In 2019, the author took over the leadership of a nurse- and physio-led bladder, bowel and pelvic health team in a large NHS Trust. It included community sites, and fifteen care homes (residential and nursing). It was soon established that the pelvic health service to the care homes consisted of providing containment products requested by care home staff and almost nothing else. It was decided that a much more proactive approach was required. A plan was set, but the arrival of the pandemic derailed the plans quickly and an alternative solution was required. It took several attempts to develop a strategy that was welcomed and supported by the care home staff, provided sufficient information for the pelvic health team to offer advice, and prescribe suitable products. There is now a process sin place that is working well and operates in all fifteen homes. Subjective feedback from staff, bladder and bowel champions in the homes, and home managers has been positive. 
It is now time to move to another stage of the process, and funding has been received to run a more detailed analysis over the next 6-12 months, using one care home as the focus. The aim is to see how much can we improve the continence status of the residents in one care home. It is also aiming to identify the particular barriers to achieving this, and to discover ways that we can work around this. The project starts in April 2024, and the results will be transferable initially across the rest of the care homes in the Trust. The aim is to then share the results more widely to enable the lessons we learn to be of benefit to others working in similar situations.

The project has evolved organically, adjusting the assessment process and forms as feedback has been received.
The process now involves care home staff using the following for each new resident, or resident with a change in continence status:
1. Simplified assessment/screening form
2. One day fluid intake diary
3. One day voiding diary
4. One day pad weigh test

The clinician responsible for the care home service reviews the forms, returns any that are incomplete, provides personalised advice and prescribes appropriate products. These are reviewed annually as a minimum. Moving away from product prescription and towards more active treatment will be one focus of the study we are about to embark upon.

Results (detailed below) indicate that the appropriate assessment and product prescription has reduced containment product costs compared to the national average. This is not fully indicative of success but is one element of a person-centred service and addressed the largest issue in this service, of the widespread and normalised use of containment products in care homes.

United Kingdom NHS Home Delivery Service figures for quarter 3, 2023-2024 (October - November 2023):
National average spend per patient, per day:
Residential homes - £0.63
Nursing homes - £0.65

Trust spend per patient,per day:
Residential homes - £0.55
Nursing homes - £0.60

The results indicate that we are using containment products less frequently that the national average, and that the ones we are using are perhaps less expensive. This suggests that we are using the right products, for the right patients. It is essential to move towards active treatment of bladder and bowel issues, and also prevention. Our next step is to look at this more robustly.

Care home residents are so often overlooked when it comes to bladder and bowel assessment and treatment. This service is working hard to overturn this and to treat all care home residents with the same robustness and positivity that we offer patients who attend our outpatient clinics.