Incontinence

Melanie Onn Excerpts

Tuesday 5th September 2017 Commons Chamber

[Mrs Madeleine Moon (Bridgend) (Lab)]

Incontinence is not an issue that is often discussed in the Chamber. Society sees the condition as a taboo, which is hidden from public view while sufferers cope in private. However, an estimated 14 million people in all age groups will, at some point in their lives, experience a problem with bladder dysfunction. A further 6.5 million will have bowel dysfunction.

It is generally assumed that incontinence is a condition that affects older people, but that is only half the story. The National Childbirth Trust estimates that almost half of all women experience urinary incontinence after childbirth; there are around 700,000 births a year, so as many as 350,000 women could face this problem. NHS figures suggest as many as 900,000 children and young people experience some form of problem.

More than 300,000 people are diagnosed with ulcerative colitis and Crohn’s, otherwise known as inflammatory bowel disease, and the most common age for diagnosis is between 18 and 30. Those conditions affect the digestive system to different degrees, but one in 10 people will experience regular incontinence. A 2012 survey by Crohn’s and Colitis UK found that 61% of people had not sought medical advice for the incontinence. Like all other conditions that have associated problems with incontinence, that leads to social isolation. Crohn’s and Colitis UK surveyed 1,000 young people on their experience, and 75% said that their condition made socialising impossible because of always needing to know of the proximity to a toilet. On a very simple level, given how many local authorities are closing access to public toilets, is it not time that we looked at alternatives? It is surely not beyond our wit in this House to look at issues such as rate relief, so that hotels, restaurants, pubs and cafes provide access to their toilets for those who urgently need to have it.

[Melanie Onn (Great Grimsby) (Lab)]

I draw the House’s attention to my entry in the Register of Members’ Financial Interests. Does my hon. Friend agree that businesses with a high footfall could do an awful lot more to support their customers’ needs in respect of incontinence issues, and consider additional aids such as the Crohn’s and Colitis UK “Can’t Wait” card—a facility to enable individuals who suffer from incontinence issues to access the toilet facilities of businesses that would not ordinarily allow people to use them, but which support their customers as and when they might need it, to avoid any emergency situations?

[Mrs Moon]

I thank my hon. Friend for her work in this area. That most certainly would help, and it is so simple; it is not a huge thing to do. Another example is simply having a shelf in toilets where someone with a colostomy or ileostomy can place the clean bag, so it is readily available while they remove the full bag. That would make things so much easier and healthier, by ensuring there is no cross-infection. Instead, people often have to scrabble on dirty toilet floors, trying to access what they need.

All the figures I have to hand today are estimates—as one patient group pointed out to me, the collection of statistics in this field is patchy at best, and putting a true figure on the scale of the problem is very difficult—but we will not tackle taboos until we start talking about them: we must destigmatise the subject so that no one faces humiliation if they admit to a problem. We need to bring this issue out into the open once and for all, so that people no longer suffer in silence and we can reduce the long-term health implications and additional costs for the NHS.

An analysis of calls to the Bladder and Bowel Foundation’s helpline in 2015 suggested that half the people with a continence problem had never spoken to a healthcare professional. Another study found that only one in three families seek help for children and young people with a continence problem. Imagine the long-term impact on a child’s health of having to try to manage such a problem at school, with all the stigma of being the smelly kid and all the fear of having an accident during a lesson.

--- Later in debate ---

[Mrs Moon]

I commend my hon. Friend’s work for the all-party parliamentary group on continence care, which does invaluable work in this area.

I am going to jump to another section of my speech. It is shocking how many people go into hospital with no continence problems but may be incontinent or doubly incontinent and have major problems by the time they leave. It is far too easy for nurses and doctors to see the use of pads as the only solution. At some point, I hope the Minister will look at how we can gather figures from hospitals on how many patients enter with continence problems and how many leave with continence problems to get some idea of how great the problem is.

I chair the all-party parliamentary group on Parkinson’s, and the Minister will be aware that Parkinson’s UK has campaigned for many years due to the problems that people with Parkinson’s have when they go into hospital and their carefully timed medication regime is changed to fit in with drugs rounds on the ward. A perfectly mobile and continent person can become immobile and incontinent due to NHS failure. That cannot be allowed to carry on. It is shameful that we are facing such problems in 2017.

Diagnoses are not made in a huge number of cases. Healthcare professionals do not provide consistent assessments, diagnosis and follow-through according to standard practice. Even basic things, such as an assessments of where the toilet is in relation to where someone sleeps, are not carried out by social workers. I cannot begin to tell the House how many times people are admitted to hospital as the result of a fall at night caused by them trying to negotiate the stairs to go up or down to a toilet that is on a different level from where they sleep. It is shocking that people face having to wear an incontinence pad because they cannot use the stairs or because there is a risk of them falling at night when accessing the toilet. We simply must get this sorted out.

Incontinence can cause additional problems. Urinary tract infections, pressure sores, anxiety, depression and falls cost the NHS a great deal of money, and we could save money by making relatively simple changes. I have not been able to find any comprehensive analysis of the cost to the NHS and other services that would demonstrate potential savings from early interventions. As far as I am aware, such an assessment has not been carried out. A series of parliamentary questions tabled last year revealed that data are not held by the Department of Health on the number of people admitted to hospital for catheter-associated urinary tract infections, for non-catheter-associated urinary tract infections or with urinary incontinence generally. If it existed, such information would help to clarify the extent of the problem. An estimate was offered in 2014-15, with NHS trusts reporting an annual cost of £27.6 million, which is almost certainly an underestimate.

Too many individuals are bearing the brunt of managing their condition. Buying a regular supply of pads costs anywhere between 10p a pad, for a child, and 60p a pad, depending on the type of pad required.

[Melanie Onn]

My hon. Friend is being generous with her time. Does she think that now is the time for the Government to reconsider the VAT on these products?

[Mrs Moon]

We need to reconsider the issue of VAT on a whole range of sanitary and continence products. As a society, we need to take responsibility for the facts of our daily life. For a person on any sort of restricted income, such as those on benefits, the costs even of simple laundry are huge when dealing with incontinence.

Some families are spending up to £100 a week buying incontinence products. It is ludicrous if they are not able to access those products through the health service or joint stores with local authorities. It is a postcode lottery whether or not a person can access the help and support they need, which is shocking. Think of the savings in sickness pay, in hours of work lost and in mental health and wellbeing if we started to tackle this problem.

It is time to raise a number of issues, including what happens when things go wrong.