Incontinence: ‘Lack of support’ for older children says Dr Penny Dobson

April 30, 2019 in Uncategorized by Whitehouse

Guidelines from the UK’s National Institute for Health and Care Excellence (NICE) say that people with bladder and bowel problems from birth to 19 years old should have access to integrated, community-based paediatric continence service led by a specialist nurse.

In 2017, just one of the seven Welsh health boards provided the recommended service, according to a Freedom of Information inquiry by a campaign group, the Paediatric Continence Forum.

Across the UK, the figure was 41% – two out of every five equivalent bodies.

Research by BBC Wales suggests the situation in Wales has improved recently to reflect the UK average, with three health boards – Aneurin Bevan, Betsi Cadwaladr, and Cardiff and Vale – saying they provide the recommended service.

The other four boards said children were supported through a range of services such as school nurses, physiotherapists and consultants.

However, Dr Penny Dobson, founder and chair of the Paediatric Continence Forum, claimed there was a “failure” of provision and the situation still needed “radical improvement”.

Dr Penny Dobson

“I think many will be suffering in silence,” she said.

“It’s a neglected area of child health but the effects on the child and the family – if it’s not addressed at an early stage – can be devastating.”

“Continence problems have a known link with mental health difficulties,” Dr Dobson added.

“Children can feel different, it affects their self-esteem, they can’t always go on social activities and it affects them at school. Bullying is a problem for many children with continence problems.”

If not properly assessed and treated, Dr Dobson said children could also end up in A&E with serious constipation, or kidney problems caused by urinary tract infection.

Where the full service provision does exist in Wales, parents claim it is overstretched.

Bethan (not her real name) is also in her first year at secondary school and has bladder incontinence which has led to anxiety problems.

“Only one friend knows, she’s really close. If I tell another friend she’ll probably tell everyone,” she says.

“Everyone will start asking – I don’t want to go through that hassle.”

Her mother says: “For young people, living with this is horrendous. There’s nothing funny about it. It affects their quality of life and they need support.

“Bethan has had times where’s she’s refused to go to school, leave the house or go anywhere because she’s hiding. That’s heartbreaking.”

She adds: “There’s not enough funding, not enough staff, not enough counselling services for children with bladder and bowel problems.

“It’s really important to remember that the children go to the clinic every couple of months and that’s the only chance they get to offload, to cry, to laugh and to bond with the health professional.

“It’s just so important to children’s general wellbeing.”

‘Lack of school support’

Children’s Commissioner for Wales Sally Holland said youngsters should have the same level of support wherever they live.

“If 40% of the health boards in Wales can meet the NICE guidelines, then there’s no reason why the others can’t as well,” she said.

Ms Holland added that families had contacted her with complaints about the lack of support in school.

“That reinforces the fact that this not just an issue in the home, it’s an issue wherever the child goes,” she said.

The Welsh Government said it expected health boards to deliver services in line with NICE guidelines.

“It is essential that children and young people with continence problems undergo a comprehensive assessment to identify underlying problems and ensure these conditions are diagnosed and treated by the appropriate clinician,” a spokesman said.

Weekly political news round-up – w/c 22nd April 2019

April 22, 2019 in Uncategorized by Whitehouse

Although she promised to resign upon her Brexit deal being voted through, Prime Minister, Theresa May, kicked the notion into the long grass when the Brexit deadline was extended until the 31st October. This week, senior Conservatives ruled out changing their rules to allow for an early challenge to Theresa May’s leadership, but have asked the Prime Minister for more clarity about exactly how long she plans to remain in office.

Under current rules, MPs cannot hold a new confidence vote in her leadership until December – 12 months on from last year’s vote, which she won. The 1922 Committee rejected bringing forward this deadline at a meeting, but Chair, Graham Brady, said MPs need a “clear roadmap” about her future.

Meanwhile, Scotland’s First Minister, Nicola Sturgeon, said she wants to hold a second referendum on Scottish independence by 2021 if the country is taken out of the EU. She told Holyrood that she would introduce legislation soon to set the rules for another vote, but indicated that she would need the agreement of the UK Government before doing so. Downing Street have said previously that it will not grant a new Section 30 order, which underpinned the 2014 referendum, so Ms. Sturgeon now faces the challenge of making ‘IndyRef2’ a reality.

Elsewhere, The Brexit Party and Change UK: The Independent Party launched their European Election campaigns with a flurry of candidate announcements. Reports of unsavoury tweets, racism and misogynistic slurs quickly came to light – but not from where you might expect. Change UK, self-proclaimed progressives standing up for EU citizens, landed themselves in hot water after one of their key MEP candidates was discovered to have said derogatory remarks about Romanian nationals just two years ago. Although different from their usual candidates, perhaps not the change they were looking for.

