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