THE UNPLANNED ADMISSIONS CONSENSUS COMMITTEE RESPONDS TO NHS ENGLAND’S ‘EXCELLENCE IN CONTINENCE CARE’ GUIDELINES - AUGUST 2018
The Unplanned Admissions Consensus Committee (UACC) welcomes the Excellence in Continence Care guidelines, published by NHS England last month. The guidelines, which build on an earlier publication from November 2015, give practical guidance for commissioners, providers, and health and social care staff to help ensure people receive excellent continence care consideration.
The UACC is delighted to announce that the guidelines are aligned with many of the recommendations of the committee’s Best Practice Guide. Key conclusions, such as the importance of ensuring a greater patient involvement in the decision-making process by improving patient education; or developing a public awareness campaign are shared by both guides.
The UACC also welcomes NHS England’s efforts to highlight the importance of other non-medical clinicians in continence care management. Whilst this was mentioned in the original guidelines, it has been reinforced in this updated version. The guidelines emphasise the role of physiotherapists and other clinicians, such as occupational therapists – a role which is sadly forgotten in many occasions. The UACC believes that non-medical clinicians are essential in continence care, and including them in the committee is currently a priority.
However, whilst improving training is clearly mentioned within these new guidelines, they could go further to emphasise the importance of training general practitioners specifically. As the UACC Best Practice Guide shows, a poor understanding of continence issues within general practice can leave patients in the community feeling isolated and unsure of who to turn to for advice.
The committee welcomes the recent interest in improving continence care, not only by NHS England, but also conveyed by Getting It Right First Time (GIRFT) in its urological report, published in July as well. However, it is now time to move from words to actions and ensure that high-quality continence care services can be accessed by everyone in the United Kingdom.
THE UNPLANNED ADMISSIONS CONSENSUS COMMITTEE RESPONDS TO GIRFT REPORT ON UROLOGY SURGERY - JULY 2018
On the 11th July 2018, the Getting It Right First Time (GIRFT) programme published a report calling for the further development of specialist urological nursing to deliver high quality, patient-focused urological care.
The report is a major acknowledgement of the importance of addressing urological issues, which put an enormous strain on the NHS. It is essential to change the way in which services are delivered.
The report sets out a series of recommendations to improve the delivery of NHS urology services and offer a better patient experience. The aim is to reduce unnecessary admissions, length of hospital stays and help improve waiting times for those requiring admission for surgery, which clearly aligns with the UACC’s objectives.
The UACC welcomes the recommendations and hopes to see positive change in urology moving forward. As always, the Committee is looking forward to collaborating with different units and organisations to ensure that better care to deal with incontinence issues is delivered.
THE UNPLANNED ADMISSIONS CONSENSUS COMMITTEE SUPPORTS WORLD CONTINENCE WEEK 2018 - JUNE 2018
The Unplanned Admissions Consensus Committee (UACC) is delighted to have supported World Continence Week 2018, which ran from 18 – 24th June, and is an annual initiative to raise awareness about continence and continence-related issues. The UACC believes this is an important initiative which highlights that more needs to be done to improve continence care.
Despite being a healthcare taboo, continence is one of the most frequent reasons for emergency hospital admissions in the UK. Urinary tract infections (UTIs) are the second-largest single group of healthcare-associated infections in the UK, accounting for 19.7% of all hospital-acquired infections in England. Furthermore, 39% of patients with blocked catheters ended up being admitted to hospital. On average Clinical Commissioning Groups (CCGs) receive £2.1 million to handle unplanned admissions for UTI’s and blocked catheters cost the NHS over £17 million a year. This demonstrates the importance of preventing blocked catheters and UTIs and highlights the significant opportunity for CCGs to reduce expenditure, allowing the redistribution of these funds for other areas.
The UACC was established in 2015 and is a collaborative body of nurses, GPs, healthcare professionals and patient representatives who work to promote best practice in continence care across the country. The Committee also works closely with NHS Improvement and the Royal College of Nursing to engage with and support clinicians, as well as the NHS. The UACC believes every patient should receive the right care at the right time and in the right place.
