Nurses have “a problem being heard” in the continence care space despite being key to the multidisciplinary teams that can drive forward changes, Sir Robert Francis has said.
The former barrister, who led a landmark inquiry into care failings at the former Mid Staffordshire NHS Foundation Trust, raised concern about continence care standards and urged healthcare teams to “professionally act together” to highlight any issues with government.
“Please find ways in which you can all professionally act together and agree what is needed”
Robert Francis
His comments came during a meeting of the All-Party Parliamentary Group (APPG) for Bladder and Bowel Continence Care, held in the House of Commons this week and attended by many senior continence nurses.
Opening the meeting, Sir Robert, who oversaw both an independent and then public inquiry into the Mid Staffs scandal between 2009 and 2013, noted how the inquiries heard a “significant number of complaints” around continence and bladder and bowel care.
The investigations found that requests for assistance to use a bedpan, or to get to and from the toilet, were ignored.
Further, they revealed that patients were left in sheets “soiled with urine or faeces” for considerable periods of time.
Many suffered distress, embarrassment and loss of dignity, often in the final days of their lives.
It was suggested that the attitude of some nursing staff at the trust towards poor continence care “left much to be desired”.
Sir Robert read out an account made to the inquiries, in which a patient’s relative recalled hearing patients “crying and shouting” for a nurse when they had wet the bed, with no response.
He said: “I ask myself, is it still like that anywhere? The answer I have is, I hope not but I don’t know.
“Have conditions of staffing improved? Not everywhere. Have the ability to be caring and compassionate got any better in many places? Yes but, in many places, probably not.”
More on Mid Staffs and continence
Sir Robert, who is a patron of the Association of Continence Professionals and president of the Patients Association, told the APPG that “there is a lot of misunderstanding about what is needed for continence care”.
“The way people are left in pads because that’s the convenient thing to do, rather than getting them up to go to the toilet, would be just one example,” he explained.
Other examples given were patients being unable access the continence products they need to be able to be discharged from hospital, or a lack of community continence services meaning end-of-life patients cannot die at home.
Sir Robert said: “Are we still accepting unacceptable standards of care for the seriously incontinent? That would appear to me the answer is probably yes.”
The former barrister told the meeting that the way forward was through “multidisciplinary approaches” in teams.
“It does need a bringing together of doctors, nurses, physiotherapists and all the other ancillary workers,” he explained.
Sir Robert warned that while doctors “do have a voice” in the continence space, “nursing still has a problem being heard”.
“Increasingly, and this isn’t just a bladder and bowel problem, healthcare is delivered on a multidisciplinary teamwork basis,” he added.
“So please find ways in which you can all professionally act together and agree what is needed, because I think, that way, you provide a voice with which… Wes Streeting and [other] people will find hard to resist.”
