Continence reviews improve care and reduce costs

Salford Royal NHS Foundation Trust is one of the latest hospitals to benefit from NHS Supply Chain’s support for improvements in continence care

Salford Royal NHS Foundation Trust has been working closely with a key supplier to help identify the potential for standardised products and cost savings, whilst still maintaining high standards of patient care and safety. The supplier is supporting the trust by working with staff to prepare a detailed implementation plan for continence care. They are also providing product training to all staff, before the new rationalised formulary is introduced, ensuring that these key stakeholders understand the benefits. Support will continue afterwards through ward training, providing supporting documentation and attending key meetings such as link nurse and housekeeper meetings.

Wendy Booth, senior buyer for the Northern Care Alliance NHS Group, commented: “Good continence care is vital for the health and wellbeing of patients. Working with NHS Supply Chain and our supplier means that we have been able to develop an effective formulary for products, alongside staff training which is so important when making changes to the service.”

Last year, following a similar process, Portsmouth Hospitals NHS Trust worked with NHS Supply Chain on a review and were able to reduce the number of products stocked – down from 27 lines to four, stop the incorrect use of some products and save over £120,000. This included a saving of £44,000 from inappropriate use of wet wipes.

Matron Janice Cloud who was involved in the project at the time, said: “We needed comfortable, quality products that would mimic what patients used in the community, improve dignity, reduce moisture damage and incontinence associated dermatitis and standardise what we provided to our patients.”

The review process explained
Continence care is clearly a key area in which NHS Supply Chain can have a massive impact, both on patient care and NHS costs. Continence is an important part of people’s health and wellbeing at any stage of life. But for older people in particular, incontinence can lead to further complications which may ultimately result in longer hospital or nursing home stays.

For example, urine infection and catheter associated infection can often cause confusion in the elderly. This in turn can result in falls, head injury or femur fractures. Incontinence also increases the level of dependency in frail older people which may delay discharge from hospital or result in a move into a residential or nursing home.

Continence is also an important factor in the use of health resources. As well as the potential impact on services outlined above, trusts use hundreds of thousands of continence products each year, resulting in significant costs. The procurement of continence products is therefore a prime target for review.

As illustrated above, NHS Supply Chain has worked with a number of trusts to look at their processes with the aim of improving patient experience, reducing harm caused by incontinence and making life easier for health care professionals, as well as achieving cost savings.

The Plymouth and Salford examples show that success in this area is not simply achieved by finding a cheaper product. Trusts need to embrace a change in culture, ensure education is available to health care professionals, standardise products, come up with a general formulary and gain the trust of all staff.

By standardising continence practice, trusts are able to ensure that all patients receive the right product for their needs. In addition to making significant efficiency savings, trusts are also able to save time as staff are able to go straight to the right product every time.

The review process can include: detailed research into current practice; benchmarking what other trusts do; reviewing current products and suppliers; benchmarking suppliers - considering not just cost but also comfort, materials, breathability, effectiveness and service support; and speaking to staff from different disciplines to understand their issues.

It also helps to establish a formulary to make things easier for nursing staff, to reduce waste, and to reduce stock of unwanted items.

The new NHS Supply Chain approach
The new operating model for NHS Supply Chain helps the NHS deliver clinically assured, quality products at the best value through a range of specialist buying functions, of which continence care is just one example. It is leveraging the buying power of the NHS to negotiate the best deals from suppliers, with the aim of delivering savings of £2.4 billion back into NHS frontline services and patient care in financial year 2022/23.

The new model includes eleven specialist category buying functions delivering Medical, Capital and Non-Medical products and services and three enabling services for Logistics, Supporting Technology and Transactional Services. Teams of buyers work in partnership with front line clinicians who continuously evaluate new products before these are made available in the catalogue.

In addition, the Clinical and Product Assurance (CaPA) function ensures that all products procured for the health and care system are value for money, fit for purpose, safe and reflect professional, patient and carer needs. CaPA also supports the adoption of new innovations into the NHS which provide improvements in patient outcomes, sustainability and/or unmet clinical need. This is informed by collaboration with wider national initiatives, one of which is Excellence in Continence Care which the CaPA team are supporting. If health and care professionals or patients and carers want to inform the Excellence in Continence Care work they can register their interest here.

Wider benefits of working with NHS Supply Chain include: leading suppliers on contract, providing enhanced range and value from a single source; the ability to view current and historical purchasing data; deliveries picked and packed to requisition point; a wider range of product options; tendering undertaken on trusts’ behalf; back office savings; economies of scale; minimising the impact of price rises; quality assurance through our Clinical and Product Assurance function; dedicated account managers; clinical nurse advisors to support trusts and their staff; and an implementation team to help set up new processes and training.