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Euro Care 4: Continence in Ireland – Little things mean a lot!
One benefit of belonging to the EU has been the extent to which national agencies can develop pan-European initiatives to the benefit of all member states. In the area of health care - the European Public Sector Award recognises best practice by highlighting exemplary models of care. This article focuses upon a continence project in County Roscommon, Ireland which was adopted by the EPSA as an example of good practice.
Continence can be a difficult topic to discuss. It is estimated that 9 million people in the UK suffer from urinary continence problems (Bladder and Bowel Foundation, 2011) and approximately 1% to 10% of adults suffer from an element of faecal incontinence (NICE, 2007). Continence problems can seriously negate life-quality. The knock-on effect can impact self-esteem, mood, personal and sexual relationships, and emotional wellbeing. So, creative approaches to promoting exemplary continence practice can have tangible benefits to life-quality.
In Wales The Older People Commissioner’s report ‘Dignified Care?’ published in March 2011, echoed findings in the All Wales Fundamentals of Care Audit of the same year. Both showed that there was more that health boards and trusts need to do to meet patients’ requirements in relation to continence.
The EU/Irish Perspective
Ireland is the Westerly most country in the EU and has been a member since 1973. The Health Service Executive (HSE) provides health and social services to everyone living in Ireland. It employs over 100,000 people with an annual budget of over €13 billion. There are four HSE administrative areas; the Roscommon Continence Care project is based in County Roscommon which is one of six counties in the HSE West administrative area.
Roscommon is an inland county with a population of 58,768, of which 15% is over the age of 65 years. It is estimated in HSE West that over 10,000 adults and children suffer from bladder problems, based on the number of people who access disposable products through HSE Services. The true figure is probably substantially greater. When left undiagnosed or unmanaged, incontinence can have devastating consequences, and can place a huge burden on healthcare providers and other resources.
Ireland like other European countries is wrestling with an aging population and the rising costs of health and social care . Consequently it is striving for transformational ways of delivering quality services. But transformational need not mean high-tech or expensive. Sometimes it is about using information more effectively to deliver greater convenience for patients.
The County Roscommon Project
The continence care model developed across County Roscommon has significantly improved care for children and adults with bladder and bowel problems by redesigning the way services are provided and delivered in all Primary, Community and Continuing Care (PCCC) settings as well as private nursing homes across the County. This involved the development of continence guidelines/protocols and delivery of a number of education programmes open to staff from all services. Central to the project is the synergy database, an information management system which manages the data derived from clinical assessments. This system leads to the provision of regular home delivery of appropriate products to clients across County Roscommon, either direct to their own homes, residential care units or private nursing homes.
This project is a partnership between all clients and healthcare staff across public, private and voluntary sectors. It has been proven to deliver cost-effectiveness and with a focus on prevention and rehabilitation it sets out a model of good practice for continence care, which has the potential for national roll out and has already been replicated in six counties so far.