Dear All,

There is a national consultation taking place now on which subjects should be included in The National Health Education Curriculum for the UK Schools

I am extremely keen that Testicular Torsion and Testicular Self Examination (TSE) is added to the curriculum. Then it will be compulsory to teach in it schools. To do this we have to draw attention to the benefits of adding Testicular Torsion and TSE to the curriculum.

The MP Member of Parliament for Chichester, Gillian Keegan, oversees the overall process.

However, many charities, health advocates and pressure group are doing the same, even if the subjects are inappropriate so we have to get Torsion high up on the committee’s radar.   

So I would be incredible grateful if you and any of your colleagues could write:

a) to The Rt Hon Ms Keegan - Gillian Keegan MP 

b) to their local MPs i) where they live now and ii) where they grew up  (as otherwise there will be a bias of trainees /thus MPs in the south east)

It is important that the letter to Ms Keegan is in your own words, so it doesn’t look too contrived. It can also be short. The letter to your own MP can be more generic. Some suggestions of points that would be useful to cover are set out below …. but perhaps more succinctly. 



-I understand that there is a public consultation period this autumn on the draft revised RSHE guidance that interested parties can contribute their comments and ideas.
-I am writing to propose that Testicular Health; testicular torsion and testicular self examination are included in the RSHE curriculum and the new guidance that you intend to publish in 2024.

-It is an unappreciated fact, by the general public, that more testes are loss to torsion, in school age children, than due to testicular cancer. 

-Late presentation of torsion, is the most common cause of avoidable, acute organ loss in school age children.  



The main reasons to include this teaching is it would have large clinical improvements.  

a) Fewer testes would be excised /removed i.e., decrease organ loss so organ preservation would occur, with less stress, upset and sequelae.

b) It would allow earlier recognition and treatment of congenital abnormalities of the scrotum, testis and groin making treatment easier and less traumatising. 

c) It would allow earlier presentation of testicular cancer and curative treatment, that is cheaper and easier to deliver with less cost and side effects.



a) Too many school age children are having their testis removed due to testicular torsion.

This is an avoidable situation and an acutely time sensitive condition. As if children could reach a hospital at an early stage, with surgical facilities, to treat torsion the likelihood of saving the testicle is high.

Whereas if they present late (over 6 hrs wait) the testicle is far less likely to be salvageable.

The commonest reason for delay is late presentation to an Emergency department, as parents, teachers and boys do not recognise the warning signs, do not know torsion is the possible cause and do not know it is such a time sensitive condition that leads to the death of their testicle…. if they wait and delay.     

We therefore urge that Testicular torsion is put on the revised curriculum for health education in PHSE/RSHE in UK schools so that knowledge of this condition is embedded and widespread.

And boys, parents and teachers can recognise the warning signs of torsion and take appropriate action quickly.  

b) Many congenital and acquired abnormalities of the testis and scrotum go unnoticed as children do not know what is normal.  Education of testicular health allows earlier recognition of treatable conditions.

Some of which (undescended testis) predispose to higher rates of testicular cancer in teenage and adult life. 

  1. Testicular Self examination needs to be taught in school age children to allow early identification of testicular cancer which occurs in teenagers and young adults. Early treatment leads to higher cure rates, less onerous treatments less side effects and cost.     

c) Accredited and evidence based Lesson plans on testicular health have been developed and have been lodged on the PHSE Association and available here.