The Committee is determined to tackle the rise of unplanned admissions from continence-related issues through sharing practical tools which can be used by continence and infection prevention leads, as well as other healthcare professionals and patients.
With this goal in mind, the UACC developed a Best Practice Guide, which showcases services that have successfully adopted innovative or best practice solutions. The examples demonstrate initiatives which create significant cost savings for the NHS, but more importantly lower the rate of infections and improve patients’ lives. The UACC also released an Online Toolkit in 2017. This Toolkit provides free examples and templates for service improvement which can be accessed on the UACC website.
Ann Yates, Vice Chair of the Committee and Director of Continence Services, Cardiff and Vale University Health Board, said:
“Raising awareness about continence is absolutely essential if we want to break down stigma around this condition. In the UK, more than 14 million people have bladder control problems. However, many people keep it secret for years, and many do not even know this is an actual issue.
The Unplanned Admissions Consensus Committee aims at being part of the solution in ensuring that the NHS can not only cope with rising demand as a result of unplanned admissions and infections, but also to help reverse this trend. We feel passionately about promoting best practice as a method of reducing regional variation in patient experience and patient outcomes.
World Continence Week has been a great opportunity to spread the word on social media and the Unplanned Admissions Consensus Committee has supported this wonderful initiative.”
Further information about the Committee can be found at their website: http://www.unplannedadmissionscommittee.com/
NEW TOOLS + VIDEOS ADDED TO TOOLKIT
If your service looking for a new way of delivering its continence prescription service and wants to benefit from improvements in patient care and GP practice workload, then the UACC urges you to view our video series by Chair of the UACC, Michelle Hunt.
Michelle has recorded a series of short videos where she discusses the patient management system implemented in her service, Cobweb. You can view these videos at the link below.
In addition, she has provided two template business cases for patient management systems which can be found on the toolkit page, for you to utilise.
Portsmouth News: Changes to service help improve patient care and GP workload
A NEW way of delivering a continence prescription service has been hailed a success. Launched in Bordon and Petersfield last November and then rolled out to Waterlooville, Hayling Island, Fareham and Gosport, the scheme has seen improvements in patient care and GP practice workload.
Previously, patients using the service dealt directly with the suppliers of products, such as catheters and bags, who then sent the prescriptions to GP practices for patients to collect.
Under the changed service, commissioned by Fareham and Gosport and south east Hampshire Clinical Commissioning Groups, patients order and deal directly with a team from Southern Health NHS Foundation Trust, based at Fareham Community Hospital.
The CCGs’ medicines management team has evaluated the impact of the scheme for patients at the Vine Group, in Waterlooville.
Jason Peett, head of medicines management, said: ‘When comparing figures for the last year with the previous year, we have found this scheme has been great news for the healthcare system.
‘It has led to a 45 per cent fall in the number of out-of-hours contacts involving patients using the continence service and a 25 per cent reduction in hospital admissions. This improvement is because of the availability of a dedicated resource to give patients specialist and personal advice.
‘The new system has considerably reduced the workload of GP practices – removing a big chunk of prescribing work.’
Read more here.
Amy Cartwright's Abstract Published: Reducing catheter-associated urinary tract infections: standardising practice
The UACC is delighted that one of it's members has had her work formally recognised in a published paper. Amy's paper shares best practice inspired by innovations in catheter practice from the USA. The paper shares the details of Amy's leadership in 2014 where Nottingham University Hospitals NHS Trust introduced catheterisation standardisation across the Trust’s two acute sites.
Standardisation was achieved by the introduction of an all-in one catheterisation tray (Bard® Tray), which included all the necessary equipment required for catheterisation, coupled with a training programme. The introduction of the tray was followed by a clinically significant 80% reduction in the CAUTI rate from 2014 to 2016. This reduction in CAUTI rate provided the Trust with a considerable reduction on annual expenditure (nearly £160 000 less in 2016 compared with 2014). The introduction of the tray has additionally improved practice with nursing staff now less likely to forget the necessary equipment before commencing catheterisation as all the components are provided in one place.
