Incontinence

Debate between David Drew and Steve Brine

Tuesday 5th September 2017 Commons Chamber

[The Parliamentary Under-Secretary of State for Health (Steve Brine)]

I congratulate the hon. Member for Bridgend (Mrs Moon) on securing this debate. I completely agree that incontinence is a public health issue. I am the public health Minister, so it is appropriate that I am responding to the debate.

It is important that I reiterate some of the hon. Lady’s points from the Government Dispatch Box. Incontinence is absolutely an issue with which too many suffer in silence, and we all need to learn to speak more openly and honestly about it. Think of the subjects that the House of Commons has discussed today, on its first day back after recess: it is incredible what the House can achieve and bring to public consciousness. The hon. Lady has certainly added to that today. By talking about incontinence, we draw back the veil and encourage others to come forward for assessment. I hope that somebody is watching or listening to this at home and decides that they are going to take the first step and ring their GP tomorrow morning, without shame or embarrassment.

As the hon. Lady said, there are 14 million adults in the UK with bladder-control problems and 6.5 million with bowel-control problems. She is absolutely right to point out that this is not just an older person’s problem: it reaches across the sexes and across the generations. Incontinence has been touched on in previous debates—the hon. Lady has raised it in the House this year—but I am told that there has been no dedicated Commons debate on it since 2004, so it is now high time for one.

All continence problems can be debilitating and life-changing. They affect a wide range of care groups and can be a particular concern for the ageing population—although, as both the hon. Lady and I have said, not exclusively. As the hon. Lady said, incontinence is not just a physical problem; it can be, and very often is, psychologically distressing. When continence care and support is done well, it makes an enormous positive difference to patients’ lives.

As the hon. Lady acknowledged, some of the issues she raised go much wider than the brief of a mere health Minister, but I shall touch on some of the other points she made, as well as those for which I am directly responsible. We absolutely do need to develop the workforce of health professionals so that they are more informed and educated about continence issues across the board and are able to support and care for individuals in a safe, effective and dignified manner. We need to measure people’s health outcomes robustly—without measurement it is hard to take action—to make sure that services continue to improve and that we can provide the best care possible.

A good-quality, patient-focused service begins with getting the specification and commissioning right from the outset. For services in England, NHS England published its commissioning framework for continence services, “Excellence in Continence Care,” in 2015 to help to achieve this. Working with clinicians, third sector organisations and people living with the condition, NHS England brought together the most up-to-date evidence-based resources and research to support commissioners, health providers and professionals to make real and lasting changes to raise the standards of continence care. As well as outlining an individual’s pathway from assessment to treatment and recovery when possible, the guidance advocates integration across primary, secondary and tertiary services, as well as across health, education—as mentioned by several Opposition Members—and social care. It is designed to ensure that commissioners work in collaboration with providers and others so that safe, informed, dignified—a key word—efficient and effective continence care is consistently provided to patients.

[Dr Drew]

The Minister will have heard my earlier intervention. Will he and his colleagues in the Department for Education commit to write to each school to make sure that they have an incontinence strategy? In particular—it is just a simple thing—they should provide incontinence pads for children who suffer from this terrible condition.

[Steve Brine]

Clearly, it is not my place to promise work tasks for Education Ministers, let alone other Health Ministers, but they will have heard what the hon. Gentleman said. I have a feeling that he will be following this matter up, no doubt through the all-party group. The chair of that group, the hon. Member for West Lancashire (Rosie Cooper), is sitting but two rows in front of him.

As well as outlining an individual’s pathway from assessment to treatment and recovery when possible, the guidance advocates integration across the different areas. Strengthening the workforce’s knowledge is absolutely key. In England, continence care and the importance of this issue to the comfort of patients is already an important part of the basic training offered to a wide range of clinicians and care workers and is part of the Nursing and Midwifery Council’s training curriculum.

The commissioning guidance builds on that by setting out the minimum standards required along with the specific roles and responsibilities for every member of a patient’s continence team including the individuals themselves, their family—very important—and carers. It is important to acknowledge that, following assessment and with the right advice, self-management of a condition can improve outcomes considerably.

There will always be people, including some in care homes, who have a need for aids. A group of specialist nurses for adults and another group for children are currently preparing some consensus guidelines on commissioning continence products, which in due course the Excellence in Continence Care board will consider for endorsement as a supplement to the framework. Of course we need to make sure that commissioners are following the framework, and NHS England is taking several approaches to tackle this. Let me touch on a few of them.