Thank you for your help in this,


James Green

Consultant Urological Surgeon, Barts Health NHS Trust  


Urology Foundation.png

The Urology Foundation (TUF) is the UK’s only charity representing all urological conditions and                                                                                                          diseases, from cancers of the bladder, kidney, prostate, testes and penis, to non-malignant conditions such as urinary tract infections, incontinence and kidney stones. They offer a range of opportunities for urology nurse development:

  • Smaller Project Fund, Nurse of clinician-led projects that are aimed at improving care and wellbeing of patients - £10,000 each
  • Urology Nurse of the Year Award, To recognise a nurse who has demonstrated an outstanding contribution to their role - £2,000 prize
  • Urology Nurse Travel Grant, To attend a training course or conference - £500 each
  • TUF Nurse Education Courses, Providing training in communications, influencing & leadership skills – Free to attend
  • Urology Nurse Bursaries, To attend further education/post graduate courses - £2,000 Grants

Find out more at https://www.theurologyfoundation.org/professionals



At the National Societies Meeting in Milan one of the topics discussed was the availability of accreditation credit points for urology nursing education through the EU*ACNE, the increasing importance of accreditation for nurses in many countries and that this young accreditation system is not very well know yet amongst them and nursing education organisers. Click here to view the article.


Updated GIRFT guidance supports teams to reduce outpatient demand

An updated version of joint guidance from NHS England’s Getting It Right First Time (GIRFT) and Outpatient Recovery and Transformation (OPRT) programmes is available to download, now including guidance for rheumatology and endocrinology and updating the resources for several other specialties and themes.

The latest version has been co-badged by BAUN and more than 20 other professional societies, and is available here.

The GIRFT/OPRT Clinically-led specialty outpatient guidance was originally shared in November 2022 to offer a concise summary of available advice, as well as resources and top tips for reducing long waits for outpatient appointments and improving patient care.

The guidance specifically highlights actions services can take to reduce the demand for outpatient appointments, and focuses on the surgical and medical specialties with the highest number of +78 week waits. It also offers support for common themes and challenges in outpatient services, such as remote consultation, reducing DNAs, and implementing patient initiated follow-up (PIFU).

Updates in the latest version include new sections for rheumatology and endocrinology, additional advice for geriatric medicine and ophthalmology, and updates on the use of LCAD (Latest Clinically Appropriate Date) to determine the latest date that a patient should attend their next follow-up appointment.

Download the new guidance.



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29 patient safety events involving urinary catheters connected with ports to allow continuous irrigation of the bladder  were reported to the NHS's National Reporting & Learning system over a 3-year period (ending in May 2022). In almost all of these instances, the catheter drainage reservoir and bladder irrigation sets had been connected to the incorrect catheter port.
An inadequate flow rate of bladder drainage arose from the relative widths of the channels within these catheters (the drainage channel having a bigger diameter than the irrigation channel) (which was compounded by clot or debris blockage).
The misidentification of the ports appears to be a significant contributing element to the risk of patient harm, even if timely measurement of intake and output quantities during the irrigations may have  allowed for the earlydetection of a problem.



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Nursing Times is inviting nurses to join our list of reviewers as part of our peer review process. You send us your list of interests/specialisms and we then contact you from time to time to see if you can review an article for us. We would normally ask you to do this within two weeks but occasionally we require reviews faster than this. We pay a nominal fee of £20 or £40 for an urgent review. The level of experience needed depends on the article to be reviewed but you will need a minimum of two years’ experience nurse post registration.  Please see our guideline here.



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Embargoed release: Prostate Cancer UK – Interim position on PSA testing

I wanted to let to give you a heads-up on our new interim position on the PSA test in asymptomatic men https://prostatecanceruk.org/PSA-position

Thank you to all of you who either directly attended/supported workshops or helped our thinking on these issues evolve.

This will be communicated to GPs and other health care professionals through our monthly Clinical Update e-newsletter from next week (28 November). The interim position replaces our consensus on PSA testing (published 2016) whilst we conduct a full evidence review and convene a consensus panel. We aim to publish an updated, full PSA consensus, during Spring 2023; we’ll bring you updates on this work in due course.

Our interim position is informed by a short review of new evidence and two co-production workshops including men with lived experience, academics, and clinicians. As a result of this activity, we have agreed some key changes in what we think and say about the PSA blood test in men without symptoms. Our position has shifted because we believe the current diagnostic pathway, including mpMRI, targeted biopsy and transperineal biopsy, has reduced the harms of over-diagnosis. Evidence shows that over-treatment rates have also reduced with active surveillance chosen more consistently by men with low- and low-intermediate risk localised prostate cancer.