ONLINE TOOLKIT LAUNCH EVENT IN PARLIAMENT - PRESS RELEASE
The Unplanned Admissions Consensus Committee (UACC) was delighted to welcome several MPs and Peers to at Westminster reception for for the launch of the UACC online toolkit.
Parliamentarians, NHS England, Committee members, infection prevention leads, continence leads and nurses and patient groups attended a reception hosted by Catherine West MP at the Palace of Westminster to show their support for reducing unplanned admissions to hospital as a result of urinary incontinence. The event coincided with the launching of an online toolkit created to support services to improve continence care and reduce infections by the UACC.
The Committee is determined to tackle the rise of unplanned admissions from continence related issues through sharing practical tools which can be used by continence and infection prevention leads, as well as other healthcare professionals and patients. It is with this in mind that the Committee has developed an online toolkit.
The toolkit includes materials such as a template catheter passport, template business cases and presentations and other support tools which can be adopted within different services to standardise and improve care and ensure the best outcomes for patients.
Michelle Hunt, The Chair of the Committee, Continence Service Manager at Wokingham Community Hospital said:
“I have been proud to serve as the Chair of the Unplanned Admissions Consensus Committee over the last year. In this time, I have worked with the Committee to develop and promote best practice in continence care and am very proud to launch the online toolkit which will support NHS services to deliver safe, cost effective and excellent care to patients.
The vision of the Committee is clear; to be part of the solution in ensuring that the NHS can not only cope with rising demand as a result of unplanned admissions and infections, but also to help reverse this trend.
We feel passionately about promoting best practice as a method of reducing regional variation in patient experience and patient outcomes.”
Book you place at the UACC Annual Parliamentary Reception
We are delighted to announce Catherine West MP will be hosting the Annual UACC Parliamentary Reception on Tuesday 12th December. This event will showcase the latest work of the Unplanned Admissions Consensus Committee and will formally launch its new toolkit. If you would like to attend please contact UACCsecretariat@mailpbconsulting.com.
Members of UACC nominated for Nursing Times Award 2017
Congratulations to Hannah Molyneux and the Liverpool Community Health Trust Bladder and Bowel Team and Gill Davey and her continence team at The Dudley Group FT, on being shortlisted for the Continence Promotion and Care Award at the Nursing Times Awards 2017.
Furthermore, Hannah impressed judges and has was also shortlisted for the Nurse Leader of the Year 2017 Award.
They are proud runners up and it is excellent to see the hard work of Hannah, Gill and their teams being recognised.
A NEW APPRAOCH TO CATHETER CARE at Nottingham University Hospitals NHS Trust
Amy Cartwright, Clinical Procurement Specialist at Nottingham University Hospitals NHS Trust, took inspiration from the USA to reduce catheter-related infections in her Trust.
Catheter care is a real passion of mine dating back to when I was an infection prevention and control nurse and then a urology nurse. During that time, I led on initiatives to reduce catheter-related infections, including creating an e-learning package for colleagues in my Trust.
I was awarded a Winston Churchill Memorial Fellowship Trust to develop this work, and spent a month in the USA to see what American health care providers did to reduce infection. The trip opened my eyes to what was possible in catheter-related care.
In America there is a catheter pack for every patient, which contains everything needed to perform the procedure. The catheter and drainage system are pre-connected, and the system remains in place for 14 days until the drainage bag needs replacing.
Finding a Solution
Only one such product existed in the United Kingdom - Bard’s Comprehensive Care Foley Tray - so I worked with a company rep, and with my Clinical Procurement Matron, to find a solution for our Trust.
