Health and Care Bill

Written Evidence to the Health and Care Bill submitted by Coloplast.

 

(HCB38)

1. Introduction

1.1 Coloplast is a leading Danish-based manufacturer of ostomy, continence, wound care and interventional urology products. Our UK subsidiary, based in Peterborough, covers the UK and Republic of Ireland. We provide a range of services in chronic care to the NHS, including community nurse partnerships and telehealth services, both of which are registered with the CQC. We develop products and services to make life easier for people with deeply personal and private medical conditions. These conditions are often associated with trauma and taboo. The more intimate the condition, the greater the requirement to understand their world and develop solutions that are sensitive to their special needs. Coloplast calls this Intimate Healthcare. For more information about us, please visit http://www.coloplast.co.uk/.

1.2 People who use our products and services include:

1.2.1 Some of the estimated 165,000 – 200,000 people [1] living with a stoma in the UK. A stoma is an artificial opening in the bowel that has been made deliberately in order to bring the bowel onto the surface of the abdomen to divert the flow of faeces or urinei. The most common reasons are due to cancer and inflammatory bowel disease (ulcerative colitis and crohn's disease). Approximately 21,000 people have stoma surgery each year [2] .

1.2.2 Individuals with urinary incontinence, which is the loss of bladder control and often occurs as people get older [3] . There are different types, each with different symptoms and causes. The most common types of urinary incontinence are stress urinary incontinence, urge urinary incontinence and mixed urinary incontinence [4] . The NHS estimates that between three and six million people in the UK have some degree of urinary incontinence [5] and it can have a serious impact on quality of life.

1.2.3 Individuals suffering from poor bowel health and chronic constipation, which is debilitating for millions of people and preventing thousands of people in the UK from enjoying the best life possible [6] . One in seven adults are affected by constipation at any one time [7] and research shows that chronic constipation is causing people to suffer in silence and pain, leading to 71,430 hospital admissions in 2017/18 [8] .

1.2.4 Individuals with a spinal cord injury, which occurs when the end of a spinal cord or the nerves at the end of the spinal canal are damaged [9] . There are an estimated 50,000 people in the UK living with a spinal cord injury and each year approximately 2,500 people are newly injured [10] . Most people with a spinal cord injury experience bladder and bowel problems.

1.2.5 Some of the over 130,000 people in the UK estimated to have MS by the MS Society, with nearly 7,000 people newly diagnosed each year [11] . More than 70% of people with MS will experience bladder issues. About 34% of people with MS are believed to have bowel problems to such a degree that it affects the quality of their daily life [12] .

1.2.6 The NHS managed 3.8 million patients with a wound in 2017/2018 equivalent to 7% of the adult population, 25% of all wounds lacked a differential diagnosis. The annual prevalence of wound increased by 71% between 2012/2013 and 2017/2018. The total annual cost of wound management is estimated at £8.3 Billion of which 67% is spent on managing unhealed wounds [13] .

1.3 Coloplast broadly welcomes the Health and Care Bill and the move towards greater collaboration and partnership working at a local level. We also welcome the moves to strengthen the current rules around patient choice (clause 67). However, we are seeking further clarification and reassurances on the following areas as to what the legislation might mean for the patients we serve with intimate healthcare needs. In particular, we are keen to understand how the Bill will make a difference for those who need health and care to do better, particularly for those conditions where there has historically been significant variation in care across the country. We are keen to play our role in continuing to support the NHS to deliver service and quality improvements and it is our hope that this Bill will enable us to do so.

2. NHS Provider Selection Regime

2.1 Part 1, Clauses 67-69; schedule 11, Provider Selection: The procurement reforms within the Bill will enable the removal of the current rules which apply to NHS and public health service commissioners when arranging clinical healthcare services e.g., hospital or community services. The explanatory notes outline that the intention is to pave the way for a new NHS provider selection regime that moves away from competitive retendering by default in favour of a more collaborative approach to planning and delivering services. As a company that provides a wide range of services as a partner to the NHS, Coloplast would welcome further, more detailed definitions, of what is meant by "clinical healthcare services" and "non-clinical services" to better understand the impact of future changes on patient choice and procurement rules.

2.2 Improvement to Quality of Life & Gold Standard Patient Care – Case Study One

A 53 year old man who had his stoma from birth and never seen a Stoma Care Nurse, who worked on a building site.  He was having to change his clothes over 4x daily due to leakage. In addition, he was changing his stoma bag multiple times a day. He was in tears when he first attended a clinic. He was told by a previous HCP that there was nothing that could be done to help the leaking and try to self-manage it. On initial examination, the stoma was poorly sited in groin area and two pieces not attached due to leakage; he reported that this happens all the time.  Our Coloplast nurse offered him a one piece bag to try and arranged a follow up appointment.

