Freedom of Information Report 2011

Transcription

1 Freedom of Information Report 2011

2 2 Contents Executive Summary 3 Question 1 Analysis 4 Question 2 Analysis 5 Question 3 Analysis 6 Question 4 Analysis 7 Question 5 Analysis 8 Summary of Responses 11

3 3 Executive Summary Contents With the support of Portcullis Public Affairs (Portcullis), the Paediatric Continence Forum (PCF) issued a Freedom of Information (FOI) request to all PCTs in the UK in February Seventy-two of the 152 PCTs responded to the questions posed concerning their paediatric continence services. This report analyses these 72 responses to provide an overview of the quality of paediatric continence services across the UK. With this number of responses we can confidently presume that the findings are indicative of the general situation in the UK. Nevertheless we should bear in mind that PCTs running less-thanexemplary services could be disproportionately represented among those that chose not to respond. A table summarising the responses can be found in the final section below. This report identifies examples of best and worst practice and gauges the extent to which NICE guidelines have been effectively implemented by PCTs. The findings will be shared with relevant parties including NICE, the Department of Health, the Department for Education, their concomitant Select Committees, and the Continence Care APPG. The data will inform direct approaches to PCTs and new Commissioning Care Groups (CCGs) with a view to advising on best practice in service provision. In addition, the PCF intends to contact the MPs of PCTs with poor services to enlist their support for local improvements and mobilise them in Parliament to raise the issue of paediatric continence services with the Government. Key facts Eighty-eight percent of PCTs commissioned services in four areas but provision varied in quality and type. Daytime wetting and toilet training services tended to be less adequate than services for bedwetting and constipation/soiling. Over 10% of PCTs were largely reliant on health visitors and school nurses for non-acute services. Forty-nine percent of PCTs did not class their services as joined-up. Approximately a third of PCTs that identified their services as joined-up did not actually have a designated lead or team delivering all services. Three quarters of PCTs did not operate a dedicated paediatric service. One quarter of PCTs intended to commission new services or redesign existing services in light of the recently published NICE guidelines. No PCTs were aware of any plans to cut back services as a result of commissioning reforms, but many pointed out that they simply did not know how new Clinical Commissioning Care Groups would operate. Health Visitors and school nurses led in assessing and distributing products. Seventeen percent of PCTs did not offer washable products. Two thirds of PCTs limited products to 4 5 a day per individual.

4 4 Question 1 Contents Of the four main paediatric continence services (bedwetting, daytime wetting, toilet training and constipation/soiling), which are being commissioned by your PCT? Although 63 out of 72 PCTs commissioned all four services, there was notable variation in the quality and type of provision. Five PCTs failed to offer one of the services, and four PCTs only offered one service. PCTs offering four services The vast majority of PCTs commissioned all four services. It is apparent, however, that among the four services, provision for daytime wetting tended to be the least adequate. Coventry PCT, Southwark PCT and Walsall PCT reported that they only dealt with daytime wetting on a partial or ad hoc basis. This could reflect the lack of a NICE guideline on daytime wetting, and indicates the need for advice on best practice in this area. While most PCTs commissioned services in all four areas from their provider arm or community trust, a small number only offered certain services through the local hospital. Coventry PCT, for instance, only commissioned constipation/soiling services from University Hospitals Coventry and Warwickshire NHS Trust. And North Yorkshire and York PCT provided all four services within the Selby and York area through the York Hospital NHS Foundation Trust. Most of the PCTs noted the important role that school nurses and health visitors play in assessing childrenʼs continence needs and administering treatments and products. Some PCTs such as Nottinghamshire County PCT, West Essex PCT, North East Essex PCT, Gloucestershire PCT, West Kent PCT and Lincolnshire PCT had little else by way of non-acute provision. Others, however, such as Manchester PCT, Luton PCT, Warrington PCT, West Sussex PCT, Somerset PCT, and Bradford and Airedale PCT had nurses leading a dedicated paediatric continence service with specialist clinics and established referral pathways. From certain responses it is evident that PCTsʼ services catered for different age groups. Surrey PCT, for instance, operated a 0 19 paediatric team, while Medway PCT ran services for children between PCTs offering three services Five PCTs offered three of the services in question. Mid Essex PCT did not offer a constipation service, but hoped to provide one in the future. Richmond and Twickenham PCT did not offer daytime wetting services, and had very limited school nursing and health visitor based provision in the other areas. Peterborough PCT, Milton Keynes PCT and West Sussex PCT lacked a proper toilet training service. PCTs offering one service Four PCTs only offered one service. Wiltshire PCT, Hertfordshire PCT and Suffolk PCT only mentioned nocturnal enuresis clinics run by school nurses, while Western Cheshire PCT only cited ʻtoilet training supportʼ.

