Paediatric Continence Forum
Political and Parliamentary Monitoring
Week Commencing 6th August 2018

The number of patients waiting over a year for non-urgent NHS surgery a hit a record high, new data has revealed, as the chair of the Royal College of GPs has urged the Government to address the “haemorrhaging” of staff and serious shortfall of doctors.

New figures indicate that 3,517 patients in June had been waiting over a year for non-urgent surgery, despite a pledge in 2014 by the then Health Secretary, Jeremy Hunt, to end “unacceptable” delays. The news that the waiting list has increased by another 400 patients since May comes as the health service is reeling from a ‘summer crisis’ brought on by the hot weather. NHS Providers, the trade association representing NHS acute, ambulance and community health services, has said some Trusts are experiencing unprecedented demand on A&E services.

The NHS target is to see 90 per cent of patients who need non-urgent operations within 18 weeks, but the new data shows that the number of patients seen within the target time was 87.8 per cent. Chris Hopson, Chief Executive of NHS Providers, has said the summer was providing “no respite” for NHS staff, with the service running at “boiling point” all year round. June’s figures also show that the waiting list for routine treatments continues to travel in the wrong direction. Performance by NHS Trusts against the 62 day wait cancer target, for example, shows the performance rate is at its lowest level since data collection began in 2009.

The news that the NHS is experiencing unprecedented strain comes in the same week that Professor Helen Stokes-Lampard, Chair of the Royal College of GPs, has warned that waiting times for GP appointments were already at an “all time high”, and that the country needs the help of thousands of overseas doctors in order to plug the shortage of staff. An annual survey of more than 800,000 patient experiences of getting GP appointments has found that 20 per cent wait more than a week to be seen, whilst a further 11 per cent are unable to obtain an appointment at all. Ms Stokes-Lampard urged the Health Secretary to increase investment in general practice in order to ease pressure.

This news will interest PCF members, as urological assessments and treatments are usually considered non-urgent. We will continue to monitor waiting times, and any Government announcements regarding extra funding for the health service.

• Better training needs, Forum says
• NHS embraces technology
• New public toilet campaign launched

Better training needed to improve continence care
The Nursing Times, which held a roundtable event discussing continence care last month, has said that whilst awareness of continence issues is on the rise, better training was needed in order to improve levels of care. Colleagues from across the charity and health sectors celebrated the fact that the quality and number of products had improved vastly, but warned that funding pressures sometimes limited the ability of nurses to provide appropriate options.

Many members warned that cutting the budget for pads and other continence devices was a false economy, with costs incurred later as patients appear at GPs or hospitals at a later date with more complex needs that takes longer to assess, treat and prescribe for. Indeed, many panel members suggested that there weren’t enough ward nurses, with Juliana Tinhunu, a clinical nurse specialist for continence at Barts Health NHS Trust saying that “sometimes [nurses] think it’s easier to put pads on patients instead of doing continence assessments”.

Moving forward, many members at the roundtable event suggested that more work needed to be done to attract nurses in to the continence sector. Caroline Knott, Bladder and Bowel Specialist Nurse at Kent Community Health Foundation Trust, described how nurses have been “putting off” training because they don’t want to do continence procedures. Others described how staff can struggle to discuss continence issues openly, making it difficult for patients to be treated.

The views expressed at this conference will be of great interest to PCF members, who have expressed concern about the pressures on nurses and lack of trained staff specialising in continence care. Whilst many members will agree that the quality and variety of pads has continued to improve, the Forum will acknowledge the value of having trained staff on hand to support young people and others with continence issues.

Whitehouse will monitor any response to the Government to the round-table discussion, most notably regarding nursing staffing levels and the provision of continence services.

NHS embraces new technology in effort to tackle stress urinary incontinence
The NHS is moving to embrace new technology in an effort to tackle incontinence. This week, NHS Supply Chain announced it was making available an at-home biofeedback device for pelvic floor muscle training. With a retail price of £169, the ‘Elvie Trainer’, as the device is known, will help the 32% of women who have urinary incontinence. As it stands, the NHS spends over £230 million annually on treatments, devices and support for people with continence issues.

It is claimed the new technology could revolutionise continence care. The device is places inside the vagina and connects to an app in which the user can receive biofeedback to help improve continence techniques. The biofeedback device is thought to improve both compliance and success rates by 10% as well as reducing surgery rates by 50%. Hannah Rose Thornton, Head of Strategic Partnerships and Health at Elvie, said the availability of the Elvie Trainer “represents the opportunity to reduce the costs to the NHS and improve outcomes for patients”, adding that the company was “thrilled that the NHS is investing in tools to support conservative management of stress urinary incontinence”.

The product has been hailed as simple to use, whilst the App which provides user feedback has been lauded as “beautiful” and “simple” by health physiotherapists. The news that the new urinary continence device has been launched comes less than a month after the new Secretary of State, Matt Hancock, announced a £500 million investment in technology. Criticising the “binary” approach to care, Mr Hancock pledged that the money would be spent on reducing waiting times, digitsing the health service, and development new and effective treatments.

Whitehouse will continue to monitor technological advances, and will report on any new consultations linked to technological testing or development.

New campaign to increase the number of toilets available for use
Over the last month, we have reported on the news that some of the UK’s largest cities have no public toilets suitable for people with disabilities and continence needs, with some councils reducing all of their services. Now a new campaign has been launched to encourage private businesses to open up their toilets for general public use.

Over the past two decades the number of public toilets in the UK has slumped by nearly 40%, according to responses to freedom of information requests, as local councils continue to experience squeezed budgets. The total number of public toilets in the UK has fallen from 3,955 in 2000 to 2,414 this year, according to the British Toilet Association, with the average local authority in England operating just 15 toilets. This means that, on average, each public toilet in the country serves 12,500 people.

The news that there has been such a dramatic cut in the number of toilets comes just a month after Paula Sheriff MP raised the issues of Changing Places facilities in the House of Commons. This week it was revealed that disabled women and undergoing unnecessary surgery in order to avoid the embarrassment and discomfort of struggling to find or use a public toilet.

A new campaign, “Use our Loos”, launched by the British Toilet Association, is urging businesses to make their toilets available to non-customers. Each participating outlet will be encouraged to have a sticker on display so the public can easily spot a business happy for people to use its facilities. Many restaurants and cafes have easily-accessible facilities, which would benefit the 250,000 disabled people who currently struggle to find public toilets. Indeed, the British Toilet Association said this would be a great help to older people, families and people with medical conditions.

The PCF will monitor the launch and the success of the scheme, highlighting successes and reporting on concerns and feedback.