On examination at his follow-up appointment, the nurse noticed a pea size granuloma, together with a deep skin crease due to old scar. The granuloma was very tender to touch.  The nurse arranged a referral to the consultant with a view to this surgically as she had identified this was likely to be a contributing to the leaking.  She also introduced a seal (supporting product), to secure the plate to help prevent leakage.

The patient fed back the seals had been life changing, and he is now leak free. 

2.3 Improvement to Quality of Life & Gold Standard Patient Care – Case Study Two

55 year old gentleman had formation of ileostomy 35 years ago, He’d not received or been offered a stoma nurse review since his surgery. He was experiencing leakage several times a day, having to change his bag each time (was currently using 90 bags per month and numerous supporting products). On completion of the review theColoplast nurse suggested he try an alternative bag, which gave a much better fit to his body shape.

The patient phoned to thank the nurse. He couldn’t believe the difference the different bags had made to his life. He had experienced no further leaks, and the next holiday that he’d been dreading, turned out to be one of his best holidays ever.

3. Workforce Planning

3.1 Part 1, Clause 33, Workforce Planning: This part of the Bill states a new duty for the Secretary of State to set out how workforce planning responsibilities are to be discharged, which we welcome. However, it is widely recognised that nursing continues to be the most significant workforce shortage area in the NHS, with the Government setting its own target for 50,000 new nurses in England by 2024/25 [14] . Achieving this is essential for high quality patient care and specialist nursing staff in particular, such as Stoma Care Nurse Specialists, who play an important role in preventing complications and supporting self-care for patients, as well as reducing costs to the NHS by preventing emergency admissions. Other significant shortages are evident in district and community nursing, despite rising demand. We are seeing this impact on patients across all therapy areas we work on, with particular issues around wound care.

3.2 In light of the current workforce shortages, we feel strongly that our partnership with the NHS is of benefit to stoma and continence patients alike. Coloplast works closely with the NHS to provide innovative solutions to specifically support patient care and alleviate stress, workload and workforce gaps in the health system, such as through our CQC registered community nurse partnerships and telehealth service, which recently received an ‘Outstanding’ rating [15] . The positive role we can play to support the NHS and its workforce has been even more important during the COVID-19 pandemic. For example:

3.2.1 Working closely with the NHS, Coloplast nurses have seen 8,300 new patients since March 2020 across the UK. These were mainly new patient discharges for those with a stoma or continence patients who were waiting to be taught intermittent self-catheterisation (ISC). Around 12,500 patient reviews were conducted with patients over the phone (65%) or through a digital platform (35%) over this period.

3.2.2 During these nurse-led consultations, Coloplast identified a range of patient issues, which prevented A&E admissions, inpatient days and appointments with hospital consultants thus relieving the burden on the NHS at a time when services were already stretched because of COVID-19. Alongside the provision of clinical reviews, Coloplast also provided a social prescribing service for patients requiring non-medical support. Additionally, the safety and wellbeing needs of patients during these consultations are also considered. There were five safeguarding cases over concerns about a patient’s vulnerable state, which were escalated to the CCG and healthcare professionals for further action.  

3.3 Admission prevention – Holistic Care from Coloplast Stoma Nurses, (Going Above & Beyond) – Case Study Three

A patient had not attended stoma review appointment at GP practice for their appt with the Stoma Nurse in the afternoon.  The patient has recently been in hospital and also had COPD.  The Coloplast nurse called the patient at home to offer a home visit.  On answering the call, the patient was very breathless and their wife was distressed and panicking and was about to call 999. Coloplast nurse assured them both she would visit within the hour. On arriving at the patient’s home address, as a fully qualified nurse, a full assessment was completed, (respiratory rate 32, pulse rate 135).  Action was taken, patient put on a nebuliser, positioned to ensure optimal breathing, and an urgent prescription for antibiotics raised and emailed to the GP for approval, and also an urgent GP appointment arranged.  The nurse was then able to review the patient’s stoma, and catheter (catheter causing concern). As a result, the nurse arranged a referral to the community team for catheter support.  The nurse stayed until both patient and his wife were reassured and much calmer.

GP emailed their thanks for Coloplast’s nurse involvement, noting admission prevention and confirmed community support actioned.

3.4 It is imperative that the NHS has access to enough nurses, including specialist nurses, to deliver both high-quality care for patients and prevent potentially avoidable costs. This includes both recruiting new nursing staff as well as putting in place measures to retain more experience nurses. We would therefore like to see an additional duty added to the Bill, which ensures even greater accountability for workforce planning, potentially through annually updated long-term projections alongside the provision of information on strategy to achieve this and funding.

3.5 In addition, as we look to the resumption of routine NHS care following the rollout of the vaccination programme and the easing of the pandemic restrictions, we would encourage the NHS to explore new ways of collaborating with us to help alleviate workforce and workload issues, both immediate and over the longer term. We have the resources to provide good patient support and are experts in community stoma and continence care.

