Bladder and Bowel Continence Care

Will Quince Excerpts

Thursday 29th June 2023 Westminster Hall

[The Minister for Health and Secondary Care (Will Quince)]

It is a pleasure to serve under your chairmanship, Sir Graham. It is unusual to have almost an hour to respond to a Westminster Hall debate. I assure you that I do not intend to use all that time, but I will endeavour to answer as many questions as possible.

I congratulate my hon. Friend the Member for South West Bedfordshire (Andrew Selous) on securing this important debate, and on his appointment as chair of the all-party parliamentary group for bladder and bowl continence care. I join him in paying tribute to campaigners such as the Urology Foundation for their incredible work during Continence Week and throughout the year.

I thank my hon. Friend for sharing the experience of the young adult who contacted him. That is what this debate, and this place, is all about. It is about destigmatising the issue, which was the No. 1 ask of that young adult. It is also about trying to bring about positive change not just for him but for patients up and down the country, especially given how many people we know are affected by continence issues.

We know—my hon. Friend set this out very articulately and eloquently—that incontinence is an issue with which too many suffer in silence. We must all learn to speak more openly about it. As the hon. Member for Bristol South (Karin Smyth) rightly set out, it is estimated that around 14 million men, women, young people and children, of all ages, are living with bladder problems. As has also been pointed out, all continence problems can be debilitating and life-changing. As we have heard, they can affect a wide range of care groups and can be of particular concern to the ageing population.

As my hon. Friend the Member for South West Bedfordshire rightly set out, this also creates pressures for our healthcare system. Complications and treatments for continence problems—for example, pressure ulcers, urinary tract infections, catheterisation, which my he pointed to, or faecal impaction—can all lead to admission and extended stays in hospital, which we should try to avoid wherever possible. The need to do what is right for patients and healthcare professionals alike means that care pathways should be commissioned to ensure the early assessment and effective management of incontinence.

To improve continence care across the whole public health and care system, NHS England has established the national bladder and bowel health project to improve continence care. As my hon. Friend rightly pointed out, it has also published “Excellence in Continence Care”, which is a practical guide for leaders and commissioners. That includes guidance for commissioners—so ICBs—and leaders in healthcare systems to ensure that people who are diagnosed with UTIs receive high-quality treatment.

I have heard my hon. Friend’s concerns about the implementation of the continence care guidelines. I will, as he asked, take this back to the Department and raise it with the Minister for Social Care, my hon. Friend the Member for Faversham and Mid Kent (Helen Whately), to discuss what more we can do alongside NHS England.

On 9 May, NHS England published its delivery plan for recovering access to primary care. It is an ambitious plan that includes proposals to improve options for community-based services to treat urinary tract infections. As part of that, appropriately trained community pharmacists will be commissioned to provide a clinical service to care for patients with urinary symptoms, providing timely access to assessment, information and advice.

In addition—this does fall within my direct remit in the Department—the National Institute for Health and Care Excellence has produced guidance on the management of faecal incontinence in adults, which healthcare professionals and commissioners are expected to take fully into account as part of the delivery of services. That guidance outlines that management strategies should consider diet, bowel habit, toilet access, medication and, importantly, coping strategies. Those management strategies will be required to account for the sensitive and socially stigmatising nature of incontinence, as my hon. Friend the Member for South West Bedfordshire set out. We know how important that is to patients, their families and—as the hon. Member for Strangford (Jim Shannon) pointed out—their carers.

I want to touch on another area, which my hon. Friend the Member for South West Bedfordshire touched on also, which is antimicrobial resistance, because we have updated the 2019 to 2024 national action plan on tackling antimicrobial resistance. The plan is core to this debate because it outlines that the UK will enhance the prevention of UTIs by providing early, accurate diagnosis and treatment of suspected and confirmed UTIs. That includes the prescription and use of antibiotics and therapeutics for older people, both in their own homes, which is critical, and in care homes, so that patients get the care they need, when and where they need it, and are less likely to suffer from the discomfort of urinary tract infections, or indeed secondary infections, which we know can follow.

