debate—that I avoid the terms “incontinence” and “continence”. I have spoken to so many people with bladder and bowel conditions, and my feeling is they are the wrong words to use and they carry too much stigma.
To give justice to the debate, I have conducted roundtables with experts and patients and have shared anonymous surveys. Dawn shared her story with me. She noticed some urinary leakage 10 years ago, when she was 50. Now, at the age of 60, she spoke to me about her journey. She did not go to the GP because she felt ashamed. It got worse and she began to see the gynaecologist. She got the strength to speak to the GP, who gave her tablets. Three rounds of tablets did not work. Her symptoms got worse, and she was unable to leave the House. The gynaecologist referred her to a physiotherapist and specialist nurses. I asked what went wrong here: it was the lack of prevention.
Prevention, prevention, prevention is key. Physiotherapy is recommended as an integral part of women’s health, especially with pelvic floor dysfunction. According to the 2019 NHS long-term plan,
“Physiotherapy is by far the most cost-effective intervention for preventing and treating mild to moderate incontinence and prolapse”.
Insufficient physiotherapist numbers mean that women who experience pelvic floor dysfunction or prolapse wait months or years, or miss out on treatment entirely. Women often end up needing surgery that could have been avoided with earlier intervention. Dawn eventually received specialist care, and her symptoms have vastly improved. She only gets the odd leakage here and there. Her advice to others is
“see your GP… don’t leave it and ask for a referral to see a specialist”.
I had the privilege of seeing one such specialist service in my constituency—Dudley adult bladder and bowel service, known as DABBS—where I met patients and practitioners like Ola Rawlins, team lead and clinical pelvic health physiotherapist, who shared her story, which was eye-opening. Patients told me how GPs ask about bowels but seldom bladders. A patient—Leanne—said she felt ignored, fobbed of and misdirected. One felt like a “prisoner”. Ola’s patients felt like a ball bouncing around different parts of the system. Men, especially those with prostate cancer, were reluctant to take part in self-help groups, and many men did not even know they had a pelvic floor and thought only women did.
Yet symptoms can be easily treated with the right interventions, treatments and course of rehabilitation. Research shows that for every £1 spent on women’s health services, there is a return of £13, thanks to a reduction in emergency admissions, fewer missed days at work and better long-term health outcomes. I know the Department of Health and Social Care is consulting on the men’s health strategy, and I trust that the Minister will ensure that this aspect of men’s health is front and centre.
The DABB service calls itself a “Cinderella service”. The testimonies of patients and professionals is humbling to hear, but it makes me so angry. We are letting too many people down. So what must change? We need to talk about the taboo, and we need action. We need a renaissance of public toilets: to maintain the ones we have, open the ones that are closed and build new ones. I want to see bins in both men’s and women’s toilets, so people can throw these products in the bin. I support the Boys Need Bins campaign by Prostate Cancer UK, and I congratulate the all-party parliamentary group for bladder and bowel continence care for its work. I ask that this place be a pioneer in this space by placing bins in all men’s toilets.
We also need better food labelling, so that fibre is listed on products and people can understand how they can get better bowel health. We need to ensure that the AI and robotics revolution in healthcare does not miss bladder and bowel care. We need a joined-up service between GPs, hospitals, clinics and patient groups. Perhaps we could have more sympathetic and subtle signage in healthcare settings. Products provided outside healthcare settings could have simple labels on shelves, such as “body care” instead of “incontinence products”. That tackles the embarrassment of being seen by a friend or neighbour buying them in the shops.
I urge the Minister, as the 10-year plan nears publication, to ensure that bladder and bowel care is included. Much needs to change, but today I have five concrete asks for the Minister. First, we need a public information campaign to raise awareness and smash the stigma, as recommended by Dr Sara Webb of the Royal College of Midwives. The NHS rightly spends millions on campaigns, such as cancer screenings, the use of 111 and sepsis awareness. Will the Minister commit to a campaign on bladder and bowel care?
Irene Campbell (North Ayrshire and Arran) (Lab)
Many years ago, when I worked in the NHS, the board tried to save money by changing the incontinence products that people used. The products were not quite the same, which caused a lot of distress for the people who used them, as well as a lot of inconvenience for the health professionals working with patients, particularly the district nurse team. In the end, it did not really save any money. Does my hon. Friend agree that it is important that people get access to the products that work for them?
Sonia Kumar
I agree that products need to be readily available, and that is one of my recommendations.
Secondly, beyond awareness is prevention. We need real understanding, and I want bladder and bowel health to form part of the school syllabus, enmeshed into the curriculum. That is a recommendation from surgeon Dr Robinson from the Royal College of Obstetricians and Gynaecologists. Let us give teachers the tools to teach it. I want this to form part of the training of all healthcare professionals, so that medical professions understand bladder and bowel care from their earliest time in the job. We need a specialist workforce that includes physiotherapists, nurses, surgeons and many others. Can the Minister commit to placing this issue high on the agenda for schools, and to building a specialist multidisciplinary workforce who have the relevant skills and knowledge?
Thirdly, we need enhanced research and development on bladder and bowel conditions and their treatment. That does not necessarily mean vastly increasing spending; it could mean looking at how resources could be better prioritised. We cannot diagnose, treat and rehabilitate, or look into future medical interventions, if there is limited research.
Fourthly—this recommendation is from Dr Ashish Pradhan, chair of the British Society of Urogynaecology —can the Minister commit to banning misleading advertisements that send the wrong message? Products subject to no regulation are advertised, and patients are told to live with their symptoms.
Fifthly, I have a recommendation from a patient I met, Leanne. Could we have a one-stop shop in which all services are under one roof, care that is closer to home, and cheaper incontinence products? They are exempt from VAT if they are purchased for personal use, or use by a registered charity, but what if they are purchased by care homes?
Those are my five demands, backed by experts—five things that will ensure real progress. I look forward to the Minister’s response. Lastly, let me say this to men, women, young people and children listening to this debate: you are not alone, and there is no shame. This subject is often surrounded by silence. It is a subject that people do not want to talk about, or do not know about, and that the NHS does not do enough about. That ends now, and it ends here.
John Cooper (Dumfries and Galloway) (Con)
Incontinence is no respecter of person, and no respecter of sex, and it is male incontinence that I rise to speak about. The wry old joke is that men do not know they have a prostate until their other half reads about it in the Daily Mail. Campaigning newspapers, such as the Daily Mail, and charity groups like Prostate Buddies in my Dumfries and Galloway constituency have done a power of work to make men aware of prostate disease and prostate cancer—just as well, given that prostate cancer is the most common cancer among men. One in eight of us will be diagnosed with it, and that figure rises to one in four for black men. It is well recognised that early diagnosis is key, but it is less well known that as many as 60% of those treated with surgery will face urinary incontinence, outwith surgical intervention.
