We need to talk about…

Since the publication of this blog Dr Martin McShane has left NHS England.

Dr Martin McShane, NHS England’s Director for Patients with Long Term Conditions, explains why we must ask patients the right questions and not let them suffer in silence:

Domain 2 of the NHS outcomes framework is about ‘enhancing the quality of life for people with long term conditions’ and, as I listened to this year’s Reith lecture by Atul Gawande about how he learnt to ask the right questions, I thought about the questions we don’t ask, the topics we don’t address and the problems that people are reluctant to discuss unless given the space and acceptance to do so.

So we need to talk about incontinence.

In the UK, there are over 14 million people who have bladder control problems and 6.5 million with bowel control problems. That is a lot of people who could have a better quality of life if it was acknowledged and addressed.

However, men, women and children of all ages and vulnerable groups in particular continue to suffer with this condition unnecessarily and often in silence. It is a significant factor in admissions to hospital and residential care. It robs people of dignity and mobility. Which is why, working with colleagues from the Nursing Directorate, I want to support work to raise the profile of continence care.

Nursing colleagues have launched a programme of work, Excellence in Continence Care, to support commissioners to recognise the value better continence care brings; value to the system as well as, most importantly, the individual.

Improving continence services has many benefits including:

  • A reduction in admissions to permanent care settings: nursing homes, secondary care, homes for disabled children and adults;
  • Fewer costly emergency admissions to secondary care with urinary tract infections, pressure ulcers and catheter related infections;
  • Reducing prolonged use of costly incontinence products through low cost interventions such as physiotherapy and medication;
  • Better continence care contributes to independent living and improved quality of life.

Imagine if we could enhance the quality of life for 14 million people – wouldn’t that be something worth talking about?

Dr Martin McShane was previously National Clinical Director for Long Term Conditions, since the publication of these blogs he has left NHS England.


  1. Danielle Harari says:

    I am a physician with continence expertise representing the British Geriatrics Society and strongly support Martin McShane’s statement. Poor quality continence care featured prominently in the Francis report on failings at the Mid Staffordshire NHS Trust. And yet the All Party Parliamentary Group for Continence Care 2103 survey showed downgrading of continence services across England, with a very concerning decreasing number of continence nurse practitioners. NICE Quality Standards for urinary and faecal incontinence have now been published, so guidance on quality care is readily available. For the benefit of millions of sufferers, it is vital that Clinical Commissioning Groups and clinicians prioritise continence care right now.

  2. Patricia McDermott says:

    We need to talk about…, totally agree with Martin. It’s not a topic that people talk about and most people think they are on their own with Bladder and Bowel problems. So many people say to me “am I the only one with this problem”. We need to encourage people and health care professions to be proactive not reactive. Continence is a costly business both for people and the Goverment.

    Lynne Craven I am so glad you persevered and got the right help and yes personal accounts are the most powerful, do you speak much about your experiences?

    September used to be Continence awareness month but we seam to have lost this. It would be good to have a dry pants month and encourage people to seek help and do Pelvic Floor exercises. What are your thoughts on this?

  3. Adrian Wagg says:

    As General Secretary of the International Continence Society, based in the UK, and previous lead of the HQIP commissioned Royal College of Physicians National Audits of continence Care I wholeheartedly support these moves. We know from the 2010 data that continence is seldom a priority to commissioners and any action to alter the perception that continence, with its associated morbidity and decrement in quality of life for sufferers is not something to bother much about should be applauded and encouraged

  4. Sharon Eustice says:

    Thank you – this is really helpful. I agree that we do need to ask the right questions as well as listen effectively to individual stories and experiences. We must collectively drive much better treatment and care with intelligent compassion.

  5. Dawn Brookfield says:

    Below the belt & beyond welcomes Martins’ comments & remains committed to helping healthcare professionals to improve standards of care in this often neglected area which impacts so dramatically on the quality of life of so many in the UK

  6. Bladder and Bowel Foundation says:

    Bladder and Bowel Foundation welcomes Dr McShane’s recognition of this enormous health and social care challenge.

    B&BF provides a range of services that help people living with bladder and bowel control problems to manage their symptoms in collaboration with healthcare professionals.

  7. Lynne Craven says:

    I often find my stories about my own incontinence troubles are the most powerful, especially when they’re about becoming a ‘de-activated patient’! Imagine that, at a time when you most need support for self-management, it isn’t there! Luckily I persevered and found the right help…unfortunately many people give up…we need to change this.