To improve bowel care for people with spinal cord injury, NHS England has also published a service specification, with specialist multidisciplinary teams that provide advice and care in bowel management, including promoting and managing continence. My hon. Friend also referred to medtech, and I am really passionate—

[Andrew Selous]

The Minister might not be able to respond to this now, but before he moves on to the tech, the Spinal Injuries Association made the very good point that a lot of people with spinal injuries have carers—trained people—who are willing to come in and assist the very hard-pressed hospital staff, but are unable to. Can that be looked at? I get the complications, and I am not asking the Minister for an answer now, but one of my children spent some time in healthcare in hospitals in Africa, and in many parts of the world, if a patient’s family and friends do not go into the hospital, they will not survive. If we completely keep carers out and bar the door, have we not gone a little too far? There have to be standards, of course—it would have to be done in agreement with the staff and there would have to a be risk assessment. I absolutely get all that, but the current position seems bizarre, when there are hard-pressed staff and carers who are willing to come into hospital with their patients, so I wonder whether that could be looked at.

[Will Quince]

My hon. Friend makes a very good point. Instinctively, I totally agree with him, and I would be very happy to meet him to discuss, alongside NHS England, what more we would need to do to enable that to happen. I suspect that, in this kind of area, an individual with incontinence would often much rather have a family member, a carer or another trusted loved one support them through that process, alongside trained medical professions than anything else. So it is a good point, a fair challenge and one I will take away and consider in more detail.

Let me turn to medtech, which is a real passion of mine. We want to make sure that patients in our NHS get access to the most cutting-edge technological advances. We talk a lot about pharmaceuticals, but medtech is something that we should take very seriously, too. Earlier this year, we published our first ever medtech strategy, which says that the lowest price does not always translate to the best value. That is an important point, because the Government believe that the value of a product should be considered across the whole patient pathway, not in terms of the individual cost.

The application and adoption of value-based procurement in the NHS is a key priority in the medtech strategy, in order to realise, as I have set out, the potential of that technology to improve patient outcomes and, importantly and alongside that, to support the NHS workforce. Without getting too technical, the strategy includes a commitment to modernise part IX of the drug tariff, which lists devices that can be prescribed in the NHS.

The reason I am labouring this point is that the Government and I recognise how important patient choice is, and that a range of continence products is really important to living well with this condition. That is why there is a focus on making changes to part IX. By re-categorising part IX into groups of clinically comparable products that are interchangeable by their nature, cost-effectiveness can be compared fairly, and ICBs and clinicians will be more informed and more likely to use part IX. Doing so will also enable companies that are making innovative products to enter the market and encourage further innovation in this space, which will ultimately only benefit patients. We will continue to support the provision of a range of continence products in part IX of the drug tariff, to ensure equitable access for all patients.

The reason I labour the point about patient choice is that we must ensure that patients have a voice in the product range available in the drug tariff, so that patients’ interests are at the heart of how the tariff operates. We are currently engaging with patient groups, which is really important, and a targeted consultation will be launched later this summer to ensure that the tariff continues to be able to provide effective products to patients.

My hon. Friend and others also referred to the long-term workforce plan and the need for specialist continence nurses. I have spent the last few months saying that the plan will be published “soon”, then “very soon” and now “imminently”. I do not know if I can say “very imminently” —I am not sure there is such a thing—although I have spent most of today talking about the NHS long-term workforce plan. I anticipate spending most of tomorrow, and indeed Monday, talking about the NHS long-term plan. My hon. Friend and others will not have to wait very long before they will be able to read the plan in full. I am sure that he and others will understand why it would not be right for me to share details of it ahead of publication, but I mean it when I say that he will not have to wait very long at all.

On the points about public toilets and accessible toilets, I am conscious that I am straying into the territory of the Department for Levelling Up, Housing and Communities, which has responsibility for building regulations. It approves documents for the provision of toilets in publicly accessible buildings, which falls under the Building Act 1984 and the Building Regulations 2010. That legislation does not currently require sanitary bins in men’s toilets, but I understand the points made by my hon. Friends the Members for South West Bedfordshire and for Don Valley (Nick Fletcher), as well as the hon. Member for Strangford, about the anxiety that men feel. They make a compelling argument, and I would encourage them to raise it with the relevant Minister at DLUHC—I will do that too.

I understand that Colostomy UK has a stoma-friendly toilet campaign that is aimed at organisations, businesses and individuals. The campaign focuses specifically on accessible toilet facilities and the needs of people living with a stoma. The hon. Member for Strangford makes a fair challenge to the civil service and Government Departments to lead by example on that point. I will raise the issue with the Cabinet Office to see whether it is something we should explore further.