Our position continues to be that of informed choice, and we continue to advocate that men should understand their risk factors for prostate cancer, understand the pros and cons of the PSA test and use that information to decide if they want a PSA test. We have for the first time included more directive messaging for the men at highest risk: Black men and men with a family history of prostate cancer. We continue to work with NHS colleagues to collaborate and support with local risk awareness campaigns and sign-post men to our risk checker.

If you have any questions on the PSA position please get in touch.

Kind Regards,


Amy Rylance 
Head of Improving Care

Prostate Cancer UK
Counting House
53 Tooley Street
London SE1 2QN

07506 222991

Prostate cancer: Know your risk in 30 seconds visit prostatecanceruk.org/riskcheck





Rapid and Durable Response Observed with Nivolumab in Advanced Bladder Cancer

(Uxbridge, Middlesex, 8th October 2016) - Bristol-Myers Squibb today announced results from an investigational Phase II CheckMate -275 study (n=270) looking at nivolumab in platinum-refractory patients with metastatic urothelial carcinoma (advanced bladder cancer). Data presented show nivolumabhad a confirmed objective response rate (ORR) – the primary endpoint – of 19.6% (n=265 95% CI 15.0–24.9). The median duration of response was not reached in the overall population with a minimum follow-up of six months and ongoing responses were observed in 77% of patients. The safety profile of nivolumab in this study was consistent with other tumour types. These investigational data were presented today at the 2016 European Society for Medical Oncology Congress (Abstract #LBA31_PR).[i] 

“The prognosis for patients with metastatic urothelial carcinoma progressing despite platinum-based chemotherapy is poor, and treatment options have historically been quite limited,” said Matthew Galsky, M.D., professor of medicine and director of Genitourinary Medical Oncology, The Tisch Cancer Institute at Icahn School of Medicine at Mount Sinai. “In the CheckMate -275 study, we observe that with nivolumab,patients who responded experienced rapid and durable responses, including patients with PD-L1 expressing and non-expressing tumors. These results are encouraging and provide new information to the scientific community on the potential of nivolumab as a treatment option for this type of advanced bladder cancer.” 

Responses were observed in both PD-L1 positive and negative expressors. The confirmed ORR in patients expressing PD-L1 ≥1% was 23.8% (n=122 95% CI 16·5–32·3) and 16.1% (n=143 95% CI 10.5–23.1) in patients expressing PD-L1 <1%. In patients expressing PD-L1 ≥5% the confirmed ORR was 28.4% (n=81 95% CI 18·9–39·5) and 15.8% (n=184 95% CI 10.8-21.8) in patients expressing PD-L1 <5%.i

Vicki Goodman, M.D., Development Lead, Melanoma and Genitourinary Cancers, Bristol-Myers Squibb, commented, “There is a significant unmet need for improvement in response rates with the existing standard of care. The results from CheckMate -275 show that treatment with nivolumab resulted in durable and clinically meaningful objective response of 19.6% in all-treated patients. Based on these findings, we believe nivolumab has the potential to become an important new treatment option for patients with platinum-refractory advanced bladder cancer.” 

In the UK, there were over 10,300 new cases of bladder cancer reported in 2013 and, in 2014, 5,369 people died of the disease.[ii] Urothelial carcinoma accounts for approximately 90% of cases of bladder cancer.[iii]

In other data presented at ESMO

A breadth of data for nivolumab as monotherapy and in combination with ipilimumab is scheduled to be highlighted at the ESMO congress across eight tumour types. 