4. Hospital Discharge

4.1 Part 1, Clause 78, Hospital discharge: The intention of the clause is to introduce flexibility for local areas to adopt the discharge model that best meets local needs, including an approach known in England as ‘discharge to assess’. We recognise and welcome the need for greater flexibility. However, we know that some patients requiring Coloplast products will have complex medical and social care needs that require ongoing specialist support, for example, those with spinal cord injuries or those who have a newly formed stoma. It is therefore important that when these patients are discharged from hospital, appropriate planning and support is put in place, and increased flexibility does not lead to variation in standards of care; no one should fall through the gaps.

4.2 For example, concerning ostomy patients, we are aware that there is currently variation in out of hospital care, and a significant number of patients are presenting back to acute or primary care services in the six-month period after discharge. As part of our Coloplast Charter [16] , our Best Start programme provides patients with a newly formed stoma with assistance adapting to life back at home, establishing their new routine and ensuring they have the right products ordered and delivered. Our Always There [17] programme, recognises that patients can face new challenges over time, and offers ongoing access to an experienced team of specialists who can help with the early identification of issues, provide prompt resolution and escalate into the NHS when necessary. As such, we feel that this is another positive example of how private providers like Coloplast can effectively support the NHS in its ambitions to get people back into their homes or usual care setting safely, as well as reducing the burden on the NHS by preventing potentially avoidable readmissions.

4.3 Poor discharge – Intervention and Support by Coloplast Stoma Nurse – Case Study Four

A 72 year old lady had been an inpatient for 115 days, with multiple complex medical issues.  The outcome of emergency surgery - complex wound fistula, a high output ileostomy in a deep crease (obese lady).  Her stoma management was poor as unable to see stoma.  The Coloplast Stoma Nurse Team stepped in to support her discharge, with her complex training needs.  The nurses visited her at home every 48 hours to ensure a safe discharge was in place, and the prevention of readmission to hospital.

The nurse team liaised with PCN leads, the patient’s GP and Medicines Management to ensure she received the correct products and repeat prescription to manage such a complex stoma.

Next steps and further information

Coloplast will be following the progress of the Bill with great interest. For further information regarding our written submission, please contact Hannah Gagen, Head of Government Affairs & Patient Advocacy, Coloplast UK & Ireland via gbhgn@coloplast.com or 07469154085.


[1] Taylor P, Introduction to stomas: reasons for formation, Nursing Times, 2005 Vol 101 (29).

[2] NHS Digital Hospital Admitted Patient Care Activity, NHS Digital 2020

[3] https://www.mayoclinic.org/diseases-conditions/urinary-incontinence/symptoms-causes/syc-20352808

[4] https://www.coloplast.co.uk/Bladder-and-Bowel/consumer/living-with-bladder-problems/#section=_239081

[5] Source: Irwin, D., Milsom, I. et al. Impact of overactive bladder symptoms on employment, social interactions and emotional wellbeing in six European countries. British Journal of Urology International: 2005; 97, 96-100)

[6] https://www.coloplast.co.uk/Global/UK/Continence/Cost_of_Constipation_Report_FINAL.pdf

[7] https://www.coloplast.co.uk/Global/UK/Continence/Cost_of_Constipation_Report_FINAL.pdf

[8] The cost of constipation second edition 2021, Bowel Interest Group

[9] https://www.mayoclinic.org/diseases-conditions/spinal-cord-injury/symptoms-causes/syc-20377890

[10] https://www.backuptrust.org.uk/spinal-cord-injury/what-is-spinal-cord-injury#:~:text=There%20are%20an%20estimated%2050%2C000,2%2C500%20people%20are%20newly%20injured . Accessed August 2021

[11] https://www.mssociety.org.uk/what-we-do/our-work/our-evidence/ms-in-the-uk

[12] https://www.coloplast.co.uk/Bladder-and-Bowel/consumer/multiple-sclerosis/#section=Multiple-sclerosis-and-bowel-issues_243597

[13] ref: Guest JF, Fuller GW, Vowden P. Cohort study evaluating the burden of wounds to the UK’s National Health Service in 2017/2018: update from 2012/2013. BMJ Open 2020; 10:e045253.doi:10.1136/bmjopem-2020-045253

[14] https://www.conservatives.com/our-priorities/nhs

[15] https://www.cqc.org.uk/location/1-303719872/reports

[16] https://www.coloplastcharter.co.uk/

[17] https://www.coloplastcharter.co.uk/advice-and-support/continence-support/catheter-support-and-coloplast-charter/isc-always-there/

[17]

[17] Thursday 2 nd September 2021.

 

Prepared 15th September 2021