From taboo to priority: Improved continence care
At a glance
Across North Yorkshire many of you told us: you felt embarrassed, overlooked or simply uncertain where to go when bladder or bowel problems arose. You said finding the right products, getting clear advice, or receiving consistent help was often harder than it should be.
Healthwatch shared these concerns with local health and care services. As a result, hospitals, GP practices, community teams and social care providers have started to make changes. These include earlier continence checks in hospital, better training for staff, clearer information, more support for stoma patients and fairer access to continence products.
There is still more to do. People want quicker support, clearer advice, better conversations in general practice, and the confidence to leave their homes knowing suitable toilets are available.
Healthwatch will keep working with local services to make continence care more consistent, respectful and easy to access for everyone.
You can read the full update below to see what has changed so far and what still needs to happen.
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
We raised these concerns with hospitals in York, Scarborough and Harrogate, GP practices across the county, North Yorkshire Council and the local NHS.
Together with local people we asked services to:
- support people to manage continence in hospital, rather than defaulting to pads
- improve access to a wide range of continence products through clear product lists
- give stoma patients the right information and supplies before leaving hospital
- train hospital and social care staff in catheter, stoma and continence care
- update public information and signpost to peer support
- recognise and address continence poverty, including prevention
- keep accessible public toilets open all year
- encourage GPs to have proactive conversations about continence and improve responses to urinary tract infections
Here’s what is changing to make support more visible, accessible and respectful.
What has improved
Hospitals
Hospitals across North Yorkshire have begun to make continence care a higher priority, with earlier checks, more support and stronger training.
York and Scarborough Teaching Hospitals NHS Foundation Trust
- Introduced continence screening within 72 hours of admission so needs are spotted early
- Encourages patients to bring their own products and underwear to support recovery and dignity
- Offers pre operative counselling, written packs and ongoing follow up for new stoma patients
- Holds continence awareness days at York Hospital and provides lifestyle advice leaflets and posters in practices, health centres and public toilets
- Works with local support groups, including the Multiple Sclerosis Society and cancer support groups
- Provides staff training in stoma, ostomy and catheter care, and is developing new pathways for bladder scanning and intermittent self catheterisation
Harrogate and District NHS Foundation Trust
- Uses toilet plans in patient notes to encourage continence wherever possible, with pads used only when needed
- Has a wide continence product list that is regularly updated
- Gives stoma patients pre operative counselling, a two week supply pack and at least twelve weeks of follow up, including home, clinic, phone and video support
- Offers refresher training on catheter care and is rolling out an updated policy and new online training
- Is considering restarting a stoma support group in Harrogate
Product choice and consistency
People told us they want continence products that suit their needs and are available wherever they live.
We asked services to follow the approach used by York and Scarborough Teaching Hospitals NHS Foundation Trust, which already offers a good range of products.
A group of specialist clinicians and commissioners is now working on a single product list for the whole area. This shared list would help ensure everyone has access to the same products. The group is also reviewing assessment documents and processes so they are used consistently by all services.
GP practices
General practices are beginning to respond to people’s concerns and are trialling new approaches.
- We recommended that GPs raise continence more proactively
- The NHS Humber and North Yorkshire Integrated Care Board has reinforced that urinary tract infections should be managed through full assessments, not automatic record flags
- Some practices in Hambleton and Richmondshire are trialling new continence assessments during routine appointments
Community continence services
Specialist community continence services have grown so people can get help closer to home.
- Services in Craven and Selby have expanded, reducing pressure on hospitals
- Community teams are providing more advice, assessments and product support in local settings
Social care and the community
North Yorkshire Council and the local NHS are:
- training care home and domiciliary staff to spot urinary tract infections, constipation and continence needs, especially for older people and those with learning disabilities
- promoting awareness of bladder and bowel health through the Bristol Stool Chart and linking to bowel cancer prevention
- running improvement programmes in care homes that have reduced urinary tract infections and other avoidable harms
- supporting training on continence product use in the care sector and challenging the overuse of pads
- exploring how continence poverty could be included in prevention programmes, although redistributing unused products is restricted by medical device rules
Peer support and awareness
Support groups and awareness activities are helping people feel less isolated.
- The York and Scarborough bladder and bowel team attend local events and work with support groups
- Harrogate and District NHS Foundation Trust is considering restarting its stoma support group
- Patients are being signposted to peer led groups such as Second Chance Ostomy and groups in York and Leeds
Public information
Services have also begun to share clearer information.
- York and Scarborough Teaching Hospitals produce leaflets and posters with contact details for the bladder and bowel service, plus guidance on products
- Harrogate’s continence website provides information, referral options and leaflets
What still needs to happen
Despite progress, people’s experiences show there is more to do.
In healthcare
- more proactive support in general practice so continence is raised routinely
- consistent standards across all hospitals and community services
- shorter waiting times, especially for children and older people
In communities and social care
- year round access to public toilets
- better training for care staff in early signs of continence problems, urinary tract infections and constipation
- action on continence poverty and access to essential products
Information and awareness
- clearer, more accessible information online and in print, with self referral options where appropriate
- stronger peer support networks, including restarting local stoma and continence groups
It is also positive to see wider progress on changing places and accessible toilets changing across North Yorkshire. While not a direct result of this work, these improvements will make a real difference for 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.
We know continence isn’t the easiest subject to raise. But because people were willing to speak up, that is beginning to change the story. Support and care are improving. And we will keep checking that every person in North Yorkshire can get dignified and timely continence care that fits them, wherever they live.
