National Audit of Continence Care : How to end the 'life sentence' of suffering?

The audit surveyed the care given to 18,253 people across 135 NHS Acute Trusts, 26 Mental Healthcare Trusts, 86 Primary Care Trusts, and 122 care homes. One of the key findings of the report is that the diagnosis and treatment of incontinence is often poor or non-existent. Commenting on the documentation of incontinence the audit mentioned that no diagnosis for urinary inontinence was documented in a large proportion of older people, ranging from 19% in primary care to 38% in mental health care, indicating a reduced rate of assessment or limiting the potential for treatment.

The other key findings in this audit are:

• Only 50% of patients in mental health and care home settings had a treatment plan for urinary incontinence and 29% of older people in primary care and 36% in acute care did not have a treatment plan.
• 41% of patients in acute care, 27% in primary care, 54% in mental health and 43% in care homes had no bowel history taken despite being faecally incontinent
• Only half of older people in acute and primary care services had a documented diagnosis for faecal incontinence – the rate was higher but still not ideal for younger people at 68% and 65% respectively. Less than a third of patients in mental health care had a clear diagnosis
• The great majority of continence services are poorly integrated across acute, primary, care home and community settings, resulting in disjointed care for patients and carers – although 55-80% of services say they are integrated across healthcare settings, only 4 services across the country fulfil all the requirements set out in “Good Practice in Continence Services” (2000)
• Training of healthcare professionals is inadequate – structured training in continence care only occurs in 49% of acute hospitals and 39% of mental health care sites
• Clinical services are not complying with NICE guidelines – only 74% of PCTs commission according to NICE guidelines and many hospitals fail to provide care according to NICE recommendations

The National audit concluded that the findings show that there is an urgent need for improved and equitable practice for all people with bladder and bowel problems

Improving dementia service in Wales

Recent studies showed that there are currently 39,000 people with dementia in Wales. This is set to rise by 35% over the next 20 years with one in three people over 65 years of age is expected to suffer from a form of dementia.

The Health minister in Wales announced on 13^th July 2010 that the dementia services in Wales are to receive an extra £1.5 million a year to extend and develop provision. The fund is for an additional dedicated dementia clinical post in every older person's community mental health team across Wales, to provide advice and support to those diagnosed with dementia and also provide direct support to memory clinics, dementia training and awareness-raising for staff working in dementia care across Wales.

The dementia plan which was developed by a group of professionals is aiming to:

• Develop better joint working across health, social care, the third sector and other agencies;
• improve early diagnosis of dementia and timely interventions;
• provide better information and support for people with the illness and their carers/ families;
• Offer additional training for those delivering care.

A new Mental Health Programme Board will oversee these goals. The board will be responsible for improving the quality of general hospital care for people with dementia and reducing the time between the onset of symptoms and diagnosis being communicated to patients and their families.

Gwent Frailty Programme: Information sharing and single point of access conference

On 29th July 2010 a team from Gwent Frailty project called for a conference which was attended by professionals from different backgrounds to discuss the details of the Frailty Programme in Gwent which is going to be started in April 2011.The first key note speaker in the conference was Alison Ward from Torfaen County Borough Council. The title of her presentation was: Frailty Programme: focus – requirement, programme and strategy

She said that the present NHS system in Wales is broken and unsustainable. She mentioned examples of unnecessary admission to the hospitals all around the country as an indicator of the difficulties in the current practice. Adding to that is the problem of the Length of stay and delayed transfer of care or DTOC.

Alison mentioned that 50% of people in hospital community beds do not need to be there and too much money invested badly in acute service.

In her presentation Mrs Ward mentioned that the aim of the frailty programme is to achieve a better outcome for frail people: fewer acute hospital admissions, shorter stay in hospital, improved flow via secondary care service, 24/7 access to community service and reduce hospital acquired infections. Reduction of the demand for complex care packages is another important aim of the project.

Regarding financing of the project, the conference was informed that this can be done on the short term through pump priming transitional funding from the Welsh Assembly Government to set up the new teams and to manage the high demand for community based service.

On the medium term, closure of community beds and overall reduction in the pressure on acute care and reduction in purchasing the residential and nursing homes will be the financial resource for the frailty project. On the longer term, the conference was told that the reduction in the cost of continuing care packages will be one of the targets to finance effectively the frailty project in Gwent.

The second key speaker was Lynda Chandler, the programme manager, Torfaen County Borough Council. She discussed some details regarding the workforce developments, governance and the structure of the frailty programme. She addressed the issue of the integration between the community mental health team and the community resource team as part of the comprehensive assessment tool for a better service for frail citizens in Gwent.

The third speaker was Dr Gwyn Thomas, chief information officer, informing healthcare and the title of his presentation was: strategic direction for community informatics.

He mentioned that the best way forward is to deliver community set of patients centred information service that improve care, safety and trust. He gave details of his vision regarding the service user’s and provider’s portals.

There were three work stream sessions in the conference addressed issues of mapping the call management process, assessment and management of work/ allocation and unified assessment based community records.

9th Welsh Stroke Conference: What Is The Future Of Stroke Medicine?

For the 9^th year running the Welsh stroke Conference has managed to attract the attention of the hundreds of stroke specialists and members of the multidisciplinary teams from Wales and all around the country. The conference which was held on 25^th June 2010 in the River Front of Newport has started with a presentation from Professor Steven Cramer about the subject of brain repair after stroke.

The speaker is an Associate Professor of Neurology at the University of California, Irvine. His research focuses on brain repair process after central nervous system injury in humans, with an emphasis on recovery of movement after stroke.

The subject of cerebral small vessel disease and its diagnosis and management was the main focus of Dr Mike O’Sullivan lecture. Mike is one of the Neurologist and MRC fellow in Cardiff. His main research interest is in mechanism of cognitive impairment in aged population and its relation to cerebral small vessel disease.

The third lecture in the first session of the stroke conference was about advances in stroke rehabilitation by Professor Robert Teasell from Ontario. The lecturer has edited 4 books and authored over 200 peer-reviewed articles in his field. Professor Teasell is the primary investigator of the acquired brain injury evidence-based review (ERABI) and the spinal cord injury research evidence (SCIRE)) projects.

The main lecture of the conference was given by Professor Jeffrey Saver from California about the subject of future of stroke medicine. He is currently chair of the stroke council of the American heart association. Professor Saver is the principal investigator of a specialized program of translational research in acute stroke.

The 9^th Welsh stroke conference has addressed the issue of living with stroke and discussed subjects like: oral health care and visual problems post stroke. Professor Kennedy Lees from Glasgow was speaking about thrombolysing for acute ischaemic stroke and the evidences available so far for the practice in hyperacute stroke care. Professor Keith Muir was lecturing about Neuroimaging for stroke patients and the recent advances in this field. He was a guest speaker few weeks ago in North of Gwent where he was speaking about the latest developments in the field of stem cell in stroke research and management.

The organisers of the conference have chosen few posters about subjects related to stroke service delivery, stroke research and stroke case presentations. The experience of the stroke teams in Wales in using the teleconferencing to facilitate educational meetings across Wales was presented in a poster by Dr. P. Jones and Dr.Tom Hughes from University Hospital of Wales.