Nearly half of Brits who have a family member currently living in a hospital setting or care home – say their loved one struggles with incontinence, research has found.
The condition, which causes loss of bladder or bowel control, currently affects two-thirds of adults living in care homes, and one in three of those in a residential setting – adding up to 164,833 people in the care system nationwide.
And this leaves 42%, of the 1,000 relatives polled, feeling worried about their loved one's general wellbeing – as 45% said their family member with incontinence requires professional medical assistance to help manage it, which can be required up to five times a day.
And the same number (45%) even feel their relative has a poor quality of life – with more than nine in ten needing to wear some kind of protection to guard against their lack of control.
However, the concerns related to these include discomfort (42%), leaks (41%), and the fact that they need changing so regularly (42%).
The study followed an eight-week, value-based procurement pilot, carried out at two care homes in Lincolnshire – which exposed both the cost, and the indignity, of cheap, ill-fitting pads and protection.
It emerged that substandard incontinence care is costing the NHS over half a billion pounds a year, compared to investing in more expensive, but better quality, pads.
The study was carried out by hygiene and health company, Essity, in partnership with the NHS, and 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. This adds up to a saving of £3,157.25 per person, each year – or £520,418,989.25 nationwide.
It also recorded a 75% reduction in leakages requiring bedding or clothing to be washed, and an 18% 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 conducted a separate survey of 500 medical professionals who look after incontinence patients, which revealed 67% find it particularly difficult that the person they care for might be deeply distressed or ashamed of their situation.
And 71% admit they are sometimes supporting patients who might be able to be independent, were the quality and fit of their pads or pants better.
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Meanwhile, 78% can find themselves treating patients who would self-manage better with more education and information.
And furthermore, 59% have frustrations with the procurement of incontinence pads via the NHS – with poor fit being the main concern (62%), while 37% 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% saying the extent of the incontinence needs to be the number one consideration, followed by the patient’s physical (62%) and mental (49%) 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%), the patient’s dexterity (35%), and gender (31%).
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.
“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.”
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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