Prostate Cancer UK says that one in 25 men aged over 40 will experience some form of urinary leakage every year. The scale of the issue, and the number of people facing the problem who report feeling shame, embarrassment and isolation, is greater than many suppose. The guardedly good news is that far from being alone, people suffering incontinence are a very large portion of society. It has been another silent epidemic, and people have been left to suffer in obscurity. Today is part of the solution to that. I congratulate the hon. Member for Dudley (Sonia Kumar) on securing the debate. Given her medical background, I defer to her for advice on what can be done to relieve the physical symptoms of incontinence—and much can be done. According to the American Urological Association, better prostate treatment is cutting the number of men who suffer incontinence after prostate treatment. Pelvic floor exercises can help both men and women, as can bladder training.
But what can Government do, aside from making health policy decisions on treatment for incontinence in all its forms, be it suffered by men or women, and be it post-op, prostate-related or childbirth-related? Small steps can help. When the hon. Member for Cheadle (Mr Morrison) asked whether there had been discussions about providing bins in men’s toilets for disposal of sanitaryware made necessary by incontinence, a Minister in the Department for Environment, Food and Rural Affairs gave a rather technocratic answer, promising a Health and Safety Executive review of workplace regulations dating back to 1992 on the provision of disposal facilities in workplace toilets “in due course”. I hope the Minister can today confirm that the consultation can be fast-tracked.
I hope that we have taken a giant stride in this place today by stripping away some of the stigma merely by giving an airing to the issue of incontinence. There has been much talk recently about Parliament at its best, but surely this is Parliament at its best, considering unfashionable yet critical issues. Today we bury the myth that this condition is somehow shameful. With this first ever debate on the subject, we take a modest but significant step towards improving the life of those who struggle with the burden of incontinence.
Ben Coleman (Chelsea and Fulham) (Lab)
A big thank you to my hon. Friend the Member for Dudley (Sonia Kumar) for securing this extremely important debate. I was fascinated and not a little shocked to hear that this is the first full debate in the Chamber on this subject, and it is absolutely tremendous that we are talking about it, because we need to. As everyone has recognised, it is a subject that people rarely talk about, despite the fact that millions of people are affected by bladder and bowel control issues—I will try to use that phrase instead of the term “incontinence”, after hearing the point that my hon. Friend rightly raised; I was scribbling away when she said that.
For much too long, this issue has been treated as a private embarrassment—something to whisper about, not act on. I was struck by what she said about the number of people who got in touch with her, crying out for this subject to be discussed, and for us to take action. We need to take action, because as well as being a very important health issue, it is almost a social justice issue, and an issue of dignity. Far too many people and families face a daily struggle that has been quietly ignored.
As was said, it is estimated that one in three women in the UK experiences urinary control issues, but the issue affects men, too. It is important that men speak in this debate, and I am very pleased that the hon. Member for Dumfries and Galloway (John Cooper) did. As for my city, London, a recent survey for Prostate Cancer UK found that 54% of all male Londoners had experienced urinary control problems. More than one in four men—28%—experienced symptoms as early as between the ages of 18 and 25. That contradicts the widely held view that bladder conditions affect only older adults. Then, of course, we come to bowel incontinence, which is more closely associated with age: 15% of those aged over 85 and living at home are affected, and the figure is even higher for men and women living in residential and nursing homes.
Of course, we also have to think about bladder and bowel conditions affecting children and young people, and especially those with disabilities, whose voices are often the last to be heard anyway, and particularly the last to be heard on this subject. Disabled and other children with these conditions can miss out on education, friendships and an ordinary life because of a lack of basic provision. Families feel ashamed when they ask for help, because they think that no one else is facing the same thing. That brings us back to the importance of us discussing this matter in the House today. Many families face this issue; we need to make it safe to talk about it, and safe to ask for support.
As I say, bladder and bowel conditions are not only a health issue, but a social justice issue, and it is time we treated them as such, because that is not what happens now. Despite the evident human cost, and the prevalence of these conditions across society, support and services remain inadequate, and those affected and their families are left to scramble for help. They face stigma. They too often endure isolation, yet as my hon. Friend the Member for Dudley set out, there are simple, straightforward solutions that would make a huge difference to those who live with bladder and bowel control issues. We can start by destigmatising the issue; that is what we are doing today, as has been said.
At a national level, we need a public health campaign, led by the Department of Health and Social Care, that makes it clear that these conditions are normal, treatable and nothing to be ashamed of. Let me tell Members about one of the very few people in either House that I have heard talk about these conditions. I went to a meeting on assisted dying—one of many such meetings, which colleagues of all parties have been to—at which I heard from a disabled Member of the House of Lords, and other people who are disabled and wheelchair users. They spoke in a very matter-of-fact way about being incontinent—that was the word they used. They made it quite clear that it was perfectly possible to lead a normal and fulfilling life with that condition. When I was growing up, older people would say to me, “The one thing I dread above all is being incontinent— I think I’d take my life if that happened.” It was very inspiring for me to hear a Member of the other place talking about their situation, and talking about it released all of us from a particular challenge when it came to reflecting on assisted dying.
My hon. Friend the Member for Dudley mentioned Prostate Cancer UK’s Boys Need Bins campaign. There are others, including the End Bladder Shame campaign by TENA, the maker of incontinence products. These things show what is possible if people feel heard—but they need more support. Alongside a public health campaign, let us have more investment in infrastructure. That means more modern, accessible public toilets with clean, safe disposal facilities for men as well as women, which has been a long-standing request from charities like Age UK.
We need to make sure that every school—mainstream schools as well as specialist schools—has trained staff who can support children with bladder and bowel conditions, not as an afterthought but as part of their core pastoral care. We have a Minister from the Department of Health and Social Care on the Front Bench, but I hope she can pass on the message to her colleagues in the Department for Education that they should make sure school toilets are accessible, hygienic and inclusive, with disposal bins, locks and space—with dignity built in.
Finally, I would like to see us integrate bladder and bowel care into national health strategies. They should be a core part of NHS England’s work on long-term conditions, ageing and preventive care, not an afterthought. I look forward to that being reflected in the 10-year plan and, I hope, in the forthcoming men’s health strategy.
Better bladder and bowel care will save men, women and their families from stress, it will save children from shame and the feeling of being left behind, and, wonderfully, as my hon. Friend the Member for Dudley said, it will save public money. It is a public good, and if we take this seriously, it will make a huge difference to a lot of people’s lives. Let us give this issue the attention it deserves and do right by every person who has been living with these conditions in silence for too long.
Several hon. Members rose—
Mr Deputy Speaker (Sir Roger Gale)
Order. A significant number of Members want to take part in the following debate, so we are playing “beat the clock”. I will not introduce a rigid time limit at this stage, but if Members could confine their speeches to no more than six minutes, we should get everybody in, get the Front Benchers in and give adequate time for the next debate.
Jim Shannon (Strangford) (DUP)
I welcome you to your place, Sir Roger; it is a pleasure to see you there again. It is a pleasure to speak on this issue as my party’s health spokesperson. I thank the hon. Member for Dudley (Sonia Kumar) for setting the scene so incredibly well.