I thank my hon. Friend the Member for South West Bedfordshire for alerting me to the bladder and bowel CONfidence app, which was something that I was not aware of before my research ahead of the debate. I now know that a number of NHS trusts and medical centres are aware of the app and promote its use. Following this debate, I will look into whether NHS England could reference the app on its health webpages, which would be really helpful. I will also look into what more we can do to promote the app, as it sounds like a great tool.

My hon. Friend the Member for Don Valley raised the possibility of a men’s health strategy, and specifically a Minister with responsibility for men’s health. I know it is an issue that he is hugely passionate about and has campaigned long and hard on. I can give him the assurance that the major conditions strategy will take into account the needs of both men and women. Of course, we recognise that different approaches need to be taken for men and women in the provision of treatment of major conditions, especially over the whole course of life.

The Secretary of State for Health and Social Care, in Men’s Health—which is not a magazine I have read, but I have seen the cover—explicitly invited men to respond to the call for evidence to help us to ensure that the strategy takes into account the needs of men. I know that my hon. Friend the Member for Don Valley wants the Government to go further on this issue. He has already raised the issue with the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Lewes (Maria Caulfield), and I would also be happy to meet with him to discuss it.

[Andrew Selous]

I ask the Minister to forgive me if he was coming to this, but before he concludes, will he say a little bit about the third of dementia patients who go into hospital continent and come out incontinent? Many of them are actually trying to get to the toilet but have had difficulty. I find that very upsetting. As I said, it is not an easy issue, and I 100% get the pressures on the staff, but I think the issue is something that has not been spoken about. It has just happened under the radar. I am not expecting an answer today, but I would like a recognition that the Minister has clocked it, is concerned about it, and will take it back to the Department, because I was really upset when I learnt about that figure.

[Will Quince]

I entirely understand why my hon. Friend would be upset. In truth, I do not have an answer for him immediately. If he holds fire, however, I am going to make a broader offer to meet with him directly or alongside the APPG to discuss that and any other issues with NHS England and officials in the Department who are experts in the area. He raises a powerful point, and it is an issue that we need to explore further.

The hon. Member for Strangford raised prostate cancer statistics. I will write to him specifically, because I know he would like more detail on this issue. He is absolutely right that there has been a considerable increase in diagnoses of prostate cancer. I think the statistics are that in 2020 we diagnosed something in the region of 36,000 cases, whereas in 2000 it was 25,000, which is something like a 45% increase. Diagnosis is generally a good thing, especially early diagnosis, because it means that we are catching the disease early. However, I understand that about 51% of prostate cancers were diagnosed at an early stage in 2021, which demonstrates that we have a lot more to do in that space. I will write to the hon. Gentleman on that point, and will raise it with my hon. Friend the Member for Faversham and Mid Kent.

I have not answered all the questions that my hon. Friend the Member for South West Bedfordshire asked. As tempting as it is to take up the remaining 35 minutes of the debate, I will commit to meeting with him personally, or indeed with the all-party parliamentary group and campaigners, alongside NHS England and the Department, to talk about some of the other issues in detail. I think they certainly warrant that, so I would be delighted to do that.

In summary, NHS England has published its delivery plan, which sets out our proposals to improve options for community-based services to treat urinary tract infections. In addition, NICE has produced guidance on the management of faecal incontinence in adults. The annual spend on incontinence products from part IX items alone is approximately £255 million. As I said, we know how important patient choice is and understand that having a range of continence products is important to living well with this condition. That is why I can promise that there will be a focus on making changes to part IX of the drug tariff.

To conclude, I know that many people who experience bladder and/or bowel problems experience stigma, a point made eloquently by my hon. Friend the Member for South West Bedfordshire. They can be embarrassed to talk about the symptoms with friends, family and even, to some extent, healthcare professionals. That is why I am particularly pleased that my hon. Friend secured today’s debate, which has provided me the opportunity to play a small part in tackling the stigma that surrounds this issue. I think all hon. Members that have taken part in this debate have helped to defeat the stigma that surrounds the issue. I am not so naive as to think that there will be thousands watching this debate at home, but the debates are kept online and I hope people will watch. They will realise that it is vital to talk to medical professionals about their health issues and problems in this space and, wherever they feel it is necessary, to seek out professional care.