NHS leaking over half a billion pounds a year – due to poor incontinence care

People affected by incontinence share how it has affected them and their loved ones

The NHS is “leaking” more than half a BILLION pounds a year – through substandard incontinence care, according to a report. There are currently 164,833 people in residential care and nursing homes who experience difficulty with bladder or bowel control.

But an eight-week, value-based procurement pilot, carried out at two care homes in Lincolnshire, has exposed both the cost, and indignity, of cheap, ill-fitting pads and protection.

The study, carried out by hygiene and health company Essity in partnership with the NHS, investigated the impact of providing more clinically appropriate products, in lieu of those chosen on unit cost alone.

It found the average patient wearing the current product offering was likely to experience up to 2.5 leaks a day, needing staff time to change, and required six pads per day – at a total cost of £15.33.

By comparison, just four of the more expensive pads were needed, and there were an average of 0.5 leaks per person, with a cost of only £6.68.

It also recorded a 75 percent reduction in leakages requiring bedding or clothing to be washed, and an 18 percent increase in patients being able to self-toilet.

Essity is now calling for the government to conduct an urgent review of continence care procurement practices in the NHS.

It also wants to work with the NHS and industry partners to support the implementation of value-based procurement – an approach that takes the total cost of care into consideration and puts the benefit to the patient first, rather than simply procuring based on the cost per product.

In addition, Essity surveyed 500 medical professionals who look after incontinence patients, which revealed 67 percent find it particularly difficult that the person they care for might be deeply distressed or ashamed of their situation.

There is no such thing as one size fits all when it comes to incontinence care

Gareth Lucy, Essity

And 71 percent admit they are sometimes supporting patients who might be able to be independent, were the quality and fit of their pads or pants better.

Meanwhile, 78 percent can find themselves treating patients who would self-manage better with more education and information.

And furthermore, 59 percent have frustrations with the procurement of incontinence pads via the NHS – with poor fit being the main concern (62 percent), while 37 percent said they’re not always fit for purpose.

These nursing professionals want the determining factors for the procurement of products to be addressed – with 67 percent saying the extent of the incontinence needs to be the number one consideration.

This should be followed by the patient’s physical (62 percent) and mental (49 percent) health.

Other factors used to work out what products are needed to treat a patient with incontinence would ideally be whether carers are needed to assist with a change (45 percent), the patient’s dexterity (35 percent), and gender (31 percent).

Gareth Lucy, spokesman for Essity, said: “There is no such thing as one size fits all when it comes to incontinence care.

“We are appealing to the government to look beyond simply the cost per unit of the products they procure for the NHS, and instead look at the specific needs of the patient first, and consider the total cost of their care.

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“Choosing the cheapest incontinence product might seem like a cost saving, but it’s a false economy.

“A lower-quality incontinence product is more likely to leak, needs changing more often, and therefore increases the use of related products such as latex gloves, aprons, wipes, and the cost of cleaning bed linen and clothing.

“In addition, more regular changing and cleaning requires time for healthcare professionals, and impacts the dignity for the patient.”

A second study was carried out, via OnePoll, polling 1,000 adults with relatives in a care home or hospital setting – and of these, just under half said their relative is incontinent.

For those affected, 45 percent need medical assistance from a professional or carer to manage their incontinence for them, and this can be anything up to five times a day.

More than nine in ten said their relatives with incontinence wear some kind of protection – but problems cited with this include comfort (42 percent), the fact it needs changing so regularly (42 percent), and leaks (41 percent).

Understandably, this leads to 45 percent of those polled feeling that their relative has a poor quality of life as a result, while 42 percent feel anxious about their overall wellbeing.

Independent dementia nurse consultant, Zena Aldridge, 51, from Norwich, regularly supports people living with dementia, and their family carers, who are affected by incontinence.

She said: “The NHS and social care tend to adopt a pad culture approach, which means some other strategies that help promote continence aren’t offered.

“Assessments need to be offered to highlight effective strategies for managing or reducing incontinence.

“People with dementia need a full assessment to see which product might be most appropriate for them.

“For a lot of people there’s this pad culture, where incontinence is seen as a symptom of dementia, rather than looking for underlying problems that might be contributing to it.

“Containment appears to be the priority. For me, there’s a balance between maintaining independence, autonomy, and dignity.”

Tracy Evans, clinical team leader for the Continence Service, Southern Health NHS Foundation Trust, added: “Provision of products without assessments could result in patient harm.

“Without clinical influence in tendering, the focus becomes on cost per product, rather than quality and patients’ needs.

“In some areas of procurement, there is a belief that clinical input is not required when selecting products.”

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