Continence care requires a holistic and patient-centred approach
Sometimes the NHS makes false economies which are short-sighted and lead to a reduction in patient dignity, a worsening of health outcomes and the creation of avoidable costs for the system as a whole. Nowhere is this clearer than in relation to the purchasing of absorbent pads in continence care.
Although incontinence is often regarded as a taboo topic, with many people reluctant to seek professional help, it is a very common condition. It is estimated that 14 million people are living with some form of incontinence, roughly the equivalent size of the over 60 population in the United Kingdom. Last month’s World Continence Week (WCW), an international health campaign run by the World Federation for Incontinence and Pelvic Problems, raised awareness of incontinence related issues.
Incontinence and associated conditions (such as Incontinence Associated Dermatitis and pressure ulcers) can have a profound impact on all aspects of people’s lives from their ability to travel and socialise, and the physical discomfort and stigma that people experience, to the financial worry of having to purchase products when supplies run out.
The financial cost to the NHS of managing incontinence is also considerable, particularly when treatment is ineffective from the beginning and patients have to be admitted to hospital with avoidable urinary tract infections or skin conditions.
Providing the highest level of continence care is essential in ensuring each individual has a personalised and dignified experience. It is important that each individual care plan details not only their care needs and requirements, but also their preferences. Patient dignity should always be upheld, and the appropriate clinical assessments and care plans should be put in place to meet the needs of each individual.
Despite the importance of providing patient-centred care, the current approach within the NHS to purchasing continence products and other medical supplies is failing adequately to account for patient quality of life and health outcomes.
Providing high-quality and person-centred care is not only beneficial for the patient, but also for the wider NHS system
The government and the NHS have committed, in principle, to the practice of value-based procurement (VBP). The concept has now received an accepted definition by academics and NHS Supply Chain that stresses two things: a purchasing process that “generates opportunities to release capacity”, and that it should “deliver tangible, measurable benefits that make a positive impact on patient care and increase efficiency”.
However, despite this apparent commitment to VBP, suppliers of medical products and devices have raised concerns and frustrations that the NHS is continuing to prioritise short-term costs over long-term value. The current issue is twofold: first, the current NHS tender framework for the procurement of continence products is too heavily weighted in favour of upfront costs and, second, there is not enough understanding of VBP at a local integrated care system (ICS) level. Whilst, in theory, ICSs were established to deliver better joined up care, a gap remains between government policy and NHS practice.
Considering the importance placed by the government on patient choice, innovation and resilient supply chains, this disconnect between policy and practice is a serious mistake. This prompted me to table a written question in the House of Lords, in which I questioned government ministers on the delivery of “value-based procurement” across the NHS. The answer I received highlighted a commitment to “an environment that supports the understanding and delivery of value for money and affordability across the whole patient pathway”.
Earlier this year the government published its MedTech strategy, in which it recognised the need for procurement to deliver value for money across the NHS. The strategy acknowledges that “the value of MedTech products should not be considered in isolation but across the patient pathway” and that “lowest price does not always translate to best value”.
As we await the government’s implementation plan for the strategy, expected in the coming months, the moment to raise awareness of these issues, and deliver the shift in NHS purchasing practices that is so desperately needed, is now.
Lord Hunt is a Labour peer, former health minister and first chief executive of the NHS Confederation
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