Incontinence

Rosie Cooper Excerpts

Tuesday 5th September 2017 Commons Chamber

[Mrs Moon]

I thank my hon. Friend for that intervention. In particular, we should look at the need for teachers to understand the issue of incontinence. They need to understand that a child who constantly puts their hand up and says that they need to go to the toilet is not trying to get out of the lesson, and that it is perhaps an indication of a deep-seated problem that needs to be tackled. There is certainly a need to educate and to build awareness of continence problems in schools. This relates to the little ones coming into the reception class—some of whom, increasingly and shockingly, have not been potty-trained and have not learned to control their bowels and bladder—and the problem continues throughout the school. Schools need to step in and ensure that parents and children have access to the help and advice that they need.

People should have the confidence to talk about the problem to GPs and to seek an early diagnosis and intervention. People should not have to assume that it is something they have to live with. It is estimated that people manage the problem themselves for an average of five years before seeking help. We also need to highlight the detrimental impact that incontinence can have on an individual, and the fact that existing policy responses exacerbate the situation. This is a quality-of-life issue. It affects sleep and mental wellbeing, and it can cause isolation. For a child, it can have a long-term impact on their self-esteem and on family relationships, and it often makes them vulnerable to bullying.

Access to toilets can become a determining factor in every journey and activity away from the home. The condition can also lead to more complex health problems, which are inevitably more expensive to treat, and some people even choose residential care so that they can have management of their problem. One specialist in the field summed the situation up by saying:

“The reality is that bladder and bowel continence needs can affect anyone at any age. It can reduce a person’s enjoyment of life, ability to live an independent life, reduce education and work opportunities and lead to further medical complications.”

Patient surveys have highlighted the limitations imposed on people’s lives by their conditions. For sufferers who responded to a survey, those restrictions and sleep deprivation were the worst aspects, with 93% saying that it had affected their mood, 63% saying that it had affected their ability to work, and 39% saying that it had forced them to take time off work. Frustratingly, there are solutions for many, but people all too frequently struggle to cope on their own, using incontinence products available in local chemists rather than seeking the help that could be available from the NHS.

[Rosie Cooper (West Lancashire) (Lab)]

It is really important to note that people who rely on getting pads and looking after themselves are not getting the best service, and doctors and nurses are sadly not receiving training in this most important area. Shockingly, the pre-registration nurse curriculum does not include training for bladder or bowel incontinence, so it is all too easy not to address the real problem. We need that experience to help people; we should not just pad them up. People can be helped with exercise, for example, and there are many interventions that could help instead of them being told simply, “Go and buy a pad.”

[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.

--- Later in debate ---

[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.

[Rosie Cooper]

The Minister’s comments are very welcome, but what pressure can he really apply to get clinical commissioning groups to implement NHSE’s guidance and to get the GMC, the Nursing and Midwifery Council and medical schools to include training in continence? If we can get that right, those facilities will be there when people say that they have the problem. Then we will get the clinical intervention, not just the costly pads in response.

[Steve Brine]

I thank the hon. Lady for her intervention. I will take that away with me, and I will come on to the point about the CCGs.

I was just about to outline the approaches that NHS England wants to take to ensure that commissioners are following the framework. They include arranging for CCGs to have access to teams of expert clinicians, commissioners from areas that have adopted the guidelines and are following best practice, and people with lived experience to review their existing service against the best practice and make appropriate improvements. NHS England is also exploring the potential for a mandatory data set to provide transparency about the continence services being commissioned and encouraging CCGs to develop integrated commissioning arrangements to improve co-ordination, experience and use of resources. That is all very positive.

In addition, the National Institute for Health and Care Excellence—or should I say NICE as I am now getting to grips with all the acronyms—has produced a range of guidance for clinicians to support them in the diagnosis, treatment, care and support of people with continence problems, including the 2015 quality standards for urinary tract infection in adults, which sets out how treatment must be holistic.

I understand that the Under-Secretary of State for Health, my hon. Friend the Member for Thurrock (Jackie Doyle-Price), recently replied to the hon. Member for Bridgend on the issue of paediatric continence data and the risk of losing the National Child and Maternal Health Intelligence Network, which provides a valuable data resource. Let me take the opportunity to reassure the hon. Lady that the ChiMat legacy website can still be accessed. Paediatric continence is a very important issue. I understand that Public Health England is grateful to the Paediatric Continence Forum for its productive collaboration over the years and that it wishes this relationship to continue. It has agreed that if PHE’s infrastructure remains the best place within the health system to enable these reports and to make the data available at a local level, it will make every effort to recreate the paediatric continence needs assessments during its 2018-19 business planning process. I am the Minister responsible for Public Health England. I see its leaders regularly and I will raise it with them next time I see them.