These include the following key data presentations:

  • Initial report of survival data from a Phase 3 trial evaluating ipilimumab versus placebo after complete resection of stage 3 melanoma (Abstract #LBA2_PR).
  • First disclosure of overall survival and safety data from a Phase 3 trial evaluating ipilimumab at 3 mg/kg vs. 10 mg/kg in patients with metastatic melanoma (Abstract #1106O).
  • Interim analysis of a Phase 1/2 study evaluating the safety and preliminary efficacy of nivolumab in patients with advanced hepatocellular carcinoma (Abstract #615O).
  • Evaluation of patient-reported outcomes data in recurrent or metastatic squamous cell carcinoma of the head and neck treated with nivolumab or investigator’s choice (Abstract #LBA4_PR).


 EU Referendum- Statement from LEXCOMM

The UK’s decision to leave the UK and David Cameron’s decision to step down as Prime Minister will, of course, have repercussions for the entire country. However, for the healthcare sector the impact will be more challenging and extensive.

The impact on the NHS

The NHS was a key battleground ahead of the referendum and whoever is now appointed as Prime Minster will need to try to stabilise the ship; supporting the current level of NHS funding and delivering the reforms of the Five Year Forward View, whilst ensuring patient safety.  That will be Simon Stevens’ focus. The Leave campaign committed to an additional £350m a week for the NHS but in the cold light of day, there are significant questions as to whether this figure can be delivered, with Nigel Farage already dismissing this as unachievable. Health Select Committee Chair Sarah Wollaston has already tweeted today that the Committee will look into when and how the £350 million a week pledge will be honoured. In addition, with many healthcare professionals recruited from the EU, a major obstacle for the sector will be how to recruit a sufficient level of staff from elsewhere.

Political turmoil and electing a new Prime Minister

In light of Cameron’s decision to step down as Prime Minister we have outlined below the rules of a Conservative Party leadership and how a new leader will be elected:

  • The Prime Minister’s resignation triggers a leadership contest. 
  • Candidates enter the race. Nominations for candidates are received by the Chief Whip, the deadline for which is noon on a Thursday.
  • If there are more than two candidates the parliamentary ballot to whittle it down takes place on the Tuesday immediately following the closing date of nominations. The candidate receiving the lowest number of nominations is then eliminated.
  • Further ballots then take place on subsequent Thursday and Tuesdays until two candidates remain.
  • MPs vote for two final candidates.
  • The ballot of the membership then takes place. The Chair of the 1922 Committee is the returning officer and chooses the date by which ballots have to be returned. Graham Brady MP is therefore important.

Broader considerations:

  • The Conservatives have never run a leadership ballot under these rules while they have been in Government.
  • In 1997, 2001, and 2005 there were at least 4 candidates. So the parliamentary process has always meant extra ballots. The only exception was 2003 when Howard succeeded Iain Duncan Smith uncontested.
  • It’s worth noting that in 2001 and  2005 the membership part of the process took around 3 months. However, Howard stayed on until October 2005 before resigning and triggering a contest.  
  • Timing is complicated depending on when the contest is triggered. If it happens over the summer then the campaign is likely to last longer and has an impact on who will be the winner (i.e. the person with most staying power).

Parliament returns on Monday 27th June. Therefore it is perfectly possible for the nomination process to start immediately as MPs will be in Westminster. The first ballot (if there are more than two candidates) would then take place on Tuesday 5th July. This is speculation, but the process will need to move quickly and Cameron has stated he expects a new leader to be in post by the party conference in early October.


The NICE medical technology guidance (MTG26) on UroLift, published in September 2015. The UroLift system is recommended for treating the symptoms of benign prostatic hyperplasia – a condition where an enlarged prostate can push against the urethra, making it difficult for a man to pass urine. Using the UroLift system involves inserting implants to move the excess prostate tissue away from the urethra, which stops the extra tissue blocking the flow of urine.  The system avoids the need to cut or remove the extra prostate tissue, which are the methods commonly used to treat a urine blockage caused by an enlarged prostate. The NICE guidance supports UroLift for use in men aged 50 years or older with urinary tract symptoms, where the size of their prostate is less than 100cm3. 

