Refocus bowel health to cut unnecessary admissions and spending

As a learned professional, would you feel comfortable having a conversation with your GP about the state of your bowels?

If the mere thought of it makes you embarrassed, you’re far from the only one. But a reluctance to discuss such topics not only stops patients from getting timely treatment, it also has a significant financial impact.

‘Constipation can devlelop into a chronic problem with significant consequences’

Constipation is a common condition which most people will suffer from at some point in their life. It can usually be dealt with at no great cost.

But for some groups of people, particularly those with long term neurological conditions, constipation can develop into a chronic problem with significant consequences.

Costly condition

Research recently published by the Neurological Commissioning Support has highlighted that constipation cost the NHS £59m due to unplanned hospital admissions in 2012-13.

This figure was based on an analysis of hospital episode statistic data across several neurological conditions. As well as the amount of money spent on non-election admissions, chronic constipation can lead to increased use of community nursing resources and most importantly, seriously affects quality of life in particular patients with spinal injuries, multiple sclerosis, spina bifida and Parkinson’s disease.

Better treatment for constipation would improve patient outcomes and concomitantly as frequently with improved outcomes, would save money.

‘Constipation costs the NHS £59m due to unplanned hospital admissions’

The £59m is partly explained by reluctance – among patients, healthcare professionals (patients frequently specifically mention their GP) and the public in general – to talk about our bowels.

This sense of embarrassment – a reluctance for patients to bring up problems, and for healthcare professionals to ask at risk groups if they’ve experienced problems – prevents problems being identified at an early stage and effectively dealt with.

But even when problems are identified, there’s not always an obvious pathway to follow. This can often lead to problems becoming intractable, and resulting in hospital admissions.

Healthcare managers and clinical leaders can help alleviate this problem with a number of small but significant actions.

• Encourage a culture of openness and proactivity

If one of the reasons that constipation costs so much money is simply a reluctance to have a discussion with people about their bowels, challenging this unwillingness offers a straightforward way to improve the situation.

‘Challenging the reluctance to discuss bowel health is a straightforward way to improve the situation’

This is particularly vital in the case of at risk groups, such as those with MS, spinal injuries, or other neurological conditions.

While all healthcare professionals need to play their part – given their level of patient contact – encouraging GPs to raise the issue and routinely ask questions about bowel health when seeing patients in at risk groups could encourage earlier identification of problems.

• Ensure guidance and pathways are in place

The conversation between patients and clinicians is just the first step. Once a healthcare professional has identified that a patient is experiencing serious problems with constipation, they need to know how best to treat these problems.

Again, this is a particular challenge for non-specialist healthcare professionals, who have a wide range of health problems to deal with on a daily basis.

‘The vast majority of CCGs don’t have guidance or pathways in places, so busy GPs have few resources’

Managers within clinical commissioning groups can contribute to improving bowel management by ensuring that clinicians can access guidance and referral pathways.

This could include clinical guidelines on when to refer them to their local continence service or to more specialist care. At the moment the vast majority of CCGs don’t have guidance or pathways in place, meaning that busy GPs have few resources to turn to for advice.

• Ensure patients can access specialist care

While some patients will find their bowel problems can be improved with a better diet and exercise regime or better hydration, others will find that more specialist care is needed.

‘Ensuring patients get the most effective referrals ensures high value care’

It is this latter group that are likely be admitted to hospital without the right care.

Continence services and specialists in secondary care can provide advice on a range of options, ranging from pelvic floor muscle training and bowel retraining, to rectal irrigation, and ultimately, surgery if this proves necessary.

Ensuring that patients get the most effective referrals ensures high value care.

Refocus and respond

Focusing more on bowel management provides an opportunity for the NHS to help people get an effective solution to a problem that can significantly affect a person’s quality of life and, as a consequence, is likely to lead to better use of NHS resources.

My interest in this clinical area stems from anonymised case studies, patient surveys and personal stories I have recently had access to which identified for me an unmet need.

I know many will say “not another priority to add to the myriad of others”, but to address these needs takes a refocus of attitudes and responsiveness of existing care, in particular of neurological long term conditions.

Professor David Colin-Thomé is an independent healthcare consultant and was formerly the national director for primary care at the Department of Health and a GP for many years