Ann Widdecombe also joined the line-up of EU election candidates, cancelling her decades of faithful Tory membership to stand as a candidate for The Brexit Party. With no sign of a Brexit deal being agreed anytime soon, it looks like the UK is heading full-throttle towards electing a new batch of MEPs.


Pre-school children with chronic constipation ‘often picky eaters’

According to US researchers, care of children with chronic constipation should include consideration of sensory issues and possible referral to occupational therapy – claiming their findings are “revolutionary”.

They have found that pre-school children who are developing normally with chronic constipation have underlying sensory issues that contribute to difficulties with toileting behaviours.

These children were found to often be picky eaters who might be overly sensitive to food textures, tastes, or odours, according to the authors of the study. In addition to this, such children might also have an exaggerated response to noises, bright lights, or other senses that can be stimulated.

In the new study by the Journal of Paediatrics, they assessed the differences in sensory processing patterns between 66 children, aged three to five years of age, with chronic constipation and a matched group of 66 controls. They also examined if and how the children’s sensory profiles correlated to the typical toileting behaviours of children.

Senior author, Dr. Mark Fishbein, from Northwestern University, said: “Our study is revolutionary, revealing that chronic constipation in young children accompanies heightened sensory sensitivity.

“In many cases, chronic constipation might be the first hint that the child also has some sensory issues and could benefit from occupational therapy. Feeding problems due to sensory sensitivities are especially common in these children and they are best addressed when kids are under five, before maladaptive behaviours become more entrenched.”

This news will interest PCF, given that knowledge of the link between chronic constipation and sensory sensitivity could transform clinical practice and provide further help for children with bladder and bowel continence issues.


NHS sees productivity grow twice as fast as economy

Productivity in NHS England has grown at twice the rate of the wider economy, despite reports that the Government is using ‘inefficiencies’ to justify further cuts.

Improvements in numbers of patients treated in the NHS each year have vastly outpaced investment in staff and budgets, a report by the Centre for Health Economics at York University found. For every £1 spent, the NHS delivered 16.5 per cent more care in 2016/17 than it did in in 2004/05. This compares to productivity growth of just 6.7 per cent for the wider economy.

With budget increases held to just 1 per cent a year as part of the Conservative Government’s drive to increase efficiency, staff have reportedly been left to work longer hours and more days.

“This is a huge tribute to the work of NHS staff, and the intrinsic efficiency of this country’s health service,” NHS England Chief Executive, Simon Stevens, said.

“This independent research confirms that NHS productivity has been growing at more than double of what was achieved by the rest of the UK economy, including the private sector.”

From April, the NHS is due to receive the first instalments of the £20.5bn additional funding promised by Theresa May. However, the investment is less than NHS England said was needed to overturn austerity measures imposed by the Government. Despite this, the Prime Minister has said it was only available on the basis that it “tackles waste, reduces bureaucracy and eliminates unacceptable variation”.

A spokesperson from the Department of Health and Social Care said: “The NHS Long Term Plan sets out a plan to make every penny of taxpayers’ money count and ensure the health service works hard to provide the best possible services and outcomes for patients in the most cost-effective ways.”

PCF will welcome this news, given that it demonstrates the NHS is making progress, despite ongoing budget cuts, to boost productivity and meet increased demand. Children with continence issues may find that they are seen quicker and more frequently as a result.


Councils place ‘unlawful hurdles’ in way of parents seeking SEND support

Councils with stretched budgets are allegedly putting hurdles in the way of parents seeking support for children with special educational needs and disability (SEND) by setting “unlawful” criteria to receive a needs assessment, The Commons Education Select Committee heard this week.

MPs were told that the recommendations of SEND experts were regularly being overridden by “somebody who is controlling a budget”. The Committee was hearing evidence as part of its ongoing inquiry into SEND.

One of the topics covered during the session was the high number of successful appeals against council decisions relating to education, health and care plans (EHCPs).

Alison Fiddy, the Chief Executive of the Independent Parental Special Education Advice, which offers independent legal advice on SEND, said: “If local authorities complied with the law and were able to justify their decisions not to carry out an assessment of a child’s needs when a request is made, that would also result in fewer appeals.”

Ms. Fiddy said that councils were engaging in “gatekeeping” when it came to SEND support. Her comments were backed up by Michael King, the Local Government and Social Care Ombudsman. “What we’re seeing is some local authorities introducing requirements that parents must meet before they will accept their duty to carry out a needs assessment.” he said.

The news that recommendations by specialist nurses are being overridden by somebody who is controlling a budget will be of great concern to PCF, given that the need for continence care provision will be overlooked on a financial basis and not one of necessity.