Our new adoption resourcewhich published today, has been designed to support people to put the guidance and technology into practice. It includes case studies from NHS organisations that are using UroLift within routine clinical practice. The resource captures clinicians’ real-life experiences of using the UroLift system, including practical examples of how the technology is being used and barriers to its implementation. Benefits of using the UroLift are also reported in the resource, some of which include: 

•             Potential cost savings because of fewer inpatient bed days; pre-operative process costs and follow-up appointments. 

•             Faster procedure time (particularly if done under local anaesthetic and without catheter), leading to increased capacity. 

•             Improved quality of life because of reduced post-operative pain, reduced recovery period and preserved sexual function. 

•             Greater choice for men at the surgical stage of their pathway which does not increase risk for further surgical interventions. 

•             Improved symptom control in men with multiple comorbidities for whom surgery is unsuitable.  

You can access the medical technology guidance here

You can access the new accompanying adoption resource here




Nursing Stress Resource

Did you know that 55% of UK nurses have been made unwell by stress over the previous year?

The nursing stress resource details the:

  • causes of stress
  • signs and symptoms of stress
  • managing stress



NICE - suspension of appeal stage - prostate cancer (metastatic, hormone-relapsed) - enzalutamide [ID683] 

Enzalutamide for treating metastatic hormone-relapsed prostate cancer not previously treated with chemotherapy [ID683]

Dear Consultees and Commentators

You were sent a Final Appraisal Determination (FAD) for the Technology Appraisal of enzalutamide for treating metastatic hormone-relapsed prostate cancer in people who have no or mild symptoms after androgen deprivation therapy has failed, and before chemotherapy is indicated.

Since this FAD was issued to consultees and commentators, the manufacturer of enzalutamide (Astellas) has requested to make a submission including an amended patient access scheme. In recognition of the exceptional nature of this request NICE has agreed that the appraisal can be referred back to the Appraisal Committee.

The appeal stage of this appraisal topic has been suspended. This will allow the manufacturer to submit, and the Appraisal Committee to consider, the new evidence. We are withdrawing the FAD, it will not be published on our web site and its content remains confidential.

We will inform you of the updated timelines for this appraisal as soon as they are available.



Scottish Government yesterday announced the launch of a dedicated helpline for women who have suffered complications following transvaginal mesh implant procedures .

Please see attached link for more information.




NICE recommend rejecting degarelix for acute metastatic prostate cancer

Please see attached link for more information



Prostate Cancer Quality Standard - NICE

The prostate cancer quality standard (QS91) has been published on the NICE website today. You can view the quality standard by following this link: http://www.nice.org.uk/guidance/qs91

The consultation comments were considered by the Quality Standards Advisory Committee (QSAC) and the minutes of this meeting are now available: http://www.nice.org.uk/Media/Default/get-involved/meetings-in-public/quality-standards-advisory-committee/qsac4/QSAC4-minutes-27-02-15.pdf

A summary of the consultation comments, prepared by the NICE quality standards team and the full set of consultation comments are also available: http://www.nice.org.uk/guidance/qs91/documents/prostate-cancer-consultation-summary-report-2



Specialised Services - Policy and Specification Consultation

You may have already heard that NHS England has launched a 30 day public consultation on a proposed number of new products for specialised services, (including service specifications and clinical commissioning policies).

The consultation is for 33 policies and 5 service specifications, you can access the list and the policy documents via the website:


There is an opportunity to respond the following policy consultation and service specification which will be of particular interest to you:

  • Sacral nerve stimulation for urinary incontinence and retention Clinical Commissioning Policy
  • Service Specification Recurrent Urinary Incontinence

You can access the Service specification via this link:


Your response should take no longer than 5 minutes.  As you know there is a favourable SNS policy for Faecal Incontinence and by obtaining a policy for Bladder issues this will only strengthen the case for maintained provision of Sacral Nerve Stimulation for patients.  PLEASE NOTE THE CLOSING DATE IS 23 APRIL 2015.



