Stoma surgery can be a life-altering procedure. At the last estimate, there were more than 122 000 people in the UK living with a stoma and 50% of all newly formed stomas are permanent (Virgin-Elliston et al, 2019a). Nevertheless, whether a stoma is lifelong or temporary, rehabilitation following surgery can be a lengthy process.
Adapting to life with a stoma involves a number of physical and psychological challenges and, as a result, the NHS offers the support of stoma care nurse specialists (SCNSs). These experienced professionals are experts providing a holistic approach to caring for patients by overseeing their physical and emotional wellbeing.
There are currently around 600 SCNSs working within acute and primary care settings across the UK. These nurses support the needs of around 21 000 new stoma patients each year and act as pathfinders to guide patients during their recovery (Virgin-Elliston et al, 2019a).
To help healthcare leaders and managers to deliver the best possible stoma care services, I supported a group of senior stoma nurses in creating guidelines for commissioners. The Excellence in Stoma Care guidelines (Virgin-Elliston et al, 2019a), funded by Coloplast but independently authored, offer evidence-based recommendations to deliver consistent and appropriate stoma care services. They are structured around the NHS Outcomes Framework and are aimed at informing commissioners of the cost-effective ways to ensure stoma patients have access to the best possible care. The complementary document Stoma Care Nurse Specialist (Virgin-Elliston et al, 2019b) aims to demonstrate the positive impact of SCNS interventions.
As a former psychiatric nurse, I was keen to ensure that these guidelines included pathways to facilitate the psychological support that people with an ostomy will need to recuperate well. Like in most other conditions, a patient's mental health needs are often hidden and fall behind the immediate need to deal with their physical symptoms. I am pleased that mental health interventions are recognised as integral to the role of the SCNS in these guidelines.
The need for a long-term integrated pathway
Stomal complications and management issues can arise at any time during a person's time with a stoma and can affect every aspect of their lives. Consequently, a long-term integrated pathway is required. The pathway must include access to a variety of stoma support services and focus on how those with a stoma can adapt to ensure the highest possible quality of life.
Alongside medical advice, SCNSs provide advice on independent self-care, which includes due consideration given to the individual's altered body image and any resulting social and psychosexual complications. For instance, we know that people who are not coping well with their stoma have a tendency to exclude themselves from social situations. They may feel embarrassed or suffer from anxiety and this in turn impacts on their willingness to interact with others. These guidelines highlight the importance of this integrated approach to care, by proposing that it is the SCNS's job to identify these issues and to refer their patients to other relevant clinical specialists, such as psychologists and dermatologists, in a timely manner.
In outlining what a good stoma care support service looks like, the guidelines acknowledge that the SCNS has extensive knowledge of a broad range of causal conditions and, therefore, they are an excellent resource for the NHS in study leave and ward-based teaching. I recommend that all commissioners improve access to SCNSs by enabling better training and mentoring of junior staff in their workforce planning.
Commissioner benefits
Alongside the immediate benefits to stoma patients through implementing the guidance, there are also immediate financial incentives for the NHS to implement these recommendations. Evidence shows that specialist nurses deliver cost-efficiency savings, greater service efficiencies and better patient-reported outcomes. If patients are seen early by an SCNS, readmission to hospital and costly referrals to consultants can be avoided. Similarly, their expert product knowledge can also help reduce prescribing costs, which could have a huge impact on the current £780–£2300 spent per patient per year on stoma appliances (Virgin-Elliston et al, 2019a).
Conclusion
In a climate where the NHS faces increasing pressures, implementing cost-effective and consistent quality care for long-term conditions is essential. Cancer Research UK (2019) has estimated that there are around 42 000 new bowel cancer cases in the UK every year. Coupled with poor diet and nutrition, rising levels of obesity and inflammatory bowel disease, this means that, more than ever, the NHS needs to invest in its stoma care services.
I would encourage all commissioners to pay heed to the recommendations set out in these new guidelines. Not only do they enable local services to ensure patients have access to the care they need, in the medium to longer term they will also provide essential cost-savings and help tackle the variation in stoma care across the UK.