Meet Belfast Health & Social Care Trust
Belfast Health & Social Care Trust is an integrated healthcare system and the tertiary cancer centre for Northern Ireland. It caters for a population of around 1.8 million people.
In 2011 a patient questionnaire identified an unmet need in relation to supported management of the side-effects of treatment (most significantly continence, fatigue and erectile dysfunction support).
The survey also found that many of the men did not feel appropriately aware of the potential side effects of the treatments prior to making decisions about this.
Prostate cancer is one of the most common cancers in men (26% of all male cancers). A common side effect of its treatment is urinary incontinence but while there is a female continence service in Northern Ireland, there is no similar service for men.
A local Transforming Cancer Follow-Up (TCFU) prostate audit demonstrated that only 32.6% of men felt that they were supported to make lifestyle changes to maximise their health and wellbeing. This does not reflect the ethos of the NICE Prostate guideline (2014), the Macmillan Consequences of Cancer Treatment document (2013), or the current health and social care board TCFU model.
Specialised Continence Physiotherapy can improve incontinence and is commissioned for women, but not for men, creating a basic health inequality.
This pilot scheme was funded for 18 months by Prostate Cancer UK to assess the continence needs of patients with prostate cancer and to evaluate the outcome of Specialist Physiotherapy interventions with the project testing the best way to deliver this sort of support (for example, how best to get referrals) and make recommendations for a future model.
We have provided a service for men pre and post radical prostatectomy, to maximise their pelvic floor muscle function and enhance recovery from surgery.
We have also provided treatment for men who have already had surgery or other oncology treatments and have ongoing continence issues.
Interventions have included:
Men have seen the following benefits:
The timeframe from proposal to funding was very short and initial meetings with the urology team regarding project set-up were met with some scepticism.
This seems to have been due to lack of awareness of what physiotherapy can offer for this cohort of patients. We have found that ongoing communication and face-to-face meetings with practice teams has been essential in developing good working relationships.
Feedback from the urology team on the outcomes to date have been extremely positive and we have been supported to continue delivering the service.
I know the NHS is moving towards patients self managing and I accept that. However we need to know how to self manage and this service is fulfilling that need for education