Agenda item

Rebecca Atchinson, Public Health

Rebecca Atchinson, Public Health, presented an update on the progress to date on the Scrutiny Review’s six recommendations.

The Review had taken place during May and June, 2014, and had identified recommendations which cut across the Council’s Directorates.  The main aims of the Review had been:-

-          To ascertain the prevalence of urinary incontinence in the Borough and the impact it has on people’s independent and quality of life

-          To establish an overview of current continence services and costs and plans for future service development

-          To identify any areas for improvement in promoting preventive measures and encouraging people to have healthy lifestyles

Progress had been challenging due to the changes in staffing within the Council over the last six months as well as technical problems with the uploading of information to the Public Health TV systems since September, 2015.  Plans were now in place to move the activity forwards particularly in the area of prevention and early support agenda.

Rebecca introduced Kristy Barnfield and Joanne Mangnall from the Community Continence Service.

Consideration was given to the Appendix which contained the Cabinet response to the recommendations.  Discussion ensued with the following issues raised/highlighted:-

·           My GP surgery never had their television on

This was really disappointing and a challenge.  As part of Public Health’s wider training attempts were being made to try and integrate the messages into the wider pieces of work that were being carried out.  A different range of ways had to be tried of encouraging both staff and the public to integrate messages that might be challenging and might not be the first thing that came to mind in their consultation with individuals.  As well as Public Health messages, there was currently a piece of work being undertaken in recognising the different types of roles there were in GP practices other than a GP to be shown on televisions in surgeries. It was a missed opportunity if practices were not turning on their screens

·           Did the incontinence card give access to a toilet that shopkeepers may have?  Was there any feedback on how successful it had been?

It was an alert card that anyone could carry but it was at the individual establishment’s discretion as to whether they honoured the message on the card.  The disabled toilet access was always by way of the Radar key scheme.  It was known from patients’ report back at clinic that there were certain shops, particularly in places like Meadowhall, that had declined patients the use of their toilets and patients were alerted in subsequent clinics sessions of areas where it might not be honoured.  If a patient had a very severe bladder problem they would be told to use the Radar key, however, the number of disabled toilets was very low.  If someone had a problem with faecal incontinence they would always be guided to use the Radar scheme because they had washing facilities

There were opportunities for the Council to provide information on all of the toileting facilities across Rotherham to say have you considered x y z and pass that information and challenge back.  However, it was about getting all of the contact details of who had responsibility for each of those facilities as sometimes the organisation did not have responsibility for their own toilets

·           What was the timeframe of when the televisions were likely to be coming to the GP practices?

It was planned for it to be up and running by the end of the month

·           Will we be doing anything with SYPTE concerning the screens and promoting the issues around urinary incontinence? Have we taken up SYPTE’s offer of promoting the health issues either for incontinence issues or Right Care, Pharmacy First etc.?

There was an opportunity as to how Public Health shared its health measures around broader issues as well as including incontinence related issues with services such as SYPTE.  The challenge was to ensure if they did not have the mediums like Public Health TV, how they were provided with access to information that they could display within their passenger areas to signpost people to further information.  There was a very good website which contained resources but there was a charge so further discussions were required.  The blanket approach of using Public Health TV had been used but there was an acknowledgement that there were further opportunities to get the message to the areas outside of that scope

·           It would again be appreciated if there could be some clear data as to what progress/updates there had been to ascertain how successful they had been

·           Could you give some information about the training and the research project carried out by the Community Continence Service? How do you intend to promote training and the research around incontinence?

The training that was undertaken in Maltby was in one of the care homes focussing on the correct use of incontinence products.  If they were not used correctly residents were at risk of developing skin breakdown and pressure damage.  It was also known that incontinence products could be used inappropriately instead of a resident being taken to the toilet which was degrading to the individual and increased costs to the NHS.  The training focussed very much on when to use a product, when to change a product and how to use it correctly and had been very well received by the staff.  The problem in undertaking the training was that the turnover of staff in care homes could be quite rapid.  Work had taken place with Council Officers to deliver a year’s planned training which was circulated to all the care homes.  Staff were evaluated at the end of each training session.  The uptake could be quite sporadic; there could be a session that was fully booked on the day and then poorly attended due to sickness in the care home.