The Patient and Client Council’s 2020 report “Accessibility and Quality of Continence Services in Northern Ireland”—I always give a perspective from Northern Ireland—estimated that some half a million people in Northern Ireland live with bladder control problems and some quarter of a million with bowel control problems, with many experiencing both. When we remember that Northern Ireland’s population is 1.95 million, it puts that figure into perspective. The National Institute for Health and Care Excellence estimates that 61% of men in the general population experience lower urinary tract symptoms and some 34% of women live with urinary incontinence.
I commend the hon. Member for Dumfries and Galloway (John Cooper) for focusing on prostate cancer. It is one of those things that us menfolk do not wish to think or talk about. He is right: it is probably the wife who says to us when we have a pain somewhere, “Did you go and see the doctor about it?” We most definitely should go and see someone about it.
This debate is about raising awareness. It is not a topic that is openly discussed, as the hon. Member for Dudley referred to, because people often feel uncomfortable discussing their symptoms and problems given the personal nature of the issue—I have to say that I feel a tad uncomfortable as well. As a result, many suffer in silence or wait a long time before discussing their incontinence issues with a healthcare professional. Only 20% of those affected go on to seek treatment, with many maybe not recognising their issues at first.
Continence issues can be a significant contributing factor to social isolation. Whether we like it or not, many people will feel uneasy about these issues, so they will withdraw into themselves and seek to deal with their problems alone, which can prevent them from having a normal life. It is clear that we need to do more to remove any feelings of shame from continence issues, including by having a public conversation.
I am very thankful that my local council, Ards and North Down borough council—I served on Ards council at one time—provides sanitary bins in accessible toilets across the borough, including some male toilets. These bins are part of a wider initiative to make public toilets more inclusive, particularly for individuals experiencing incontinence or with stoma needs. This debate is also about those with stoma needs. I am surprised by how many people I meet who carry a stoma bag. They have managed to deal with that, but it is not easy—it scares the wits out of me, I have to say.
Ards and North Down borough council has upgraded 44 of its accessible toilets with features such as shelves, hooks, mirrors and bins to accommodate stoma care. My council has taken that action already. Additionally, the council is working to address the need for sanitary bins in all public toilets, including male toilets, where they are not currently a legal requirement. Ards and North Down borough council has already done that because it recognises that that is the right thing to do. The council did this at its own cost and on its own initiative—not because it legally had to but because it recognised the need. This helps to address the stigma, but it must be a UK-wide approach and not simply the decision of individual councils. We commend Ards and North Down borough council: it did that because it was the right thing to do, not because it had to do so.
One in five people are affected by these issues, and yet it is a silent topic, so it is good that we are speaking about it today with the compassion, the understanding and the carefulness that it requires. Inadequate management of incontinence can lead to escalating costs due to morbidity and unnecessary hospitalisation; those are the side effects. It is good to see the Minister for Secondary Care in her place, because she always responds helpfully to the questions we ask.
Some 6.5 million adults in the UK suffer with some form of bowel problem, so it is imperative that we do things better. One in 10 children will suffer from continence difficulties, whether it be bed-wetting, daytime wetting, constipation, soiling or difficulties with toilet training. The hon. Member for Chelsea and Fulham (Ben Coleman) referred to that issue, and it cannot be ignored.
Improving catheter care in the community would reduce A&E attendance and hospital admissions, which fits well with two of the Secretary of State’s three shifts: hospital to community and sickness to prevention. Can the Government commit to implementing that in a co-ordinated strategy?
Colleagues have flagged the many changes that are needed, and I know these cannot be made immediately, but it is important that we move forward, that we have this discourse and that we dispel the darkness of shame and shine a light for those who feel isolated in the shadows. Today is the first step in this journey, and I look forward to participating in further journeys.
Markus Campbell-Savours (Penrith and Solway) (Lab)
I thank my hon. Friend the Member for Dudley (Sonia Kumar) for bringing this issue to the House for debate. Unlike her, I am not an experienced health professional, so I will narrow my contribution to the issue of public toilets, their availability and their importance to those with incontinence.
There are people who did not go out last week and who may not go out today or next week. They are those whose trips are always challenged by the lack of, or uncertainty about the availability of, public toilets—not just those who are incontinent, but those who experience any sort of urgency: those with irritable bowel syndrome, Crohn’s disease or ulcerative colitis; those who need to use the toilet more frequently because of age or pregnancy or because they are menstruating, have had prostate cancer, have stomas or other disabilities; and those who are caring for those with disabilities. Very few of us will not be affected by these vulnerabilities at some point during our lives, and we want our country to be one in which we are able to ensure dignity and the ability for those visiting public spaces to have access to public toilets.
Local authorities have powers to provide public toilets but no statutory duty to do so, and this lack of compulsion has contributed to the decline in the number of public conveniences. As a former local councillor, I know how stretched local authority budgets are, decimated through a long decade of austerity and the political decision to centralise funding. In my constituency, which encompasses the Lake District national park, we are very aware of the importance of good-quality public toilets to support tourism, and yet even there, at prime visitor sites such as the start of the Keswick to Threlkeld railway path—a fantastic facility for those with disabilities to enjoy the Lake district—there is insufficient money to provide public toilets.
Just two years ago, this House considered appointing a commissioner for public conveniences and making it a statutory duty for local authorities to have public convenience plans. I am not sure why something so simple would require the creation of a commissioner, but like so many plans under the last Government, it never came to pass. I ask the new Government to look again at establishing a statutory requirement on local authorities. In the meantime, I invite hon. Members across the House to lobby their own local authorities to ensure that they create, review and scrutinise public convenience plans, and make public spaces accessible to those for whom quality public toilets are the difference between inclusion and exclusion.
A recent survey by the Association for Public Service Excellence found that over a third of local authorities had reduced their provision of public toilets over the past decade. We know that provision had been declining even before then, but it is not all bad news. Half of the councils that responded in the 2024 survey did provide Changing Places toilets. I congratulate the campaigning organisation Changing Places, which has lobbied so long and so hard to seek provision for the quarter of a million people in the UK, and their families and carers, who have for so long been condemned to loneliness at home by the lack of accessible public toilet facilities.
The latest count of Changing Places toilets in the UK is 2,607. The campaign will have been instrumental in the 2021 building regulations requiring all new public buildings to put in large and well-equipped toilet facilities. Many local authorities have ensured provision in creative and economical ways, through community toilet schemes and payments or rates reductions for businesses that open their toilet facilities to the public. Local authorities can make planning permission, leases and premises licences subject to the provision of public toilets, and they can hand facilities over to community operators. These are not always suitable or appropriate substitutes for standard public toilets provided and maintained by the local authority, but as part of a portfolio of provision they help to increase access and often help to circumnavigate some of the issues of graffiti and inappropriate use that present problems for some communities.