We began a four week trial of the pack in high-risk areas including on the wards and in A&E. As with any new product or initiative, there was some resistance, but the majority of my colleagues saw the benefits straight away.
For staff who do not catheterise on a regular basis, it can be difficult to remember what is needed, because there are many items involved.
Before the new pack was available, staff would go to various different store rooms, or even, in some cases, break off from a procedure because they had forgotten an item. But now, everything is in one place. This saves time and promotes better practice for what is a very intimate procedure.
In January 2015, following the trial, we rolled out the packs to the whole Trust. We’re a large organisation across two sites with more than 1,700 beds, so this had to be a methodical process, working one corridor at a time.
I spent many hours on the wards, with the company rep, talking to people about the pack, before and after their shifts. This helped to increase product recognition, and meant that staff were prepared when the time came to change.
I monitor the impact of the packs closely, and each catheter-related infection is recorded on the safety thermometer, which is how we record patient safety data across the Trust.
In 2014, before the packs were introduced, there were 132 catheter-related infections in the Trust.
In 2015, following its introduction, this decreased 45% to 54, and our most recent data, from 2016, recorded 21 infections - a reduction of 80% in just two years.
Each catheter-related infection costs the NHS £1,760 to treat, so, in just two years, this change has avoided patient costs of more than £130,000, and reduced the number of people staying longer in hospital.
Introducing the packs saved £40,000 on a product for product basis too, meaning the overall saving was £170,000.
Communicating with Staff
We have communicated these results with colleagues via the patient safety newsletter, and new staff are told about this work during their induction.
I still get queries about the packs, and it’s great to be able to show staff the evidence I have gathered. Having the confidence to positively challenge colleagues is an important part of working in procurement.
I use every opportunity to share best practice, and have taken my learnings to other Trusts across the East Midlands, as well as via the Clinical Procurement Specialist Network.
Now more Trusts are getting in touch, and I am looking forward to working with them to improve their approach to catheter care.
This article was originally featured on the Royal College of Nursing 'Same Changes, Big Difference' Blog here.
QUARTER OF PEOPLE DO NOT NEED TO BE ADMITTED TO HOSPITAL, NEW RESEARCH REVEALS - 27th October 2016
Up to one in four people admitted to hospital do not need to be there and could be looked after elsewhere if better use was made of services available to treat people in the community, council leaders stressed today.
Almost half (45 per cent) of decisions about patients' care could be improved, new research by consultants Newton Europe commissioned by the Local Government Association (LGA) has found.
Helping more people to be independent and looked after at home or in the community could save the health and care system more than £1 billion because hospital admissions cost more than looking after people in their own homes across England's health and social care system, it estimates.
The LGA, which represents over 370 councils in England and Wales, believes this saving would help ease some of the pressure on councils who have faced a 40 per cent reduction in funding over the last Parliament. More funding for adult social care is one of the key asks of the LGA's submission to the Treasury ahead of the Autumn Statement expected on 23 November.
Health and social care workers examined thousands of anonymised case notes in five parts of England to inform the Newton Europe study which found one in four hospital admissions (26 per cent) could have been avoided if opportunities to intervene had been available or not missed. The research showed that where integration of health and social care was working, fewer people needed to be looked after in residential care (see Kent case study below).
The LGA's Autumn Statement submission to government warns social care for the elderly and disabled could be facing a potential funding gap of at least £2.6 billion by the end of the decade.
The LGA says that based on "fair price of care" calculations, the immediate pressures threatening the stability of the care provider market could amount to at least £1.3 billion. On top of that, councils also estimate that by 2019/20, a further £1.3 billion will be required to deal with the additional pressures brought about by an ageing population, inflation, and the cost of paying the National Living Wage.
The scale of underfunding in social care could see even more providers either pull out of the publicly-funded care market or go bust, placing vulnerable people at risk.
The LGA is calling on government to urgently work with councils and providers to calculate and fully fund this immediate pressure and avoid a large scale crisis. Councils also need to be able to use some of the business rates income it will keep by the end of the decade to plug the £1.3 billion gap.