5 5 Question 2 Contents Are these services joined-up, i.e. is there one service for all four continence problems? If so, what is the designation of the person who leads this service? Thirty-five of the 72 PCTs did not have joined-up services. Those that described their services as joined-up often did not have a designated lead or team delivering all services. A few PCTs were in the process of introducing an integrated service. PCTs with joined-up services Just over half of the PCTs identified their services as ʻjoined-upʼ. It was apparent, however, that about a third did so on the basis that they had a care pathway in place, or because they felt that there was effective communication between the teams involved in delivering services even if there was no united management. This was the case for PCTs such as Nottinghamshire County PCT, Devon PCT, Havering PCT, Isle of Wight PCT, Lewisham PCT, and Lincolnshire PCT. A few PCTs, such as Kensington and Chelsea PCT, Derby PCT, and Mid Essex PCT, answered in the affirmative but did not elaborate on what they understood by ʻjoined-upʼ and did not name a lead. It is important to note that some PCTs had an integrated service by default as a consequence of offering less than comprehensive provision. Suffolk PCT for instance identified its service as joined-up, but this was a consequence of only offering one of the four services. Similarly, Gloucestershire PCT and North East Essex PCT only had a joined-up service because they relied heavily on the health visiting team. A couple of PCTs Leeds PCT and Sheffield PCT reported that they had introduced an integrated service this year. Leeds had piloted an integrated Paediatric Continence Service from January, while Sheffield had united their services under Sheffield Childrenʼs Hospital with a paediatrician leading. In terms of best practice, Southwark PCT offered services in all four areas through its Childrenʼs Bladder and Bowel clinics and all its services were provided under one roof Sunshine House. Somerset, Bradford and Airedale, Southampton City, Warrington, and Manchester PCTs also had joined-up Paediatric Continence Services with designated leads. In general, the leads cited by PCTs were split fairly evenly between specialist nurses (band 6 8) and paediatricians. PCTs without joined-up services Thirty-five PCTs did not class their services as joined-up. Among these, Great Yarmouth and Waveney PCT, West Sussex PCT, Luton PCT, and Hertfordshire PCT indicated that they were working towards establishing an integrated service. Others such as Stockport PCT and Salford PCT offered comprehensive services with established pathways but did not have a designated lead. Richmond and Twickenham PCT and Wiltshire PCT did not commission any services directly, leaving school nurses, health visitors and paediatrics to manage needs within general budgets. As a consequence they lacked clear pathways and proper management.

6 6 Question 3 Contents Does your PCT have a ʻstand aloneʼ paediatric continence service that is led by a paediatric continence advisor? Fifty-four of the 72 PCTs did not have a stand-alone paediatric continence service. A few of these nevertheless had advisors. Some with dedicated services did not provide all of their services through it. PCTs without a stand-alone service Three quarters of PCTs did not offer a stand-alone service, instead relying on a general continence service for all age groups and/or school nurses and Health Visitors. Among those without a standalone service, Derbyshire PCT, North East Essex PCT, and East Lancashire PCT did have a paediatric continence advisor, and Devon PCT and Dudley PCT had specialist nurses in an advisory role. Worcestershire PCT reported that within their general continence service they had special paediatric continence nurses and Hertfordshire PCT announced plans to employ a Paediatric Continence Lead within their general continence service. Southwark PCT operated a Childrenʼs Bladder and Bowel Clinic covering all four services under one roof under the lead of a paediatrician, but did not identify their service as stand-alone. Nottinghamshire County PCT reported that since October 2010 their general continence service ceased to deliver a specific paediatric service. Like Richmond and Twickenham PCT they relied on Health Visitors and school nurses PCTs with a stand-alone service Sixteen PCTs said they had a stand-alone service. For Middlesbrough PCT, Gloucestershire PCT, and Northamptonshire PCT this meant that there was a defined paediatric continence promotion service within the general continence service led by specialist nurses. Similarly, Calderdale PCTʼs stand-alone service was a defined subset of Children and Young Peopleʼs Services. Leicester City PCT ran a Dry Time Clinic covering all four services that was led by a Childrenʼs Urology Specialist Nurse (band 7) employed by the acute trust. Similarly, Havering PCT ran paediatric clinics under a paediatric lead. Eastern and Coastal Kent PCT ran a Childrenʼs Bladder and Bowel Nursing Team, but this did not provide all of their services. Meanwhile, Manchester PCT operated two dedicated paediatric continence services with input from advisors. Bradford and Airedale PCT, Warrington PCT, Somerset PCT, and West Sussex PCT stood out as examples of best practice with clear stand-alone paediatric continence services led by advisors or senior nurses. The other PCTs that answered in the affirmative did not elaborate on their arrangements.

