Bladder and Bowel Continence Care

Karin Smyth Excerpts

Thursday 29th June 2023 Westminster Hall

[Karin Smyth (Bristol South) (Lab)]

It is a pleasure to serve under your chairmanship, Sir Graham. I commend the hon. Member for South West Bedfordshire (Andrew Selous) on this comprehensive and moving debate. He gave voice not just to a particular individual but to many people, and that is one of the highlights of being in this place. I also commend the hon. Members for Don Valley (Nick Fletcher) and for Strangford (Jim Shannon) for being here and for their work on Boys Need Bins and men’s health. It is unusual that I am the only woman in this debate. I am happy to be in this company because the hon. Member for South West Bedfordshire is right that there is a taboo and we all need to work together to reduce the stigma.

It is estimated that 14 million people in the UK have some degree of urinary incontinence, while at least 6.5 million people experience bowel control difficulties. Those numbers are staggering. Although it affects twice as many women as men, one in 25 men over the age of 40 also experience urinary incontinence. Gynaecology waiting lists have faced the biggest increase of all medical specialities, with more than half a million women in the UK on gynaecology waiting lists last year. That is something I recently discussed with Dr Ranee Thakar and Kate Lancaster at the Royal College of Obstetricians and Gynaecologists.

We have known about the need for education and prevention for many years. It is something I worked on in the health service in the late 1980s, but we still have not seen the results, and people are living with poor continence all the time. It is different for everyone, but we have heard about some of the significant impacts that incontinence can have on quality of life and mental health, as well as through a reduction in physical and social activity. We should remember that in most cases the problem can be either prevented, cured or managed so that it does not interfere with daily life, but to do that the right support must be available so that we can all live our lives with dignity.

There are excellent innovations and surgical products for stoma wearers, and I pay tribute to the health staff, from specialist nurses to pelvic floor physios, who go over and above to support those with continence issues and to help people to adjust to life-changing surgery. Too often people with continence issues face unnecessary hurdles, and we have heard some today—whether that is a lack of public toilets, lack of awareness or, indeed, the normalisation of continued incontinence following childbirth. Those impacts cannot be underestimated, and I know from my constituents how a lack of amenities can cause isolation, while a lack of awareness around care can lead to people living with these problems for far longer than they should have to. There are also financial pressures on the NHS as a result of poor continence care, from costs associated with hospitalisation or catheterisation to high workload pressures and increased laundry costs. That means the cost to the NHS of incontinence-related care is more than £5 billion every year.

Many people are admitted to hospital with urinary tract infections, often caused by catheter-associated urinary tract infections. That increases A&E attendance and costly unplanned admissions. Improving catheter care in the community would significantly ease the burden and reduce A&E attendance and hospital admissions. That is one reason why the Labour party will shift more care out of hospitals into the community, so that the NHS becomes more of a neighbourhood service.

In Bristol, we are fortunate to have highly recognised work in this area. The CONfidence app, which has already been mentioned, is led by Dr Nikki Cotterill in association with the University of the West of England and Bristol Health Partners. I commend that work to the Minister. It aims to address inequalities for patients with pelvic floor disorders and improve services for the future, as well to provide vital care and support to people who are suffering in silence.

Another project conducted by Bristol Health Partners and the West of England Academic Health Science Network highlighted six opportunities, which I think are worth listing. We need to help people by improving perception; communication; the environment; health services; recognition and support, particularly for mental health issues and anxiety; and participation in society.

The hon. Member for South West Bedfordshire addressed the issue of race inequalities, which we are looking at in Bristol. We have a project to explore the barriers faced by women with incontinence in the Somali community, which I hope all of us across the country can learn from. Not everyone everywhere has the same experience, so it is important that we share. However, everyone facing these problems deserves access to high-quality information and suitable treatment in an NHS that is supported and fit for the future. You would expect me to say this, Sir Graham, but 13 years of Conservative Government have not helped the health service. Waiting lists and preventive care in the community are at breaking point.

People who support those living with incontinence need quality training to ensure the right bowel and bladder care regime for each patient. That is particularly important for those with mobility issues who rely on carers either at home or in a community setting. Nurses are currently required to learn specialist continence care on the job, because of the removal of NHS training courses over the last few years. That adds additional pressure to already overworked nursing and caring staff, putting patients’ quality of life and their health at risk. We are still waiting for the workforce plan, although we hear that it is imminent. I agree with the hon. Member for South West Bedfordshire that those living with incontinence would welcome an update from the Minister on whether the Government will introduce NHS training courses on stoma and continence care for nursing and care professionals.

This is not just an individual health matter, but a public health matter. It would be helpful if the Minister could explain what discussions he is having with integrated care boards throughout the country about tackling incontinence as a prevention issue, knowing, as we have heard, that it affects one in five people across the country. From the examples we have heard, it is clear that specialist treatment and support, including mental health support, is vital. How are the Government ensuring that those who need that support receive it, and particularly those in harder-to-reach communities?

Much has been promised in the women’s health strategy, but we are still awaiting action on things from tackling gynaecology waiting lists to appointing a deputy women’s health ambassador. We have heard good promises but we need to see the findings. Also, any disruption to the flow of medical devices into the UK would have a devastating impact on those who rely on them, and urology projects are no exception. Can the Minister give any assurances to the industry in respect of the sustainability of production and regulatory alignment post Brexit?

Finally, can the Minister provide any information on updating the guidance regarding the disposal of sanitary dressings in the building regulations and in approved document M? I understand that that work has been ongoing since 2020, but it would address many of the issues that have been raised today. If he cannot provide an update now, will he do so in writing? I think the hon. Member for South West Bedfordshire would appreciate that too.