The Urgent Need for Effective Bowel Care Standards for Spinal Cord Injury Patients

Article by Jamie Rhind, Client Support Manager at JMW Solicitors

 Spinal cord injury (SCI) doesn’t just affect a person’s ability to move their arms and legs, it can also have a significant impact on a person’s ability to control their bladder and bowels. The majority of people affected by SCI need interventions to empty their bowel at a convenient time, helping avoid constipation and incontinence. Many will rely on others to assist with these interventions, such as carers or district nurses, which can prove an issue when someone with an SCI is admitted to a non-specialist healthcare setting.

Currently, there is widespread inconsistency in bowel care standards in non-specialist hospitals across the NHS, which is causing significant issues for patients.

Here, we will shed light on these challenges, and the importance of the Spinal Injuries Association’s (SIA) latest campaign for better bowel care in hospitals

Revealing Data

For many patients affected by spinal cord injuries, the inconsistency in bowel care at non-specialist hospitals is a daily struggle that impacts their health and emotional wellbeing. The SIA has launched the #SeriousSh1t campaign to draw attention to the dire need for standardised care protocols. Their advocacy underscores the disparity in care and the necessity for uniform practices.

A recent Freedom of Information (FOI) request initiated by the SIA to 123 NHS trusts has uncovered a troubling landscape:

• Only 44% of these trusts have a formal written policy tailored to the specialist bowel care needs of SCI patients.
• A concerning 21% of trusts admit to having no bowel assessment and management policy whatsoever.
• Approximately one-third reported a lack of ward-based staff trained specifically in SCI bowel care.
• Over half of the trusts do not have policies that permit personal care assistants or carers to aid in bowel care, though 17% do allow this essential assistance.

The daily experiences of spinal cord injury (SCI) patients in the NHS highlight the urgent need to reform the policies in place within non-specialist hospitals.

The distress and complications arising from current inconsistencies go beyond the statistical data, bringing to light the profound impacts on individual lives. Behind every policy gap is a human being whose dignity and well-being are at stake.

To deepen the understanding of the complexities surrounding SCI bowel care, the NHS should be utilising insights from a diverse group of experts—medical professionals, SCI patients, and healthcare policy analysts.

Medical Perspective

The medical necessity of standardised bowel care protocols for SCI patients isn’t just a matter of comfort—it’s essential for preventing serious complications like autonomic dysreflexia or an impacted or perforated bowel which can lead to serious infections as well as causing breathing difficulties.

These conditions can be life-threatening and are often exacerbated by inconsistent or incorrect bowel management. The NHS must implement protocols that are not only uniform across all hospitals but also adaptable to the individual needs of each patient, which can vary significantly depending on the level and completeness of injury.

From an ethical standpoint, the inconsistencies in bowel care highlight a larger issue of equity in healthcare. Every patient, regardless of their medical condition, has the right to receive high-quality and dignified care. For SCI patients, inconsistent bowel care not only compromises their health but also their dignity and autonomy. Ethical medical practice requires systems that respect and respond to the unique needs of vulnerable populations, underlining a need for policies that incorporate patient and caregiver voices in the care process.

At present, this is not the case, because many non-specialist hospitals lack specific training and resources for SCI bowel care. The variability in care often stems from a lack of knowledge and the absence of clear guidelines. It is essential for the NHS to prioritise the implementation of comprehensive training programmes and the development of accessible resources for medical staff. This training must also be backed up by better use of technology such as digital health records and care planning tools, to ensure consistency and continuity of care across different shifts and settings.

Changing Policies

An examination of current bowel and bladder care in NHS facilities has unacceptable inconsistencies, a lack of formal policies, specific training and limited caregiver involvement.

Best practice guidelines should emphasise a comprehensive and patient-centred approach to bowel care for SCI patients. An effective bowel care policy, according to these experts, should include several key components. This should include specific education and training, with mandatory training sessions for all healthcare providers involved in the direct care of SCI patients.

There should also be a programme implemented to create individualised care plans that incorporate the preferences and existing routines of patients, facilitated by consultations with SCI specialists. The care that is dispensed at the point of need should also integrate a greater caregiver involvement.

Additionally, these policies must formally recognise and integrate caregivers into the care team, acknowledging their crucial role and knowledge in managing the patient’s daily needs. Ongoing evaluation and updating of bowel care policies to incorporate new research findings and feedback from patients and care teams must also be enacted as part of an overhaul of bowel care for SCI patients.

The inconsistency in bowel care in England’s non-specialist hospitals is more than a medical oversight—it is a failing that affects human lives on a profound level. By advocating for standardised protocols, SIA seeks to ensure that every individual receives the high-quality care they deserve. This is why it is important to support campaigns such as the #SeriousSh1t campaign, which aims to support nurses, carers, charities and politicians in their goal to stop SCI patients from being denied essential bowel care in medical settings.

SIA is doing all it can to highlight this issue and take steps to improve the situation. SIA’s team of specialist nurses provide bowel management training within non-specialist healthcare settings, and anyone affected by SCI can complete an emergency care plan to highlight their specific care needs to a healthcare professional involved in their care. You  can read more about the campaign here.

If you would like to add your voice to the growing number urging the government to require all NHS hospitals to have clear bowel management policies and specialist bowel care in place, sign SIA’s petition here.