I urge all hon. Members to engage with our local authorities and impress upon them how important it is for the public to be adequately provided with high-quality, well-maintained facilities. I look to Members participating in today’s debate to join me in calling upon this Government to draw up statutory measures. Providing public toilets that support the most vulnerable people in our communities should be a duty, not an option.
Jodie Gosling (Nuneaton) (Lab)
I congratulate my hon. Friend the Member for Dudley (Sonia Kumar) on securing today’s important debate. I have recently become the chair of the APPG for bladder and bowel continence care, and there is much to be done. As someone with a background in early years, I am sure that any parent of a young child will confirm that we are probably the people who talk about wee and poo the most in this world. They tell us vital health information—from the earliest days of having a baby, it is crucial. Bladder function is one of the signs of good health, and maintaining that through adulthood leads to the prevention of incontinence.
The importance of talking about wee and poo cannot be overstated. As any three-year-old will tell you, that is because it is funny. Wee and poo is the funniest topic in nursery classrooms up and down the country—and it is funny, right up until the point that it is not. When wee and poo stop being funny, it is devastating. It impacts on people’s mental and physical health, their dignity and their very independence. In some cases, it can prove fatal. It is also entirely preventable.
Sadly, poo and wee is not funny for around 14 million people who have continence and incontinence issues. That figure alone hides some of the issues of dealing with the enormous range of health conditions in the field of continence. The figure of 14 million is based on data gathered in 2018, and no recent data is available. Continence status data is not recorded as standard on entering the NHS. The scale of the problem is simply unquantifiable. The NICE guidelines have not been reviewed, and the findings of the 2017 report “Excellence in Continence Care” have not been fully implemented. We need a stronger mandate and a greater focus on training for incontinence needs across midwifery, dementia, cancer care and health visiting teams—literally from cradle to grave—and we need to provide that care in our communities to avoid the need for crisis interventions in A&E.
Today, I will highlight just a couple of the complications from failing to provide a robust continence service. Despite spending a large amount of my time surrounded by, and occasionally covered in, poo and wee, I did not arrive in Parliament intending to take on this role. I have been made aware for many years of the woeful lack of help for those with continence issues, the poverty caused by buying continence products, and the rationing of four pads a day. I have faced the frustration of parents who had no continence service in Warwickshire at all until May 2024. I have been aware of the trauma faced by parents, especially those whose children have special educational needs and disabilities, attending A&E with their child’s constipation, which had reached agonising and dangerous levels.
It was, however, Elissa and Ivan’s story that motivated me to take on my role, and campaign for more humane, systemic changes to prevent the worst impact of continence issues. So many simple things can be done to protect the dignity and independence, and improve the quality of life, of these 14 million people. When Ivan arrived at A&E, he was screaming and in pain. His stomach was distended and he was severely underweight for his age. He had spent months in pain, attending A&E around four times a week. He was discharged without treatment, but Elissa did not leave. She did not accept the shocking assessment from consultants that disabled children just scream. She pushed back and, with sheer luck, one of Ivan’s other consultants happened to see them and gave instructions for an X-ray. On the final day, they evacuated nearly 2 kg of stool from a 10 kg three-year-old child.
Elissa believes that that day saved Ivan’s life. Others have not been so lucky. In 2019, 19 people with learning difficulties died from constipation when under continence care. Out of all the deaths of people with learning difficulties, more than a quarter were also suffering from constipation and bowel issues that would be worthy of note. Unsurprisingly, we do not even hold the data for the wider population on these issues.
Continence and constipation issues are increasing in our younger population at a worrying rate, with a strong correlation between constipation, continence issues and neurodiversity. One in four of our children who start school is not yet ready to use a toilet independently, and on average, 2.4 hours of learning time is lost every day in supporting children going to the toilet. Toileting issues, even in nursery, cause embarrassment and anxiety, which often leads to functional constipation, damaging the bowel and causing lifelong continence issues.
Getting it right from the start is hugely important. Children with continence issues are often excluded from school activities and parents are required to take time off work. Consequently, ERIC, a charity that specialises in supporting children with continence issues, whose representatives are, coincidentally, here today to celebrate and draw attention to World Continence Week, note that in the 1980s, 83% of babies were out of nappies by 18 months. New research identifies the benefits of children who start potty training earlier and are out of nappies by 30 months, but the health visiting team numbers are at a disgraceful all-time low. That is a national shame, as are the outdated NICE guidelines.
The message is not getting through, and parents simply do not know where to turn for the right support, especially in places like Warwickshire where continence care was simply unavailable. Hospital admissions for childhood continence issues and constipation have increased by 60% in over a decade, with 44,000 children admitted this year alone. The decimation of health visitor numbers and school nurses, and the demolition of institutions such as Sure Start, leave carers and families without the infrastructure and support needed to train children to toilet independently, and for constipation to be recognised before it becomes life-threatening.
Increased data collection is essential, and the NICE guidelines need to be heavily reviewed and mandated in healthcare so that we can make savings in crisis teams. If we intend to move care to the community, and move from crisis to prevention, continence care has to be a central focus of that mission.
Warinder Juss (Wolverhampton West) (Lab)
I thank my constituency neighbour, hon. Friend the Member for Dudley (Sonia Kumar), for securing this important debate, and for attempting to remove the stigma and silence that too often surrounds this key area of healthcare.
As has been mentioned, in the UK over 14 million people experience bladder leakage and more than 6.5 million people—around one in 10—struggle with bowel control. However, those figures are probably not a true reflection of the reality, as many individuals choose not to disclose their symptoms, often because of embarrassment or in the mistaken belief that incontinence is simply an inevitable part of ageing.
I want to talk about how women suffering from incontinence have been treated in the past, because we need to focus on the availability of proper treatment options for the future. For far too long, vaginal mesh surgery was widely accepted as the so-called gold standard to treat stress urinary incontinence in women. Between its introduction in 2008 and when its use was paused in 2018, it is believed that over 100,000 women in the UK underwent mesh implant procedures. Sadly, many of them were not properly advised about the alternative options available to treat stress urinary incontinence, such as the physiotherapist-supervised pelvic floor exercises that my hon. Friend mentioned, nor about the risks associated with using vaginal mesh, and some of them sustained life-changing injuries.
Before I became an MP, I worked as a solicitor specialising in representing women who had been affected by vaginal mesh implants and pursuing claims for compensation for them based on clinical negligence. I came across women who were left in constant pain, unable to work or participate in daily aspects of life. Their personal relationships were affected and their lives were changed forever by a treatment that was supposed to help them.
I commend the work of Baroness Cumberlege in her landmark July 2020 report “First Do No Harm”, which recommended that the Government should immediately issue a full apology on behalf of the healthcare system to the families affected by mesh. She also proposed setting up a scheme to meet the cost of providing additional care and support to those who experienced avoidable harm, and networks of specialist centres to provide comprehensive treatment, care and advice for those affected by mesh implants. A subsequent report by Dr Henrietta Hughes, released in February 2024 through the patient safety commissioner, recommended a Government financial and non-financial redress scheme for all those affected by mesh.
