Question to the Department of Health and Social Care:

To ask His Majesty's Government, further to the Written Answer by Lord Markham on 11 May 2023 (HL7210), what progress they have made in developing and promoting to NHS trusts and integrated care systems in England an effective methodology for assessing value, including on patient experience and outcomes, and on whole system costs, rather than item price, when purchasing medical devices and consumables; and what future plans they have to do so.

Answered by Baroness Merron - Parliamentary Under-Secretary (Department of Health and Social Care)

The Department is working with NHS England and the NHS Supply Chain to develop and promote a standardised methodology for National Health Service trusts and integrated care systems (ICS) to assess value when procuring medical technologies, including devices and consumables. As part of this, the Department is engaging medical technology suppliers, patient forums, as well as broader networks of financial teams, clinicians, and NHS procurement professionals.

The methodology will provide a consistent and transparent approach to assessing value, for use at both the national and local levels. This aims to shift the majority of the weighting in procurement decisions towards value over upfront cost. The guidance will include a bank of questions, model answers, and scoring criteria showing how to assess defined values consistently, such as patient experience and outcomes, and whole system costs.

The Department will be testing this guidance with the NHS at the ICS and NHS trust level over the coming months, with the ambition to refine and publish the guidance in Autumn 2025.

Question to the Department of Health and Social Care:

To ask His Majesty's Government what is the additional annual cost to the NHS and social care in England incurred as a result of cheap absorbent continence products leading to (1) additional, avoidable treatments being required, (2) laundry and other associated costs, including energy, and (3) staff time spent changing patients and undertaking the additional laundering of bed linen and clothing.

Answered by Baroness Merron - Parliamentary Under-Secretary (Department of Health and Social Care)

Continence is an important component in a person’s health and well-being at any stage of life, and is also an important factor in the use of health resources. Early assessment by an appropriately trained professional allows a patient centred and cost-effective care pathway to be followed. After assessment, the use of containment products, medication, and the level of intervention can be triaged and escalated.

An absorbent incontinence pad is the ‘most commonly used product for absorbing and containing both light and moderate/heavy leakage’, as per the Continence Product Advisor in 2017. An incontinence pad is classified as a medical device, as per the Medicines and Healthcare products Regulatory Agency (MHRA) in 2014, and therefore safety and fitness for purpose is fundamental in achieving quality care. The clinician who assesses an individual to provide an absorbent product is accountable for that decision, and needs to ensure that the chosen product is fit for purpose and safe to use at the time of assessment, in accordance with the MHRA.

No current assessment has been made in determining the difference between the brands of continence pads in relation to additional or avoidable treatments being required, laundry and other associated costs, including energy, or staff time spent changing patients.

Question to the Department of Health and Social Care:

To ask His Majesty's Government what assessment they have made of the number of avoidable skin infections, pressure ulcers and urinary tract infections caused or aggravated by issuing to patients the cheapest absorbent continence products rather than products which are most clinically appropriate.

Answered by Baroness Merron - Parliamentary Under-Secretary (Department of Health and Social Care)

Continence is an important component in a person’s health and well-being at any stage of life, and is also an important factor in the use of health resources. Early assessment by an appropriately trained professional allows a patient centred and cost-effective care pathway to be followed. After assessment, the use of containment products, medication, and the level of intervention can be triaged and escalated.

An absorbent incontinence pad is the ‘most commonly used product for absorbing and containing both light and moderate/heavy leakage’, as per the Continence Product Advisor in 2017. An incontinence pad is classified as a medical device, as per the Medicines and Healthcare products Regulatory Agency (MHRA) in 2014, and therefore safety and fitness for purpose is fundamental in achieving quality care. The clinician who assesses an individual to provide an absorbent product is accountable for that decision, and needs to ensure that the chosen product is fit for purpose and safe to use at the time of assessment, in accordance with the MHRA.

No current assessment has been made in determining the difference between the brands of continence pads in relation to additional or avoidable treatments being required, laundry and other associated costs, including energy, or staff time spent changing patients.

Question to the Department of Health and Social Care:

To ask His Majesty's Government what assessment they have made of the document Guidance for the provision of absorbent products for adult incontinence, published by the Association of Continence Professionals and the Royal College of Nursing in February 2023, which states that the number of absorbent products provided per 24 hours must “meet patients’ fundamental care needs, including maintaining independence”, consistent with NICE guidance QS54, CG49 and NG123; and what steps they are taking to ensure that that guidance is followed by NHS and social care providers in England.

Answered by Baroness Merron - Parliamentary Under-Secretary (Department of Health and Social Care)

We are aware of the most recent publication by the Royal College of Nursing relating to continence pads. NHS England published Excellence in Continence Care on 23 July 2018, bringing together evidence-based resources and research for guidance for commissioners, providers, health and social care staff. This guidance covers both urinary and bowel, also known as faecal, incontinence. A copy of the guidance is attached.

The National Institute for Health and Care Excellence (NICE) is an independent body and is responsible for making decisions on whether its published guidelines should be updated in light of new evidence or emerging issues not in the scope of the original guideline.

NICE maintains surveillance of new evidence that may affect its published guidance and would consult on proposed changes with a wide range of stakeholders if significant new evidence was to emerge.

Both integrated care boards (ICBs) and healthcare providers are expected to take into consideration national guidance when commissioning and delivering services, respectively.

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