Read the Local Government Association report here.
WELSH ASSEMBLY LAUNCH EVENT - PRESS RELEASE - 3rd November 2017
The Cabinet Secretary for Health, Well-being and Sport in Wales, Vaughan Gething AM, gave a uplifting speech at the launch of the Welsh Best Practice Guide. The receptions, which was hosted by Mr Gething, took place in the Senedd of the Welsh Assembly and saw a room of clinicians, patients and Assembly Members meet to discuss practical steps which can be taken to ensure best practice in continence care in Wales.
Mr Gething spoke about the importance of the Assembly's input and support in raising awareness of the need to reduce unplanned admissions due to incontinence and emphasised the need to get rid of the taboo of talking about continence problems which is widespread among the public. He told attendees that continence can and does effect people of all ages, but the Welsh Best Practice Guide is a tool to help overcome these issues.
The reception included presentations by Amy Cartwright, member of the UACC, on the cost savings her service experienced following the implementation of all-in-one catheter trays; Gail Lusardi on practical steps which can be taken to reduce catheter-associated urinary tract infections; and Janine Dailey on the cost savings her service has seen with since the implementation of a patient management system.
PARLIAMENTARY LAUNCH EVENT – PRESS RELEASE - 25th October 2016
A number of MPs attended a reception hosted by Henry Smith MP at the Palace of Westminster to show their support for reducing unplanned admissions to hospital as a result of urinary incontinence. The event coincided with the launching of an Updated version of a Best Practice Guide on improving continence care published by the Unplanned Admissions Consensus Committee.
In late 2015, in order to help reduce the cost of unplanned admissions, and improve care, the Unplanned Admissions Consensus Committee created a Best Practice Guide to provide much needed guidance about simple steps that can be taken to reduce unplanned admissions to hospital as a result of urinary incontinence. On 25th October 2016, the Committee launched an updated version of this Guide, with a collection of service-leading case studies demonstrating best practice, efficiency savings and improvement in patient outcomes.
The Guide makes a number of recommendations of steps that can be taken to reduce incidence and variation as well as improving overall patient outcomes.
MILLIONS 'SUFFER IN SILENCE' WITH INCONTINENCE - 28th December 2015
New guidance released by NHS England states that millions of people are have incontinence problems but are not receiving the help and treatment they need. Of the 14 million in the UK living with continence issues millions are 'suffering in silence' due to embarrassment of their condition, lack of awareness over their options and poor quality of care, particularly in care for the elderly.
Sara Elliott of NHS England has said "Millions of people are affected by continence problems, but it is an issue that they are still too embarrassed to talk about. This means that too many people are suffering in silence and not receiving the care and support they need."
The BBC report can be read here.
PARLIAMENTARY LAUNCH EVENT – PRESS RELEASE - 5th November 2015
In a Parliamentary reception held on the 4th November, The Unplanned Admissions Consensus Committee launched a Best Practice Guide highlighting issues and solutions in continence care.
The NHS wasted £434 million in 2013/14 on treating 184,000 patients in unplanned admissions associated with a UTI, according to a recently released report by the Medical Technology Group. The potential savings that could be made by improving this service across the country are huge. Currently 39% of patients with blocked catheters end up being admitted to hospital, unnecessarily costing over £17 million a year.
To help combat this a new Best Practice Guide released by the Unplanned Admissions Consensus Committee provides much needed guidance about simple steps that can be taken to reduce unplanned admissions to hospital as a result of urinary incontinence.
Whilst being an obvious area of focus to both save money and improved patient outcomes, a Freedom on Information request discovered worrying levels of variation in service provision across the country. Of 120 Trusts that responded to the FOI Request, just 48% have a named continence lead within the Trust.
The Guide makes a number of recommendations of steps that can be taken to reduce incidence and variation as well as improving overall patient outcomes. The Committee will work to drive uptake of these recommendations moving forward.