From taboo to priority: Improved continence care
People across North Yorkshire shared their experiences of bladder and bowel health with Healthwatch. Continence problems affect people of all ages, yet too many told us they felt embarrassed, dismissed, or unsupported when asking for help.
One person told us they avoided leaving the house because they could not rely on public toilets being open. Another described being made to feel “a nuisance” when asking their GP about continence products. These stories highlight the emotional as well as the physical impact of continence issues.
The message was clear:
- People want better information and practical advice they can trust
- They need timely, respectful support from health and care staff
- Services must treat continence as a priority
What Healthwatch did
Healthwatch raised these concerns with the people in charge at hospitals in York, Scarborough and Harrogate, GP practices across the county, North Yorkshire Council and the local NHS.
Healthwatch and the public asked for action to:
- Ensure hospitals support people to manage continence themselves rather than defaulting to pads.
- Improve access to a wide range of continence products through clear formularies.
- Provide stoma patients with the right information and supplies before leaving hospital.
- Train hospital and social care staff in catheter, stoma, and continence care.
- Update public-facing information and signpost to peer support.
- Recognise and address continence poverty, including the role of prevention.
- Keep accessible public toilets open year-round.
- Encourage GPs to have proactive conversations about continence and improve responses to urinary tract infections.
What has changed
Hospitals
Hospitals across North Yorkshire have begun to make continence care a higher priority, with new screening, support, and training in place.
York and Scarborough Teaching Hospitals NHS Foundation Trust
- Introduced a continence screening tool completed within 72 hours of admission, ensuring continence needs are identified early.
- Encourages patients to bring their own products and underwear to support recovery and dignity.
- Stoma care specialist nurses provide pre operative counselling, written packs, and ongoing follow up for new stoma patients.
- Runs continence awareness days at York Hospital and has produced lifestyle advice leaflets and posters for general practices, health centres, and public toilets.
- Works with local support groups, including the Multiple Sclerosis Society and cancer support groups, to raise awareness.
- Provides staff training in stoma, ostomy, and catheter care, with new pathways being developed for bladder scanning and intermittent self catheterisation.
Harrogate and District NHS Foundation Trust
- Uses “toilet plans” recorded in patient notes to encourage continence wherever possible. Pads and pants are only used when necessary.
- Has a comprehensive continence product formulary, regularly updated by the specialist continence service, ensuring access to both standard and specialist products.
- Provides stoma patients with pre operative counselling, a two week supply pack, written guides, and at least 12 weeks of follow up including home, clinic, telephone, and video support.
- Offers refresher training on catheter care through the a care team, with training for new nursing and healthcare staff. An updated catheter policy and new online training package are being rolled out.
- Considering reinstating a stoma support group in Harrogate, while signposting patients to York and Leeds groups.
GP practices
General practices (the doctors) are beginning to respond to people’s concerns, trialling new approaches while also reviewing how urinary tract infections are managed.
- Healthwatch recommended that general practitioners hold proactive conversations about continence.
- The NHS Humber and North Yorkshire Integrated Care Board, is in charge of how money is spent locally, has reinforced that urinary tract infections should be managed through full clinical assessments rather than automatic record flags, to avoid misdiagnosis and overuse of antibiotics.
- Some general practices in Hambleton and Richmondshire are trialling new continence assessments during routine appointments.
Community continence services
Specialist continence services in the community have expanded so that people can get advice and treatment closer to home.
- Services in Craven and Selby have grown, reducing reliance on hospitals and helping people to access continence support more quickly.
- Community teams are now providing more advice, assessments, and product support in local settings.
Social care and the community
Social care providers and local councils are taking steps to improve how staff recognise and respond to continence needs, especially for older people and those with learning disabilities.
North Yorkshire Council and Humber and the local NHS are:
- Training care home and domiciliary staff to spot urinary tract infections, constipation, and continence needs, particularly in older people and those with learning disabilities.
- Promoting awareness of bladder and bowel health through the use of the Bristol Stool Chart, and linking to wider bowel cancer prevention campaigns.
- Running quality improvement programmes in care homes that have reduced urinary tract infections and other avoidable harms.
- Supporting training for continence product use in the care sector and rejecting reliance on pads as a solution.
- Exploring how continence poverty could be included in public health prevention programmes, though redistribution of unused continence products is restricted by medical device regulations.
Peer support and awareness
Support groups and awareness activities are helping people feel less isolated and more confident to talk about continence.
- The York and Scarborough Bladder and Bowel team attend local events and work with support groups to raise awareness.
- Harrogate and District NHS Foundation Trust is considering restarting its stoma support group in Harrogate.
- Patients are being signposted to peer led groups such as Second Chance Ostomy and those in York and Leeds.
Public information
Services have also started to improve the way information is shared so people can find help more easily.
- York and Scarborough Teaching Hospitals NHS Foundation Trust produces leaflets and posters with clear contact details for the bladder and bowel service. Referrals are accepted from health professionals, with limited self referral options.
- Harrogate and District NHS Foundation Trust’s continence website provides service information, referral options, leaflets, and staff contact details.
What still needs to happen
Despite important progress, people’s experiences show there is still much more to do.
In healthcare
- Proactive support in general practice so that continence is routinely raised during appointments, rather than left for patients to bring up when they feel uncomfortable.
- Consistent standards across all hospitals and community services, so everyone in North Yorkshire receives the same level of dignified continence care wherever they live.
- Shorter waiting times for assessment and support, particularly for children and older people.
In communities and social care
- Year-round access to public toilets so people feel confident to leave their homes and live independently.
- Better training for care staff in recognising early signs of continence problems, urinary tract infections, and constipation, with practical tools such as the Bristol Stool Chart used widely in care settings.
- Action on continence poverty, including prevention programmes and practical solutions for people who cannot afford essential products.
Information and awareness
- Clearer, more accessible information online and in printed form, with self-referral options where appropriate so people know exactly how to get help.
- Stronger peer support networks, including the reinstatement of local continence and stoma groups, to reduce isolation and stigma.
It’s positive to see wider progress on related issues, such as the rollout of more changing places and accessible toilets across North Yorkshire. While not a direct result of Healthwatch's continence work, this will make a real difference to people who need safe, suitable toilet facilities when out and about.
Looking ahead
Healthwatch North Yorkshire will continue to monitor continence care and press for further improvements. Healthwatch will follow up on hospital and general practice commitments, check progress on community and social care training, and ensure people’s experiences continue to shape services.
Continence is not easy to talk about. But thanks to local people being brave and speaking up, it is helping to break that stigma. Care and support is being made better too. Healthwatch will keep working until everyone in North Yorkshire can access dignified, timely, and joined up continence care.