7 7 Question 4 Contents In light of the current NICE guidelines for childhood constipation and nocturnal enuresis and the recently published NICE Paediatric Continence Services Commissioning Guide, is your PCT planning to commission new paediatric continence services? Eighteen of the 72 PCTs said they either planned to commission new services or were reviewing their existing services in light of the NICE guidance. A number of those that had no such plans said they already complied with NICE guidelines. PCTs responding to the NICE guidelines A quarter of PCTs said they would respond to the recent NICE guidelines. The majority of these said they were reviewing/redesigning existing services rather than commissioning new ones. This was the case for Bradford and Airedale PCT, Derby City PCT, Ashton, Leigh and Wigan PCT, Richmond and Twickenham PCT, Leicester City PCT and Northamptonshire PCT. Worcestershire PCT and Portsmouth City PCT did not go quite so far, only expressing their intention to monitor against NICE going forward. Dudley PCT said they would consider the NICE guidelines at the next Board Meeting (May 2011). Eastern and Coastal Kent PCT, meanwhile, had already written a service specification for their Childrenʼs Bladder and Bowel Nursing Team based on the guidelines. Some PCTs planned more substantial changes. Wolverhampton PCT expressed their intention to have a dedicated Paediatric Continence Service up and running within a year. Kensington and Chelsea PCT, Salford PCT and West Sussex PCT also reported that plans were in place to commission new services. Devon PCT had found funding for new posts in this area, while Leeds PCT and North East Essex PCT were piloting new services that they hoped would meet NICE guidelines. North East Essex PCT noted that their new services would also follow ERICʼs guidelines. PCTs not responding to the NICE guidelines Three quarters of PCTs had no plans to change their services or commission new ones. Of these a number said that they already complied with the NICE guidelines. This was the case for Manchester PCT, Southwark PCT, Wirral PCT, Isle of Wight NHS PCT, Luton PCT and Warrington PCT. Bolton PCT and Coventry PCT, on the other hand, said that they would leave it to GP consortia (now Clinical Commissioning Groups) to consider commissioning arrangements, suggesting that the commissioning reforms may deter PCTs from acting to make improvements. A number of PCTs did not elaborate on why they had no plans for new services and some did not respond to the question. The impact of commissioning reforms In answer to a separate question, all of the PCTs said that they were unaware of any plans to cut back services as a result of the NHS reforms. Many pointed out, however, that they simply do not know how GP consortia (now Clinical Commissioning Groups) will operate. Four PCTs reported other forthcoming changes to their service provision. Sefton PCT and Peterborough PCT were moving services in April 2011 to a ʻnew provider trustʼ and ʻdifferent organisations/pctsʼ respectively. While Leicester City PCT was moving services to Leicester Partnership NHS Trust, and Dudley PCT was transferring them to Sandwell Mental Health Trust in July 2011.

8 8 Question 5 Contents Who is responsible for assessing children and supplying continence products? Please indicate whether children are offered a choice of washable and disposable products as appropriate, and the maximum number of products supplied per day. Generally the PCTs noted the important role that Health Visitors and school nurses play in assessing and providing products, often with the approval and involvement from the continence service as required. Eighty-three percent of PCTs offered a choice of washable and disposable products. Of the 12 PCTs that did not offer washable products, two Wirral PCT and Tameside and Glossup PCT said that there was no demand for them among parents. Four PCTs mentioned that they offered pull-ups for toilet training purposes: North East Essex PCT, Isle of Wight NHS PCT, Heywood, Middleton and Rochdale PCT, and Stockport PCT. Almost two thirds of PCTs supplied a maximum of 4 5 products per day to individuals. Many of these were keen to qualify, however, that this could be exceeded in special circumstances. A handful of PCTs set a maximum of three products, and a couple supplied up to six products. Seventeen PCTs did not indicate a maximum number of products. But many of these simply did not address the issue in their answer. This was the case for Richmond and Twickenham PCT, West Essex PCT, Stoke on Trent PCT, Milton Keynes PCT, and Sheffield PCT. Leicester PCT and Worcestershire PCT actually noted that they had a maximum but did not specify a number. No stated 6 maximum products Eastern and Isle of Coastal Kent Wight NHS Gloucestershire Walsall 5 products 4 products 3 products No washable products Calderdale Bradford and Airedale Bromley Berkshire West Ashton, Leigh and Wigan Lambeth Derby City Bristol Bournemouth and Poole Leicester Derbyshire County Cornwall and Isles of Scilly Home Delivery Bolton Bristol Mid Essex North Lincolnshire Bournemouth and Poole Havering Heywood, Middleton and Rochdale Lincolnshire Devon Coventry Oldham Kensington and Chelsea Medway Dorset Dudley Portsmouth City Nottinghamshire County Milton Keynes Havering East Lancashire Wirral Peterborough North Lancashire Hertfordshire Great Yarmouth and Waveney Portsmouth City Richmond and Twickenham Islington Halton and St Helens Suffolk Sefton Kensington and Chelsea Heart of Birmingham Tameside and Glossop Sheffield Leeds Heywood, Warwickshire Middleton and Rochdale Somerset Luton Lewisham Wirral Southampton Manchester Middlesbrough City Stoke on Trent Mid Essex NHS North of Tyne Sefton Stockport

