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NHS: Incontinence Services

Volume 712: debated on Tuesday 30 June 2009


Asked By

To ask Her Majesty’s Government what progress has been made in delivering the commitment set out in the 2001 National Service Framework for Older People to establish integrated incontinence services by 2004.

My Lords, we have made good progress using some of the following tools: NICE guidelines, the national framework, audits conducted by the Royal College of Physicians, the productive community services programme and a commissioning programme aimed at female incontinence. We are aware of local variations in the provision of incontinence services and so continue to work for a high level of integrated incontinence services across the country.

My Lords, I thank the Minister for that helpful reply. Bearing in mind that incontinence is the last great health taboo, a massive public health problem that affects 4 million to 6 million people—men, women and children—and is more prevalent than asthma, epilepsy and even dementia, will the Government consider adding incontinence management to the list of national health improvement programmes?

My Lords, the health improvement programmes are currently focused on the priorities set out by my noble friend Lord Darzi in the next-stage review, but we know that a modest investment by the NHS in developing early intervention and assessment services would produce important benefits in terms of a better quality of life for patients and significant cost savings, so incontinence care is being taken seriously by the Department of Health. It will be incorporated into a later phase of a package for older people in order to promote improvements to health and well-being in later life.

My Lords, that is all very fine, but at the last count only a fifth of trusts actually had someone in post who was in charge of incontinence services, which simply will not do. Will the Minister say whether there is a date by which we can expect someone responsible and trained in handling incontinence problems to be in post in all trusts? Will she also say whether incontinence products other than the usual, bog standard ones—I apologise for the pun—can be made available to meet the very different needs of incontinence sufferers?

My Lords, it is clear that the management of incontinence issues has to be developed and delivered at the local level. The noble Baroness is correct to point out the need to make available the right guidance and support to deliver these services. Those things are in place, but we now need to make sure that our monitoring services pinpoint those areas that are not delivering a proper level of care to patients with incontinence. The development of products is a matter that we have under review. I cannot give the noble Baroness any more detail on that now, so I will write to her.

My Lords, as a spinal cord-injured person, I declare an interest. Maintaining our continence is fundamental to ensuring our dignity, yet the current practice of some PCTs is resulting in some people being forced to use basic products that do not meet their needs. Can my noble friend give an assurance that the NHS will provide users with the most appropriate product, not the cheapest?

My Lords, my noble friend makes an important point. Good practice in incontinence services recommends that a range of pads should be available in all categories, including bedpans and a variety of sizes of pads with different absorbencies. Rationing is totally unacceptable and the Government have made it completely clear that incontinence pads should be provided in sufficient quantities to meet individuals’ needs.

My Lords, this is not an easy subject, but it is made more complex by the insistence of primary care trusts on adopting their own policies, thereby causing a great deal of confusion. That means that people are deprived of important medical facilities and treatments. The Government should intervene, regardless of their present stance.

My Lords, there can be no doubt that PCTs have been given the message that the Government regard incontinence care as a priority. They have been given the guidance, the toolkits and the support. Most are doing well. We have to bear down on those that are not doing well and we have to make sure that they improve the services.

My Lords, the Minister mentioned monitoring. I understand that NICE is undertaking a review of the quality and outcomes framework indicators. Would this not be a good moment to have a look at these again and will the Government support the inclusion of incontinence care in the review?

My Lords, the noble Baroness is right. In April 2009, NICE took over the responsibility for overseeing a new independent process for prioritising, developing and reviewing the quality and outputs framework of what happens in clinical and health improvements. Any new topic for inclusion in what is known as the QOF will need to be made to NICE as part of this process. The noble Baroness points to an important matter. The process of prioritisation of topics will be made by the advisory committee and decisions on whether to include things will be based on evidence of clinical and cost effectiveness. I think that I feel a campaign coming on.

My Lords, the Minister gave what I am sure will be a very well received assurance to the noble Baroness, Lady Wilkins, but the fact remains that there is a great deal of concern out there about a postcode lottery. Will the Government consider putting in place a system to monitor the practices of PCTs to ensure that some of the commissioning processes that I am aware of, including local formularies and very restrictive tendering procedures, are not used to the detriment of incontinence patients?

My Lords, what we will find with world-class commissioning and its monitoring process is that this is an issue that will be tackled at that level. Where PCTs are not using commissioning processes that provide the end result of a good-quality service for incontinence sufferers, that will be highlighted and we will need to make sure that we pick it up.

My Lords, the Minister talked about prioritising incontinence services within the health service. Can she let the House know how many priorities there are within the health service? Surely each one that is added devalues the rest.

My Lords, my point was that we regard this as a priority, but the delivery of the service has to be done at local level. That is for obvious reasons: the resources are at local level. The Government have said, “We regard this as important and this is how we think you need to deliver a proper service”.