The CCG had funded a two year Project Nurse post which had focussed on specific areas of continence care e.g.  catheter related infections which could be life threatening for a small percentage of patients.  That work focussed very much on the inpatient setting looking at reducing the useage of/looking at alternatives to catheters and raising awareness so that patients were alert to particular triggers that could indicate that they had a problem.  A patient information book had also been developed from that work and was now issued to all patients that were discharged from hospital with a catheter.  This aided smoother transition to Community Services

The other elements of the work related to referral pathways and looking at how patients accessed further help for continence problems which were very broad.  A lot of the discussion in the Review had focussed around pelvic floor exercises but they would only address one specific element of continence problems; anyone who presented with a continence problem required a complete assessment because there could be sinister underlying pathology.  The worker had identified a number of areas that required focus, on the assessment process and directing patients and had also looked at patients who were presenting at A&E with continence problems.  A high percentage of patients presented at A&E with urinary tract problems which was a very simple condition and did not warrant attendance at A&E.  Further work was required to understand why this happened

·           There was reference in recommendations 4 and 5 regarding training and the previous offer by Neighbourhoods and Adult Services for incontinence training to home care staff not being taken up.  Was there any further information?

Colleagues in Neighbourhoods and Adult Services had stated that they had established that there was a training need, however, once it was set up there was no take up.  One of the challenges was that sometimes people wanted training to be delivered in individual settings which was not feasible financially.   There was ongoing training from the Community Continence Team when they were having contact with settings albeit may be not through planned training sessions

·           Should a person applying for a job in a care home have to produce certain certificates to show competence in that field before they were actually accepted as an employee?

Care Homes did take up references but it was not thought that there was a requirement on the level of certificates that had to be produced.  We do need to try and set some examples of good practice and minimum standard. 

·           Could you not get one person from the Home to come to a training session and they go back and train the others?

That approach had been tried previously, “link post”, but it only worked in a very small percentage of Homes and where they had a member of staff in employment at that Home for a long period of time.  It was often found that someone nominated as a link person that came to one of the sessions would have left by the time of the next session so the knowledge could not be taken forward.  In some Homes there were staff that took the key role in liaising with the Community Continence Service on the delivery of pads into the Home, the monitoring of deliveries and co-ordinating assessments and would really like to adopt that approach widely but unfortunately the experience to date was that it not been effective 

·           Does the Home have to pay for the pads?  Should they not be charged?

The pads were provided free from the Community Continence Service to the Home.  If a resident was in a nursing bed the registered nurses in the Home should undertake a Continence Assessment prior to the issuing of pads.  If the resident was in a residential bed, the Community Nurses would work with the Home to undertake an assessment prior to issuing pads. The aim was always to assess and treat rather than just use pads

The Service had to provide pads free of charge as part of the health care package but it was not an unlimited numbers of pads; they were capped at a certain number over a 24 hour period and that very much depended upon on the level of incontinence the person was demonstrating

·           Rotherham Foundation Trust was taking part in a national audit of inpatient falls compliance with Best Practice in reducing risk of falls in Acute Care and one of the things on the checklist was multi-factorial risk assessment.  It was positive that the Hospital had ticked yes to three of the questions which were linked to continence - do people at risk of falling as an inpatient have an assessment of continence and toilet issues? Suggested actions where problems with continence are identified? And possible modification of any medicines that people were taking that could reduce their risk of falls?  If a patient had had this assessment and issues identified would there would be follow up to your Team possibly for support and assistance?

The Community Continence Team had four full time equivalent Nurses and possibly had to treat approximately 12,500.  The Team was not involved in inpatient continence assessment but worked very closely with key staff in the inpatient setting to develop a standard operating procedure which guided the staff through a Ward-based continence assessment and gave them a very clear referral process onto the Team.

The training package was open to Foundation Trust staff as well as Community and Nursing staff and nursing homes. 

Rebecca, Kristy and Joanne were thanked for their presentation.

The report was noted.