Looking ahead, it is critical that current recommended treatments for incontinence are subject to the highest clinical scrutiny and that we take steps to ensure that no more patients are harmed in the pursuit of quick fixes or one-size-fits-all solutions. At the heart of every treatment plan must be the dignity, safety and informed choice of the patient. Treatment must be tailored to the type and severity of each individual’s condition, not determined by cost effectiveness alone. Patient outcomes, not just financial metrics, must be central to how we define value in care for incontinence patients.
We must break the stigma surrounding the issue. A recent study found that around 40% of women had experienced urinary incontinence, yet only 17% of them had sought professional help. Poor continence care, as has already been mentioned, can lead to complications such as infections, social isolation and, in some cases, hospital admissions. Each of those outcomes is completely avoidable with early intervention and treatment, which is something that we must aim for in our healthcare system. Only by tackling the taboo, investing in better treatment pathways and listening to the voices of those affected can we ensure that people living with incontinence are able to access the support they need, and to do so with the dignity that they deserve.
Chris Vince (Harlow) (Lab/Co-op)
I commend my hon. Friend the Member for Dudley (Sonia Kumar) on securing this important debate. It is great to have her experience of having worked as an NHS physio in the Chamber and she brings a unique perspective to the issue. I thank my hon. Friend the Member for Wolverhampton West (Warinder Juss) for mentioning the pelvic mesh scandal. Soon after my election as MP for Harlow, a number of women who are victims of the pelvic mesh scandal came to see me. Now, over a dozen women have approached me about it, and that is just in the Harlow constituency, so that gives us an idea about the huge number of women who have been affected by this terrible scandal.
I do not want to focus on the pelvic mesh scandal alone, not least because my hon. Friend the Member for Wolverhampton West did it far more justice than I would. Whether people are the victim of a national scandal or they have bladder and bowel issues for any of the other reasons that my hon. Friend the Member for Dudley mentioned, nobody should be made to feel embarrassed. Talking to the women who were victims of the pelvic mesh scandal, I was struck by the journey they went on. When they initially had bladder and bowel problems, they felt really embarrassed, and it was only when they got to the point where they were in almost constant pain did they feel that they could come forward. What a terrible situation for people to be so embarrassed that they feel that they cannot come forward to the GP. We have to end that stigma.
I was not going to do so, but as we are in a safe space, I have decided to mention my own experience of suffering from IBS as a young person. It was almost a joke when we went on holiday—“We must make sure we are near a toilet so that Chris can go.” Actually, that should not be a stigma; it is a medical condition and people should understand it, support it and give others the support to deal with it.
To show solidarity with those who suffer from bladder and bowel issues, urinary incontinence impacts an estimated 14 million in the UK. As many Members have said already, if people suffer from such issues, they should not think that they are the only person to be suffering from them. A quick maths calculation tells me that that equates to roughly 20,000 people per constituency, so a significant number of our constituents will suffer from those issues. The cost to the NHS to deal with these issues is roughly £5 billion a year, and I wonder whether that bill would come down if we gave confidence to people who suffer from them to come forward sooner.
I have alluded to some of the symptoms, but there is a loss of dignity and independence, and a sense of social isolation. My hon. Friend the Member for Penrith and Solway (Markus Campbell-Savours) mentioned people who no longer go out because they are embarrassed—what a terrible situation for them to be in, and one that is entirely avoidable, if we could help to reduce the embarrassment and stigma that people feel.
I join my hon. Friend the Member for Dudley in asking the Minister about the collection of data on those impacted by the issue and supporting the need for a public health campaign. I thank the hon. Member for Strangford (Jim Shannon) for mentioning stomas. A young friend has a stoma and, having spoken to her about it, I am sure she would welcome ending the stigma associated with that.
I want to briefly mention women’s health. I recognise the vital contribution made by the hon. Member for Dumfries and Galloway (John Cooper) about the impact on men, but I welcome the fact that Health Ministers in this Government have championed the importance of health equality. I hear a number of stories from women in Harlow who feel that they are not taken seriously, and I hope that we can address that and that the Minister will respond to that in her summing up.
Finally, I thank my hon. Friend the Member for Dudley for bringing this hugely important debate to the House. I agree with sentiments raised by Members from across the House that this is the first step in ending the stigma. I hope we can work together to end the stigma and embarrassment; I know that this is just the start.
Pam Cox (Colchester) (Lab)
I thank my hon. Friend the Member for Dudley (Sonia Kumar) for bringing this debate—I cannot quite believe it is the first time that the House has debated this issue. I also fully endorse her suggested recommendations to improve bladder and bowel care, and I hope that the Minister will also endorse them.
As we have heard today, incontinence affects people of all ages across all communities. It is still shrouded in stigma and embarrassment, and it disrupts so many people’s daily activities, such as going to school, going to work, going out for the day, going out for the night and going on holiday. It really needs to be tackled at so many levels.
To echo the remarks of my hon. Friend the Member for Penrith and Solway (Markus Campbell-Savours), one way in which we need to address this issue is by ensuring that we have enough accessible toilets in public places, workplaces and schools with the necessary facilities, including sanitary bins for incontinence products for all users. In my constituency, we have just restored one of the sets of toilets in our main public park, Castle Park, after a justified outcry at their closure.
Adequate public toilet provision is just one response to this complex crisis but, as my hon. Friend the Member for Dudley said, other measures are needed to tackle it. I again congratulate her on being the first person to bring this issue to public attention in the House, and I look forward to working with her on it.
Dr Lauren Sullivan (Gravesham) (Lab)
I thank my hon. Friend the Member for Dudley (Sonia Kumar) for securing this incredibly important debate; it has been absolutely wonderful listening to how it has been conducted. As has been said, this debate is often overlooked, and it is occurring in World Continence Week.
Bladder and bowel control issues are taboo and embarrassing, so I thank my hon. Friend the Member for Harlow (Chris Vince) for sharing his experience. He will not be alone, and I am sure there are many in this Chamber who have suffered the same thing, as have our constituents. We need to talk openly about this issue. We cannot hide it in silence as it affects so many people. One in three women in the UK have a urinary incontinence issue, and half of those are likely to suffer from it due to pregnancy, childbirth or hormonal changes linked to the menopause—another taboo topic.
Let us go through the stages and where some issues still remain. How are bladder and bowel control issues detected and diagnosed? I refer to my hon. Friend the Member for Dudley for her expertise, but the University of Aberdeen has found that invasive bladder pressure tests, which are often painful and incredibly uncomfortable, are not necessarily necessary. Researchers have found that non-invasive testing, including the things that my hon. Friend has described, such as pelvic floor exercises, should be made more available to patients. That is just one of the issues.
