1. The Enhanced Continence Project – In Practice Tina Bryant – Operations Manager Sarah Thompson – Community Nurse Specialist

2. Prevalence of incontinence 14 million people in the UK with a bladder control problem 6.5 million with a bowel control problem. The prevalence of urinary and faecal incontinence increases with age

3. Current Treatment & Management Majority of elderly managed through containment costly >£50 million per annum often purchased by patients NHS pads and pants usually restricted to 4 per day Nurse-led community continence care can reduce pad usage by 50% Catheterisation is often the result of poor continence care 25% of catheters in hospital are unnecessary Cost-effective Commissioning For Continence Care – All Party Parliamentary Group for Continence Care Report

4. Impact of Incontinence on Health and Wellbeing Women presenting to GPs with UTI are twice as likely to have UI Men 60+ presenting to GPs with UTI are twelve times more likely to have UI Pressure ulcers can be directly linked to poor continence care, costing the NHS £1.4 - £2.1 billion annually Poor continence is associated with falls in the elderly Incontinence can impact upon socialisation Cost-effective Commissioning For Continence Care – All Party Parliamentary Group for Continence Care Report

5. Unnecessary Hospital Admissions

6. Number of admissions to hospital with primary diagnosis UTI Source: Cambridgeshire & Peterborough CCG data

7. Number of admissions to hospital with primary diagnosis UTI 2013-14 £757,474 2014-15 £1,297,952

8. The Solution? New service provided by B&BF and funded by Cambridgeshire County Council for 12 months

9. Benefits to Primary Care Reducing unplanned admissions Reducing length of stay in hospital Reducing emergency call-outs Better continence management reducing risk of infection and tissue deterioration Early identification of risks and complications Earlier diagnosis of UTIs Carer support Easier access to continence services for vulnerable people

10. How does it work? Modern, client centred approach to continence Client’s are seen in their own environment Research based timely intervention and follow up Based on care pathways for specific conditions

11. Referral criteria Clients must be living in Huntingdonshire They must be in receipt of council funded home care They have continence issues They must consent to the service

12. The Pathway Clients are contacted with three working days Appointment is made to visit with the carer present Clients are assessed and put on a pathway of care Interventions are discussed and agreed with the client Regular review and follow up Final review at three months depending on complexity

13. Service users So far, the majority of clients being referred are suffering from dementia related problems These clients are not able to access clinics Short term memory issues affect their ability to express their needs, carer input vital Home assessment and support is key

14. Intervention Home visit, assessment Carer support and education Provided information on products Ongoing support

15. Results The Enhanced Service has: Prevented admission by detecting UTI Given carer a means of support and contact Provides access to information to improve their quality of life Costs have been reduced

16. Multi Disciplinary Working GP Occupational Therapy Physiotherapists Community Nurses Continence Advisory Service

17. Carer Support The Service aims to train formal home carers in: Detecting UTI’s and having the confidence to report them Troubleshooting with simple issues Having better understanding of products available Being better educated in continence issues

18. Training Carers Specialist Nurse offers Introductory Training to small groups of carers Care Agencies can then access more specific training Carers are best placed to identify issues Education and support improves morale Better morale improves recruitment and retention

19. Summary The Enhanced Service provides a unique, quality service to clients, who would otherwise have limited access to continence services with the benefit of better trained carers.