Written Evidence submitted by Baroness Greengross and Rosie Cooper MP (co-chair), the All Party Parliamentary Group on Bladder and Bowel Continence Care (RTR0065)

About the APPG on Bladder and Bowel Continence Care

The APPG for Bladder and Bowel Continence Care’s aims are: To break the taboo by raising awareness of bladder and bowel continence for adults and children and to promote cost effective funding for assessment, treatment and appropriate product provision.” It was established in 2009 as the APPG for Continence Care. The name was changed in 2020 to the APPG for Bladder and Bowel Continence Care on the advice of clinicians who work closely with the APPG. 

The APPG is chaired by Rosie Cooper MP and co-chaired by Baroness Greengross.  Since 2009, it has benefited from the support of a dedicated group of clinicians and as well as supported by a number of Royal Colleges.  The Group has worked closely with NHS England and that collaboration led to the publication of the ‘Excellence in Continence Care Guidelines’ in 2015 which were revised in 2018. The document gives practical guidance for commissioners, providers, health and social care staff to help ensure people receive excellent continence care consideration.

It is estimated that 14 million men, women, young people and children of all ages are living with bladder problems.  An estimated 61% of men in the general population experience lower urinary tract symptoms and around 34% of women are living with urinary incontinence. In addition, around 900,000 children and young people suffer from bladder and bowel dysfunction. Over 500,000 adults experience regular faecal incontinence.  Urinary and faecal incontinence also affect one in three people living in residential care.

The pandemic has also resulted in a large number of people waiting longer and longer for treatment as bladder and bowel problems are viewed as a low clinical priority resulting in an increase in psychiatric disorders.  Clinical prioritisations need to be reviewed so that benign surgery is given a higher profile.

The APPG believes that it is vital that there is an adequately trained workforce to provide support, assessment and treatment for people with bladder and bowel problems who have for far too long been considered a low priority.  The development and retention of a workforce is vital to ensure not just the best care for patients but also cost effective treatment for the NHS.

What are the main steps that must be taken to recruit the extra staff that are needed across the health and social care sectors in the short, medium and long-term?

To address the acute shortage of trained staff capable of diagnosing and treating the growing numbers of those with bladder and bowel problems, there needs to be some creative thinking regarding incentives both to recruit and retain extra staff. 

The APPG would like to propose that a one-off financial incentive (‘golden hello’) could be considered to encourage the recruitment and training of staff in this much needed specialism.

What changes could be made to the initial and ongoing training of staff in the health and social care sectors in order to help increase the number of staff working in these sectors?

To what extent is there an adequate system for determining how many doctors, nurses and allied health professionals should be trained to meet long-term need?

Do the curriculums for training doctors, nurses and allied health professionals need updated to ensure that staff have the right mix of skills?

There appears to be no adequate system for determining workforce requirements to meet long term needs with regard to continence care.

The Royal College of Physicians used to carry out audits which looked at all aspects of continence care including the workforce but funding was withdrawn.  In 2010 an audit carried out by Healthcare Quality Improvement Partnership (HQIP) and the Royal College of Physicians’ Clinical Effectiveness and Evaluation Unit (CEEU) concluded that “people with incontinence are faced with a ‘life sentence’ of suffering, due to poorly organised NHS services and disjointed care for patients and carers”. ( https://www.hqip.org.uk/wp-content/uploads/2010/01/2010-NACC-Annual-Repot.pdf

Dr Adrian Wagg, Clinical Director of the National Audit of Continence Care, painted a stark picture of the care of people with incontinence:

“Bladder and bowel incontinence affects 1 in 5 people causing ill health, depression, social isolation, and costing the NHS millions of pounds. Although these are treatable conditions, people of all ages, and vulnerable groups in particular (frail older people and younger people with learning disability) continue to suffer unnecessarily and often in silence, with a 'life sentence' of bladder and/or bowel incontinence”.

The audit surveyed the care given to 18,253 people across 135 NHS Acute Trusts, 26 Mental Healthcare Trusts, 86 Primary Care Trusts, and 122 care homes.  Since this audit, it is widely recognised that there has been a profound deterioration in availability of continence care.  Examples include staff shortages in acute care Trusts such as in pelvic floor physiotherapy where many patients have to seek private consultations to get appointments, and especially in community nursing, which is now virtually non-existent in some parts of the country. 

The APPG proposes that a new detailed audit of continence care needs and workforce and training requirements be commissioned. Given our ageing population this is urgently required.

The existing tenuous situation is being compounded by an ageing workforce. Experienced nurses are retiring and at times they are not replaced or replaced with lower band nurses who do not have the in depth knowledge. There are some industry run, nurse association and regional university education courses but at the present time the APPG understands that there are no NHS provided courses to allow new nurses to enter either the stoma or urology/continence specialism. With the patient population growing there is a clear need for NHS Education to put in place training courses to allow a robust succession plan for these very specialist segments of healthcare. 

The APPG believes that the training for doctors, nurses and allied health professionals with regard to continence care needs to be addressed and a higher priority given to this specialism by those responsible for devising the curriculums as well as continuous professional development.  We suggest that an urgent review takes place at how continence care is covered in the curricula of medical schools and that greater priority is given to this important and much neglected area of healthcare.

January 2022