Diagnosis and treatment of incontinence poor

People with incontinence face with a “life sentence” of suffering because of disorganised and poor quality services, an audit published today by the Royal College of Physicians has found.

The National Audit of Continence Care found services were poorly organised so care provided was disjointed for both patients and carers. Many hospitals fail to provide care according to NICE recommendations and a quarter of PCTs were not commissioning according to NICE guidelines.

The report concluded that there is an urgent need for improved and equitable practice for all people with bladder and bowel problems.

The audit, commissioned by the Healthcare Quality Improvement Partnership (HQIP) and carried out by the Royal College of Physicians’ Clinical Effectiveness and Evaluation Unit (CEEU), surveyed the care given to more than 18,000 people.

It found that diagnosis and treatment of incontinence was often poor or non-existent. Half of patients in mental health and care home settings, and 29% of older people in primary care and 36% cent of older people in acute care did not have a treatment plan for urinary incontinence. And only half of older people in acute and primary care services had a documented diagnosis for faecal incontinence and a documented care plan was evident in only one third of patients in acute hospitals.

In general, continence services were found to be poorly integrated across acute, primary, care home and community settings, resulting in disjointed care for patients and carers. In most cases no one had specific responsibility for commissioning and improving continence services.

Training of healthcare professionals was “inadequate” with structured training in continence care occurring in only 49% of acute hospitals and 39% of mental health care sites.

Dr Adrian Wagg, Clinical Director of the National Audit of Continence Care, said the findings showed that there was an urgent need for improved and equitable practice for all people with bladder and bowel problems to ensure they received an acceptable standard of care.

He said: “Bladder and bowel incontinence affects one in five 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.”

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