Incontinence

Steve Brine Excerpts

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.

[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.

[Mrs Moon]

rose—

[Steve Brine]

I would also like to use this debate briefly to mention transvaginal mesh implants, which the hon. Lady rightly raised in her speech. She was about to intervene to ask whether I was going to mention them. I know that some women experience severe side effects and complications post operation. I know that there has been considerable interest in this across the House. The hon. Lady mentioned the hon. Member for Pontypridd (Owen Smith) who chaired a working group on it recently and is looking to set up an all-party group on the subject.

I have heard heart-breaking stories and I have talked to colleagues in the House who have been contacted by constituents about this. We have to make sure that we listen, not only to provide the best support but to inform health services so that they can reduce complications from the treatment. When complications do occur, we must ensure that they are treated promptly and effectively.

We must also remember that these procedures help thousands of women each year who are suffering the distressing effects of stress urinary incontinence and pelvic organ prolapse. Surgical procedures using mesh devices have provided an effective form of treatment that can be far less invasive than alternative surgical procedures. Let us not throw the baby out with the bathwater. In 2014, NHS England set up its mesh oversight group which, in partnership with clinicians, regulatory experts and patient groups, published its final report in July this year which helps to address the three major issues highlighted by clinicians and patient interest groups alike: clinical quality, data and informed consent. That answers the point made by the hon. Member for Bridgend about the devolved Administrations. Yes, we liaise with them, and I welcome the news that both Wales and Northern Ireland will be setting up their own working groups. We would like to see more collaboration on this topic across all the devolved Administrations, and we will give them every support so that they can learn from what we have found in the NHS England working group. I hope that that answers that point.

The hon. Lady raised a couple of other issues. She made a really good point about non-domestic rates and public toilets. That issue is raised in the House more often than it should be—it should not need to be raised. I will make sure that my colleagues in the Department for Communities and Local Government hear her call. There is a discretionary relief scheme on non-domestic rates that councils can access, and I am sure that she has made her council aware of it. I encourage other Members to do so, because that is how the discretionary scheme can be used. It is exactly what it says on the tin—it is discretionary.

The hon. Lady made an excellent point about installing a shelf in public toilets. That would be welcome. As a parent of young children in the not too distant past, a shelf would have come in handy on lots of occasions. She made an excellent point about the changing of continence products. The hon. Member for Stroud (Dr Drew) made a point about ERIC. I was not aware of that, so I thank him for doing so and will look it up. He also spoke about the need for teachers to be informed about the subject. I urge him to pursue that with Education Ministers, but I am sure that they have heard tonight’s debate, given that they have been mentioned.

The hon. Member for Bridgend made a really good point about hospital data on continence, access to tertiary care and exit from hospital care. My family and I have experienced the fight on Parkinson’s on far too many occasions. I thank the hon. Lady for the work that she does on the all-party group and I look forward to meeting her in that capacity. I will ask officials to look at the very good point that she has made. She also raised VAT on sanitary and continence products. The Government have taken action on VAT on women’s sanitary products within the realms of what is possible as a member of the European Union. We have invested that money in women’s health charities, as she knows. On the wider point about VAT, we are restricted as a member state, but we will soon be free, and we will be able to make those decisions in the House—taking back control, as someone once said.

Finally, the hon. Member for Strangford (Jim Shannon) made an excellent point about employers and their understanding of the issue. Employers should show every understanding in this area, and I expect them to do so—I do not think that I can be clearer than that.

To conclude, I thank the hon. Member for Bridgend once again for highlighting these issues. For all those who suffer from continence issues, it is important that we talk about the topic, treat it seriously, and work together to overcome the taboo and stigma by speaking candidly about it. I genuinely believe that only by doing so can we truly provide patient-centred services, where patients are at the centre of everything we do. We work with the healthcare professionals, commissioners, providers, pharmacists and trusts to improve the advice and services offered to best meet the needs of the people who rely on and—let us remember—pay for these services.

Question put and agreed to.