Quality Standards
Issued: February 2014
QS54

Faecal incontinence

Introduction

This quality standard covers the management of faecal incontinence, defined as any involuntary loss of faeces that is a social or hygiene problem, in adults (18 years and older) in the community (at home and in care homes) and in hospital (all departments). For more information see the Faecal incontinence topic overview.

Why this quality standard is needed

Faecal incontinence is a symptom, rather than a diagnosis. For many people faecal incontinence is the result of a complex interplay of contributing factors. Effective management depends on identifying the factors causing faecal incontinence for each person, and finding a combination of interventions that is acceptable to the person and that gives best control of incontinence. Between 1 and 10% of adults are affected by faecal incontinence, depending on the definition used. It is likely that 0.5–1.0% of adults experience regular faecal incontinence that affects their quality of life[1]. Nearly two-thirds of people with faecal incontinence also have urinary incontinence (known as double incontinence) although management, including any specialist input, may be quite distinct. Faecal incontinence has remained a largely hidden problem, with many people feeling too embarrassed to describe their symptoms to health and social care practitioners, or even to family and friends. People with faecal incontinence often experience social exclusion, and frequently suffer from stress, anxiety and depression. Appropriate care for people with faecal incontinence should lead to improvements in quality of life. For some people with faecal incontinence (such as people with neurological injury or severe cognitive impairment, or frail older people), better management may also eliminate or delay the need for residential care.

How this quality standard supports delivery of outcome frameworks

NICE quality standards are a concise set of prioritised statements designed to drive measureable quality improvements within a particular area of health or care. They are derived from high-quality guidance, such as that from NICE or other sources accredited by NICE. This quality standard, in conjunction with the guidance on which it is based, should contribute to the improvements outlined in the following 3 outcomes frameworks published by the Department of Health:

Tables 1–3 show the outcomes, overarching indicators and improvement areas from the frameworks that the quality standard could contribute to achieving.

Table 1 The Adult Social Care Outcomes Framework 2013–14

Domain

Overarching and outcome measures

1 Enhancing quality of life for people with care and support needs

Overarching measure

1A Social care‑related quality of life*

Outcome measures

People manage their own support as much as they wish, so that are in control of what, how and when support is delivered to match their needs.

1B Proportion of people who use services who have control over their daily life

Carers can balance their caring roles and maintain their desired quality of life.

1D Carer‑reported quality of life

People are able to find employment when they want, maintain a family and social life and contribute to community life, and avoid loneliness or isolation.

1G Proportion of adults with a learning disability who live in their own home or with their family**

1I Proportion of people who use services and their carers, who reported that they had as much social contact as they would like*

2 Delaying and reducing the need for care and support

Overarching measures

2A Permanent admissions to residential and nursing care homes per 1000 population

Outcome measures

2F Dementia – a measure of the effectiveness of post-diagnosis care in sustaining independence and improving quality of life**

Aligning across the health and care system

* Indicator complementary

** Indicator shared

Table 2 NHS Outcomes Framework 2014–15

Domain

Overarching indicators and improvement areas

2 Enhancing quality of life for people with long‑term conditions

Overarching indicator

2 Health‑related quality of life for people with long‑term conditions**

Improvement areas

Ensuring people feel supported to manage their condition

2.1 Proportion of people feeling supported to manage their condition**

Improving functional ability in people with long-term conditions

2.2 Employment of people with long-term conditions***

Enhancing quality of life for carers

2.4 Health-related quality of life for carers**

Enhancing quality of life for people with dementia

2.6ii A measure of the effectiveness of post-diagnosis care in sustaining independence and improving quality of life (Placeholder)**

Alignment across the health and social care system

** Indicator complementary with Adult Social Care Outcomes Framework

***Indicator shared with Public Health Outcomes Framework

Table 3 Public health outcomes framework for England, 2013-2016

Domain

Objectives and indicators

1 Improving the wider determinants of health

Objective

Improvements against wider factors that affect health and wellbeing and health inequalities

Indicators

1.6 Adults with a learning disability/in contact with secondary mental health services who live in stable and appropriate accommodation

1.18 Social isolation (Placeholder)

1.8 Employment for those with long-term health conditions including adults with a learning disability or who are in contact with secondary mental health services

Coordinated services

The quality standard for faecal incontinence specifies that services should be commissioned from and coordinated across all relevant agencies encompassing the whole faecal incontinence care pathway. A person-centred, integrated approach to providing services is fundamental to delivering high-quality care to adults with faecal incontinence in all settings.

The Health and Social Care Act 2012 sets out a clear expectation that the care system should consider NICE quality standards in planning and delivering services, as part of a general duty to secure continuous improvement in quality. Commissioners and providers of health and social care should refer to the library of NICE quality standards when designing high-quality services. Other quality standards that should also be considered when choosing, commissioning or providing a high-quality faecal incontinence service are listed in Related NICE quality standards.

Training and competencies

The quality standard should be read in the context of national and local guidelines on training and competencies. Health and social care practitioners involved in identifying, assessing, caring for and treating adults with faecal incontinence should have sufficient and appropriate training and competencies to deliver the actions and interventions described in the quality standard.

Role of families and carers

Quality standards recognise the important role families and carers have in supporting people with faecal incontinence. If appropriate, health and social care practitioners should ensure that family members and carers are involved in the decision-making process about investigations, treatment and care. Because of the sensitive nature of the condition and the stigma attached to it, it is particularly important that people give their agreement before family members and carers are involved.



[1] Faecal incontinence. NICE clinical guideline 49 (2007).