Another issue is surgical implants. I refer to my hon. Friend the Member for Wolverhampton West (Warinder Juss) for his incredible expertise on this topic, and I thank him for the work he does to help to protect women. The complications that have affected hundreds if not thousands of women, who are rightly outraged, have been described as barbaric. We must do more to see that those women are compensated, but no amount of compensation will ever make up for the years of pain and physical and emotional damage. This issue needs to be treated with respect and care, and the treatment options need to be empowered, so that people feel they can be empowered to prevent these things from occurring. I pay tribute to the Boys Need Bins campaign, which I have spoken with—it has been absolutely incredible—because men too suffer from incontinence. We need bins in public spaces.
How can we help people to live their lives to the full? My hon. Friend the Member for Penrith and Solway (Markus Campbell-Savours), who is no longer in his place, made the point that austerity and cuts to local government mean that many public toilets have been closed. Thankfully, in my area of Gravesham, the local council has increased the number of public toilets, including by opening one by the bus hub, so that people know about them and can plan regular breaks if they are needed. We need to ensure that there are spaces so that people feel empowered and confident to leave their homes, because we cannot have more people who stand alone.
John Slinger (Rugby) (Lab)
I pay tribute to my hon. Friend the Member for Dudley (Sonia Kumar) for raising this very important subject. My hon. Friend the Member for Penrith and Solway (Markus Campbell-Savours) and others mentioned the importance of greater and better provision of public conveniences. Does my hon. Friend agree that we need to encourage cafés and other organisations in town centres to make better provision for people suffering from these issues? Perhaps some of the campaigns that have been alluded to can help to make those spaces available. They should by no means replace what public conveniences should do, but having such places in town centres can assist vulnerable people.
Dr Sullivan
I agree. The community toilet scheme in Gravesham has been a good success. However, the issue of course comes down to vandalism. Councils cannot see this as an easy way to cut money. It needs to be a statutory duty, so I support the bid of my hon. Friend the Member for Penrith and Solway to make it a statutory duty to provide public toilets in those spaces.
No one deserves to be lonely or locked in at home, so I hope that this debate is the first step to opening the door. I again thank my hon. Friend the Member for Dudley for bringing this issue to the attention of the world.
Mr Deputy Speaker (Sir Roger Gale)
I call the Liberal Democrat spokesperson.
Helen Morgan (North Shropshire) (LD)
It is a pleasure to see you back in the Chair, Mr Deputy Speaker. I thank the hon. Member for Dudley (Sonia Kumar) for securing this important debate and for outlining the issues so well in her opening speech, particularly the importance of breaking down the taboos surrounding incontinence and the social isolation that can result from it. I have carefully scribbled out the term “incontinence” all the way through my speech and hopefully replaced it with “bladder and bowel control issues”—forgive me if I have missed one.
I recognise the importance of prevention and specialist treatment. The hon. Member for Dudley highlighted the benefit to both individuals and taxpayers from investing in women’s health up front, and I echo that call. There have been lots of excellent contributions, but I thank the hon. Member for Wolverhampton West (Warinder Juss) for raising the scandal of pelvic mesh implants. I thank him for highlighting that issue and the need for redress there.
Incontinence, or bladder and bowel control issues, can have a hugely detrimental impact on a person’s wellbeing and sense of dignity, as we have heard. Despite affecting millions of people across the UK, it is the subject of stigma, and the needs of those with bladder and bowel control issues are not properly considered in many aspects of life. All too often, people suffering from these issues are left without the right support, whether that is the uncomfortable bladder pressure tests that the hon. Member for Gravesham (Dr Sullivan) referred to, or the lack of access to sanitary bins in public and workplace toilets.
It has been widely assumed for many years that sanitary bins for men are not required in public toilet facilities. As we have heard, many millions of men are affected by bladder and bowel control issues. The absence of sanitary bins has a wholly unnecessary and damaging impact on their self-esteem, causing embarrassment and stress and, as we have heard, withdrawal from public places and the workplace. The cost is tiny but the benefits for those affected can be significant.
There has been progress in this area, thanks to the work of campaigns such as Boys Need Bins by Prostate Cancer UK, but there is much further to go. That is why it is crucial that we support all individuals with the condition by ensuring access to services such as public toilets and sanitary bins, as unfortunately that is not the case. Under the last Government, 19% of public toilet facilities—nearly 600—lost their local authority maintenance and funding between 2015 and 2021 alone. Liberal Democrat research from 45 councils found that the number of public toilets had fallen by 14% from 2018-19 to 2023.
Many local authorities are on the verge of bankruptcy and do not have the spare capacity for these vital services. Proper funding of local authorities to provide services such as public toilets and sanitary bins could make a truly meaningful difference for people with bladder and bowel control issues, and I hope the whole House will agree that these individuals deserve access to basic facilities.
There is also a clear need for more research into developing better treatments and mitigations for people suffering from bladder and bowel control issues. Crucially, these should avoid unnecessary discomfort or invasive procedures. As such, I support what the hon. Member for Gravesham has said. The University of Aberdeen has found that women with ongoing urinary incontinence can avoid invasive bladder pressure tests, and that non-invasive assessments work just as well in guiding treatment. An emphasis on respecting people’s dignity and reducing discomfort should be at the heart of how we approach the testing, treatment and mitigation of these issues.
We also know that these issues—particularly bowel incontinence—can place a significant strain on family carers carrying out personal care, who are often under-supported and suffer from ill health themselves. Many care requests go unmet; last year, the King’s Fund estimated that nearly a third of requests for local government funding result in no support for care at home. This means that there are many thousands of families struggling with the realities of caring for a loved one with bladder and bowel control issues, which can include not only feelings of shame and embarrassment —both for them and for their loved one—but difficulty with lifting and moving a family member to clean them, and in accessing the equipment necessary to cope. That is why dealing with the crisis in social care should be a top priority for the Government.
When the Secretary of State phoned me—and, presumably, the other national party health spokespeople —over the Christmas break to let me know that he was instigating the Casey review and cross-party talks to find a long-term solution to that crisis, I was hugely encouraged. Since then, the Casey review has been delayed, and the cross-party talks have apparently been cancelled. I must stress that each party giving its view to Baroness Casey is not the same as sitting in the same room and agreeing a long-term funding plan. The review’s terms of reference will not deliver meaningful reform until the next Parliament, and there is a huge risk that, again, nothing will be done by the Government of the day—in this case, despite them having a huge majority to achieve whatever they want. Meanwhile, the number of people needing care increases every year, and the step change required to transform the sector becomes larger and less politically palatable. As such, I urge the Minister to speak to the Secretary of State and help him to recover the enthusiasm for change that he showed over Christmas, because he will have my full support.
However, there are simple steps that can make a difference now, such as hospitals working with family carers ahead of discharge to ensure that they are equipped to carry out heightened personal care needs. In many places, that support is not delivered, let alone ongoing support and meaningful respite care. Wait times for a continence assessment vary across the country—it can take weeks and weeks. Improving those wait times would ensure that the right care and equipment is available much sooner. There is also a chronic shortage of speech and language therapists, who can make a real difference in helping people with limited or no speech to more easily communicate when they need the toilet or want to be changed or washed. That is particularly essential in cases in which those people suffer from bladder and bowel control issues.