9 9 West Essex North East Essex North Yorkshire and York Western Cheshire Nottinghamshire County Northamptonshire Worcestershire Peterborough Salford West Sussex Shropshire County Southwark Stockport Suffolk Surrey Tameside and Glossop Warrington Warwickshire West Kent Wiltshire Wolverhampton City

10 10 Summary of Responses Contents For a full copy of the responses please damien.green@portcullispublicaffairs.com. PCT Number of Services Joinedup? Standalone? Responding to NICE? Ashton, Leigh and Wigan PCT 4 Y Y Y Berkshire West PCT 4 N N N Bolton PCT 4 Y N N Bournemouth and Poole PCT 4 Y N N Bradford and Airedale PCT 4 Y Y Y Bristol PCT 4 N N N Bromley PCT 4 N N N Calderdale PCT 4 Y Y N Cornwall and Isles of Scilly PCT 4 Y N N Coventry PCT 4 N N N Derby City PCT 4 N Y Y Derbyshire County PCT 4 N N N Devon PCT 4 Y N Y Dorset PCT 4 N N N Dudley PCT 4 N N Y East Lancashire PCT 4 N N N Eastern and Coastal Kent PCT 4 Y Y Y Gloucestershire PCT 4 Y Y N Great Yarmouth and Waveney PCT 4 N N N Halton and St Helens PCT 4 Y N N Havering PCT 4 Y Y N Heart of Birmingham PCT 4 Y Y N Hertfordshire PCT 1 N N N Heywood, Middleton and Rochdale PCT 4 N N N Isle of Wight NHS PCT 4 Y N N Islington PCT 4 N N N Kensington and Chelsea PCT 4 Y Y N Lambeth PCT 4 Y N N Leeds PCT 4 Y Y Y Leicester City PCT 4 N Y Y Lewisham PCT 4 Y N N Lincolnshire PCT 4 Y N N Luton PCT 4 N Y N Manchester PCT 4 Y Y N Medway PCT 4 N N N Mid Essex PCT 3 Y N N Middlesbrough PCT 4 Y Y N Milton Keynes PCT 3 N N N NHS North of Tyne PCT 4 Y N N North East Essex PCT 4 Y N Y North Lancashire PCT 4 Y N N North Lincolnshire PCT 4 N N N North Yorkshire and York PCT 4 N N N Northamptonshire PCT 4 Y Y Y Nottinghamshire County PCT 4 Y N N Oldham PCT 4 N N N Peterborough PCT 3 N N N Portsmouth City PCT 4 N N Y Richmond and Twickenham PCT 3 N N Y Salford PCT 4 N N Y Sefton PCT 4 Y N N Sheffield PCT 4 Y N N Shropshire County PCT 4 N N N Somerset PCT 4 Y Y N Southampton City PCT 4 Y N N Southwark PCT 4 Y N N Stockport PCT 4 N N N Stoke On Trent PCT 4 N N N Suffolk PCT 1 Y N N Surrey PCT 4 Y N N Tameside and Glossop PCT 4 N N N Walsall PCT 4 N N N Warrington PCT 4 Y Y N

11 Warwickshire PCT 4 N N N West Essex PCT 4 N N N West Kent PCT 4 N N N West Sussex PCT 3 N Y Y Western Cheshire PCT 1 N N Y Wiltshire PCT 1 N N N Wirral PCT 4 Y N N Wolverhampton City PCT 4 N N Y Worcestershire PCT 4 Y N Y 11