Bowel Management Patient Safety Alert (SPINE 01/19)

Response to this request is long overdue. By law, under all circumstances, South Tyneside NHS Foundation Trust should have responded by now (details). You can complain by requesting an internal review.

Dear South Tyneside NHS Foundation Trust,



I work for the Spinal Injuries Association (SIA), the leading national user-led charity supporting spinal cord injured people and their families. Being a user led organisation SIA understand the challenges of living with a spinal cord injury (SCI). We strive to support all people living with SCI to access the services and support they need to stay healthy and live full, fulfilling and active lives.

Part of my role is to assist the Head of Public Affairs with FOI requests, such as the one that follows. As a request under the Freedom of Information Act, please provide the following information about the recent NHS Improvement (NHSI) Patient Safety Alert “Resources to support safer bowel care for patients at risk of autonomic dysreflexia 25 July 2018”, Alert reference number: NHS/PSA/RE/2018/005

Q1. Does the Trust have a formal written policy for digital rectal examination, digital rectal stimulation and the digital removal of faeces in spinal cord injured and other patients with neurogenic bowel dysfunction?

(a) Yes
(b) No

Q2. Following recommendation of this patient safety alert, did the Trust “review your local clinical policy and guidance relating to bowel assessment and management”?

(a) Yes – produced a new policy
(b) Yes - revised an existing policy
(c) Yes – retained existing policy
(d) No – did not review an existing policy
(e) No – no bowel assessment and management policy in place

Q3. Is your policy based on the policy template that the Spinal Injuries Association circulated to your trust in August 2018?

(a) Yes
(b) No
(c) No bowel assessment and management policy in place

Q4. If admitted to the Trust will a person with neurogenic bowel dysfunction receive the following bowel care intervention – Digital removal faeces?

(a) Yes
(b) No

Q5. If admitted to the Trust will a person with neurogenic bowel dysfunction receive the following bowel care intervention –Digital rectal stimulation?

(a) Yes
(b) No

Q6. If admitted to the Trust will a person with neurogenic bowel dysfunction receive the following bowel care intervention –Trans anal irrigation?

(a) Yes
(b) No

Q7. Are staff available seven days a week to undertake these bowel care interventions?

(a) Yes
(b) No

Q8. Has the Trust “reviewed your local education and training provision for interventional bowel management” as recommended in the Patient Safety Alert?

(a) Yes
(b) No

Q9. As requested by the Patient Safety Alert, has the trust developed “an action plan to ensure patients have adequate and timely access to staff who are trained appropriately to carry out these procedures, including in the evening and at weekends”?

(a) Yes
(b) No

Q10. Has the Trust “shared your reviewed local guidance, advice on how to identify staff who can provide Digital Removal of Faeces, and the key messages in this alert with medical, nursing and other relevant clinical staff”?

(a) Yes
(b) No

Q11. Does the Trust have a policy that allows for the personal care assistants/carers of spinal cord injured patients to assist with this element of the patient's care?

(a) Yes
(b) No

Q12. As recommended in the Patient Safety Alert, have you identified “an appropriate clinical leader to co-ordinate implementation of this alert”?

(a) Yes (please answer Q13, but ignore Q14)
(b) No (please answer Q14, but ignore Q13)

Q13. What are the contact details for the “appropriate clinical leader”(ie name, position, telephone and email)?

Q14. Why has your Trust not appointed an “appropriate clinical leader”?

(a) Alert implemented without appointment of a clinical leader
(b) Took no action following Patient Safety Alert, as policy already in place
(c) Took no action. No existing policy in place
(d) Other

Q15. Are your newly registered nurses able to demonstrate the nursing procedures as required in Annexe B, section 6.5 of the Nursing and Midwifery Council’s document ‘Future Nurse: Standards of Proficiency for Registered Nurses’?

(a) Yes
(b) No

Technical Note – Relevant annexe reads:-

“Annexe B
6: Use evidenced based, best practice approaches for meeting needs for care and support with bladder and bowel health
6.5: Administer enema, suppositories and undertake manual evacuation when appropriate.”

If you have any queries or require clarification on any of these questions, please contact the Spinal Injuries Association at [email address]

Yours faithfully,

Andrew Smart

Freedom of Information Requests, South Tyneside NHS Foundation Trust

Dear Mr Smart

Thank you for your request for information under the Freedom of Information Act 2000. South Tyneside NHS Foundation Trust does not offer this service, please direct your FOI request to the following:

The Newcastle Upon Tyne Hospitals NHS Foundation Trust
Freeman Hospital,
High Heaton,
Newcastle upon Tyne,
[email address]

Gateshead Health NHS Foundation Trust
Freedom of Information
QE Gateshead
Trust Headquarters
Queen Elizabeth Hospital
Sheriff Hill
[email address]

If you are unhappy with the way your request for information has been handled, you can request a review by writing to: Private Office, South Tyneside NHS Foundation Trust, Harton Wing, Harton Lane, South Shields, NE34 0PL or via email at [email address] .

If you remain dissatisfied with the handling of your request or complaint, you have a right to appeal to the Information Commissioner at: The Information Commissioner's Office, Wycliffe House, Water Lane, Wilmslow, Cheshire, SK9 5AF. Telephone: 0303 123 1113 Website: There is no charge for making an appeal.

The Commissioner’s Office will not normally hear a complaint until the internal complaints procedure has been completed.

I hope that this is helpful.

Yours sincerely
Freedom of Information
South Tyneside NHS Foundation Trust

Freedom of Information Office
South Tyneside NHS Foundation Trust
Tel: 01914041000 Email: [email address]
Main office: Harton Wing, South Tyneside District Hospital, Harton Lane, South Shields, NE34 0PL

Part of South Tyneside and Sunderland Healthcare Group

IMPORTANT NOTICE: This email and any attachments are intended solely for the use of the intended recipient and may contain privileged and confidential information.  If you are not the intended recipient, you are hereby notified that any distribution or copying is strictly prohibited.  If you receive this e-mail in error, please notify us as soon as possible and destroy the document. Any views or opinions expressed are solely those of the author and do not necessarily represent those of City Hospitals Sunderland or South Tyneside NHS Foundation Trusts. 

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Dear Freedom of Information Requests,

You say that your trust "does not offer this service".

Do you mean that you never offer in-patient or community health services to any spinal cord injured people (eg a patient who was spinal cord injured twenty years ago and now requires surgery for say an acute head injury)?

If there is the possibility that a spinal cord injured person could receive 'general care, we'd appreciate you answering the questions.

Yours sincerely,

Andrew Smart