Incontinence is not properly reflected in how we organise paid social care. For instance, too often the pay for domiciliary carers and the time they are expected to care for any one person do not reflect the fact that someone’s need for care might vary hugely from day to day. Any embarrassment, frustration and discomfort for the person being cared for will only be made worse if their carers are rushed, stressed and overworked, and if spending longer at one house could mean that those carers are effectively having to work for free.
I also want to highlight the importance of good care in hospital settings. NHS England’s 2018 “Excellence in Continence Care” guidance states that
“pathways of care should be commissioned that ensure early assessment, effective management of incontinence, along with other bladder and bowel problems such as constipation and urinary tract infections and their impact on social, physical and mental well-being”.
I highlight this because my constituent Trevor Collins died on 21 May 2022 as a result of aspiration pneumonia and small bowel ileus, due to a small bowel obstruction caused by constipation. The coroner concluded that neglect at Royal Shrewsbury hospital and a failure to manage Mr Collins’ constipation contributed to his avoidable death. It is essential that healthcare settings follow the NICE guidelines that are in place, not only to preserve dignity but to prevent serious harm and—in the worst cases—even death.
Liberal Democrats recognise the seriousness of the issues surrounding all types of incontinence and bladder and bowel control issues, and the critical importance of ensuring that people with those conditions can live in dignity. The Minister will have heard the calls in my speech. I hope she will commit to repairing our broken social care system, reinstating cross-party talks and wrapping up the Casey review this year, so that we can make the reforms that are necessary for long-term stability in the sector and the dignity of all those receiving and providing care.
Gregory Stafford (Farnham and Bordon) (Con)
Thank you very much, Mr Deputy Speaker. I welcome you to your place today.
It is an honour to speak in this debate on behalf of His Majesty’s Opposition, and I pay tribute to the hon. Member for Dudley (Sonia Kumar) for securing it. Her speech included the wealth of experience that she brings to the topic, and I especially congratulate her on putting this issue so clearly on the agenda today in the House. It was a powerful and wide-ranging speech that demonstrated the wide range of issues and conditions that can lead to incontinence.
As the hon. Member for Nuneaton (Jodie Gosling) told us earlier, incontinence is a condition that affects around 14 million people across the UK, yet too often it remains misunderstood, under-discussed and—worse still—dismissed. One in three women experience urinary incontinence, and half a million adults live with bowel incontinence. Incontinence does not discriminate; whether bladder or bowel, temporary or chronic, or mild or severe, it touches people of all ages, backgrounds and walks of life. It affects new mothers, people recovering from surgery, those with neurological conditions, the elderly, and even children. However, too many suffer in silence, held back by stigma, isolation, or the belief that nothing can be done.
Like other Members, I received some heartbreaking stories from my constituents in Farnham, Bordon, Haslemere, Liphook and the surrounding villages. Incontinence is a medical issue, not a personal failing. It is not something to be ashamed of; it is something to be addressed through compassion, awareness and proper care. The impact of incontinence can be profound. It affects people’s confidence, their work, their relationships and their mental health. That is why Continence Week, which we are currently marking, matters. We cannot expect people to reach out for help unless we first create a culture where they feel safe and supported in doing so. We also need to ensure that services are in place to respond when they do seek help. That means better access to continence nurses, urologists, and physiotherapists, such as the hon. Member for Dudley. It means investing in community support, and in research and innovation, and recognising that continence care is a core part of our health system, not an afterthought.
I therefore welcome the Government’s stated ambition to tackle inequalities in women’s health and to address conditions such as incontinence more seriously, but warm words and long-term ambitions are not enough when so many continue to struggle. For example, the “Excellence in Continence Care” guidance, first published in 2018, was a groundbreaking piece of work, but we now need clear next steps, funding and measurable outcomes. We must not allow this to drift for another seven years while millions suffer in silence.
Under the previous Conservative Government, we delivered real and lasting progress in this area. In 2022, we published England’s first ever women’s health strategy, a genuine turning point shaped by listening to more than 100,000 women’s voices. That strategy committed to trauma-informed care, expanded research and, crucially, improved the quality and accessibility of information on the NHS website so that women could make informed choices about their own health.
Under our leadership, women’s health hubs were launched with a clear mandate to exist in every integrated care system, bringing services closer to communities and breaking down barriers to care. We also ensured the creation of specialist mesh centres across England, delivering multidisciplinary, regionally-based care for women facing the severe consequences of surgical complications. At a recent roundtable I attended with lecturers from Bath University on mesh, Primodos and valproate, it was clear that there is still more work to do to support these women and to learn from the past. I thank the hon. Members for Wolverhampton West (Warinder Juss) and for Harlow (Chris Vince) for raising the mesh scandal so passionately earlier.
On incontinence, the Conservative Government backed National Institute for Health and Care Research funding for vital research into patient-reported outcome measures, empowering patients, improving clinical care and ensuring that the lived experience is properly reflected in decision making. As my hon. Friend the Member for Dumfries and Galloway (John Cooper) so powerfully elucidated earlier, men are often forgotten in this area. On the Opposition Benches, we support any culture and any steps that will help men with incontinence. As the hon. Member for Strangford (Jim Shannon) mentioned, we men are pretty poor at going for diagnosis and treatment, and that needs to change.
The scale of the issue remains significant. Nearly half of women experience incontinence after childbirth and one in 10 experience faecal incontinence, yet only 17% seek help. That is often because they are told subtly or directly that it is simply part of ageing or the price of motherhood. That attitude was unacceptable then and must not be tolerated now. When a third of women suffer pelvic floor disorders after giving birth and still face barriers to care, when men living with incontinence are afraid to leave their homes, and when people are forced to depend on charities for access to basic hygiene products, it is clear that we have a public health problem that transcends mere inconvenience.
Will the Department commit to publishing an updated “Excellence in Continence Care” strategy this year, with clear timelines and accountability? Will we see dedicated funding to expand women’s health hubs further, so that continence care is a core service, not a bolt-on? Will the Minister also bring forward a plan for better health services for male incontinence? Will NHS England guarantee national consistency of access to continence services and products, ending the unacceptable postcode lottery? Will the Government protect and grow funding for continence research to improve treatments for men and women?
Finally, I pay tribute to the organisations, including Bladder and Bowel UK, Prostate Cancer UK and the Urology Foundation, that are breaking taboos and supporting patients so tirelessly, but it is not their responsibility alone; the Government must lead. We Conservatives made a start, and we now need the current Government to have the same urgency, ambition and delivery to ensure that these hard-won improvements are built upon so that no one is left to struggle in silence.
The Minister for Secondary Care (Karin Smyth)
It is a pleasure to see you in the Chair, Mr Deputy Speaker; you have done an excellent job of making sure that all Back Benchers get to contribute to this afternoon’s important debate. I will have to cut some of my comments, but hopefully I will get to address everybody’s points. We are having this debate during World Continence Week, and I congratulate my hon. Friend the Member for Dudley (Sonia Kumar) on securing it. There could not be a more appropriate time to raise awareness of this issue.
Millions of men, women, young people and children are living with bowel and bladder problems. Incontinence is an issue that robs people of their dignity, as we heard from my hon. Friends the Members for Chelsea and Fulham (Ben Coleman) and for Harlow (Chris Vince), and too many suffer in silence. As my hon. Friend the Member for Dudley rightly says, this subject is taboo, and I congratulate her on securing her first debate in the Chamber. It is great to have her expertise in this area.
All continence problems can be debilitating and life-changing. They affect a wide range of care groups, and can be a particular concern for older people. In recent years, public discussion and awareness has opened up. The advertising of products has become slightly more commonplace, helping people to normalise these issues, with which so many people live from day to day. However, we are still a very long way from being a society that supports people with incontinence to live without stigma.
As these issues affect people of all ages, we need to recognise that different approaches are required. We heard an excellent contribution from the hon. Member for Dumfries and Galloway (John Cooper), who raised that point, as did the hon. Member for Farnham and Bordon (Gregory Stafford). The hon. Member for Strangford (Jim Shannon) talked about children, and my hon. Friend the Member for Nuneaton (Jodie Gosling) talked passionately about people with learning disabilities.
There is no one-size-fits-all approach to managing incontinence, but dignity and compassion must be at the heart of the care provided. That is why we are introducing reforms to put the patient at the heart of the care pathway and the decision-making process around it. The 10-year health plan, and its focus on the three shifts needed to deliver a modern NHS—moving from hospital to community, from analogue to digital, and from sickness to prevention—will benefit people at risk of developing incontinence and those already living with it. For example, preventing type 2 diabetes or helping people into remission will help to reduce the number of people who develop continence problems as they go through life.
We have heard many contributions about women’s health. NHS England has established a perinatal pelvic health service, which focuses on the prevention, identification and timely treatment of a range of issues antenatally and for at least 12 months after birth. The initiative aims to support women who experienced trauma during childbirth, including conditions such as urinary incontinence and pelvic organ prolapse, as noted by my hon. Friend the Member for Gravesham (Dr Sullivan).
In addition to perinatal pelvic health services, continence services are provided more widely via women’s health hubs, and the core specification outlines that incontinence care is a key consideration for local organisations when establishing hubs. I commend my hon. Friend the Member for Wolverhampton West (Warinder Juss) for bringing his expertise and experience to this debate, and for supporting so many women. I know that in the last Parliament many Members of this House supported women through the horrors of mesh implants, and we are moving that issue forward.
By moving from sickness to prevention, the Government want to shorten the amount of time people spend in ill health and to prevent illnesses before they happen. Although prevention is extremely important, we must also ensure that those living with incontinence receive the best possible care, wherever they live. A key part of that involves the NHS providing high-quality guidance on how to care for people living with incontinence. The National Institute for Health and Care Excellence has published five guidelines on the management of urinary and faecal incontinence, which cover the management of urinary incontinence in people with neurological disease, the prevention and management of pelvic floor dysfunction, and pelvic organ prolapse in women. NICE has also published advice on a further 14 products for urinary incontinence, and on 12 products for faecal incontinence.
My Department has commissioned NICE to produce late-stage assessment guidance on one-piece closed bags for colostomies, and on intermittent urethral catheters for chronic incomplete bladder emptying in adults. These late-stage assessments will gather the views of clinical experts and patients to help NICE assess and compare the value of products in widespread use across the NHS. In addition to NICE’s guidance, the NHS must have regard to the “Excellence in Continence Care” guidance, published in 2018.
NHS England has also produced guidance on safer bowel care for patients at risk of autonomic dysreflexia, a serious medical condition that can affect people with spinal cord injuries. The guidance offers resources to support safer bowel care practice, and highlights the importance of implementing the excellent incontinence framework. In addition, the Nursing and Midwifery Council has professional standards relating to bladder and bowel nursing care. Its code places a strong emphasis on the principle of prioritising people, setting out the expectation that registrants should always respond to individual patient needs. NHS England is also developing a best practice catheter care pathway across all settings, which is to be completed by the end of this year.
The provision of suitable care, with the products necessary to deliver that care, is essential for minimising the physical harm related to complications and treatments for continence problems, which can lead to admission to hospital for extended lengths of stay. The NHS will commission pathways of care that ensure early assessment and effective management of incontinence, along with other bladder and bowel problems. These pathways will take account of the impact of urinary tract infections on social, physical and mental wellbeing to reduce expensive pad usage, high-cost complications, and unnecessary hospital and care home admissions.
As we have heard, our focus on the shift from hospital to community will drive more joint working in neighbourhoods between primary care, pharmacies, community healthcare and social care to help people manage incontinence at home. This will help them to access the right self-care and the right professional support so they are not passed from service provider to service provider. It will also reduce their need for emergency hospital admissions, as we heard from my hon. Friend the Member for Nuneaton.
My hon. Friend the Member for Penrith and Solway (Markus Campbell-Savours) made some excellent points about access to facilities, and I know he will keep pressing my hon. Friends in the Ministry of Housing, Communities and Local Government about that issue. His points were echoed by my hon. Friend the Member for Colchester (Pam Cox).
As I stated at the outset, shifting care into community settings is one of our three shifts, and we will shortly be publishing the 10-year plan. Once again, I thank my hon. Friend the Member for Dudley for bringing forward this debate to raise awareness of this important but often overlooked issue.
Sonia Kumar
I thank the Minister for her response, and I hope she takes forward my five recommendations. I also thank all the Members who have contributed to this debate; I hope they continue this conversation in their constituencies.
The hon. Member for Dumfries and Galloway (John Cooper) spoke about men’s health and smashing the stigma. My hon. Friend the Member for Nuneaton (Jodie Gosling) talked about her work on the all-party parliamentary group for bladder and bowel continence care, and she shared information about paediatric care and the lack of provision. The hon. Member for Strangford (Jim Shannon) raised the issue of the costs to the NHS of neglecting bladder and bowel conditions.
My hon. Friend the Member for Wolverhampton West (Warinder Juss) talked passionately about the high quality of care needed for patients and about the pelvic mesh scandal; my hon. Friend the Member for Gravesham (Dr Sullivan) spoke powerfully about dealing with bladder and bowel conditions at an early stage, and about prevention; my hon. Friend the Member for Harlow (Chris Vince) mentioned health inequalities and shared his personal experience; and my hon. Friends the Members for Colchester (Pam Cox) and for Penrith and Solway (Markus Campbell-Savours) discussed the availability of public toilets.
Lastly, I thank everybody again, and I say this once more to those men, women, children and young people who are listening to the debate: you are not alone, and there is absolutely no shame.
Question put and agreed to.
Resolved,
That this House has considered the matter of incontinence.