Cancer Nursing Partnership 

BAUN is proud to be a member of the Cancer Nursing Partnership, a unique collaboration representing over 22,000 nurses, currently working to implement delivery of the Recovery Package, focussing on the person and not the cancer.

The Recovery Package is a series of key interventions which, when delivered together, can greatly improve outcomes for people living with and beyond cancer.

The interventions consist of:

  • An assessment of holistic needs and the development of a care plan to address these issues;
  • A treatment summary that explains to the GP and individual what treatment has taken place;
  • A cancer care review by the GP within 6 months of diagnosis;
  • A health and wellbeing educational event.

By creating a partnership with the individual, the focus of care remains on supporting self-management after a cancer diagnosis.

The Recovery Package demonstrates best practice for your patients please help by supporting its implementation in your place of work.

For more information, please visit www.ukons.org/cnp 


BAUN response to Degarelix FAD (Final Appraisal

We believe that there has been a significant change in the wording of the recommendation between the Appraisal Consultation Document (“ACD”) and FAD stages.

In the ACD, the recommendation is as follows:

Degarelix is recommended as an option for treating advanced hormone-dependent prostate cancer, only in people with spinal metastases who are at risk of impendingspinal cord compression.

In the FAD this sentence appears as:

Degarelix is recommended as an option for treating advanced hormone-dependent prostate cancer, only in adults with spinal metastases who present with signs or symptoms ofspinal cord compression.

This subtle amendment is likely to have a major practical effect clinically for a sizeable group of patients. The changes in guidance between the ACD and FAD should therefore have resulted in the provision of an additional opportunity to consult, with the publication of a second ACD. We believe that the Institute acted unfairly in not allowing this input.

By limiting, in the FAD, the use of degarelix to those who already show symptoms of spinal compression, NICE is considerably reducing the number of patients eligible for degarelix. This is neither consistent with the original wording of the ACD or the recommendations and evidence provided by experts. We believe that the Institute acted unfairly by not following due process by inadequately considering the evidence that was submitted to it. We should also like to appeal under Ground 2, that the wording in the FAD is unreasonable in the light of the evidence submitted and the assumptions made by the Appraisal Committee in reaching its conclusions.

We should also like to comment with regard to consideration of evidence relating to cardiovascular risk. We believe that the appraisal committee failed to adequately take into account evidence that demonstrates the positive impact that degarelix can have in reducing cardiovascular risk for the group of prostate cancer patients who are at-risk of CVD.

There is also evidence to support the use of degarelix in patients with a large metastatic burden who require urgent testosterone suppression (due to pain or risk of pathological fracture or hydronephrosis). We believe that these patients have benefited from the use of degarelix.

BAUN represents urological nurses, many of whom have a significant caseload of men with advanced prostate cancer. Degarelix provides an important alternative treatment in cases where we need to achieve fast castration without the risk of tumour flare and may offer a safer alternative to LHRH agonists when treating patients with co-exising cardiac risk factors.

Important New Research Into Intermittent Catheterisation

The Multi/Cath Study

Evaluating the safety and acceptability of reusing catheters for intermittent catheterisation (passing a tube into the bladder to drain urine) is one of the top 10 continence research priorities (Buckley, 2010). Globally both single-use catheters (thrown away after use) and multi-use ones (cleaned between uses) are used, but uniquely the UK supplies most patients with single-use catheters.  A Cochrane review (Moore 2007) and a more recent systematic review (Bermingham, 2013) both concluded that there is little difference in symptomatic UTI between hydrophilic, gel-reservoir and uncoated catheters.  NICE guidance on infection control (2012) states that re-use of uncoated catheters cannot be recommended as, without published evidence-based cleaning and storage methods, catheter re-use cannot be done safely.  However, Bermingham et al suggest that, in the absence of clinically significant differences between catheters, re-use of clean catheters is the most cost effective method for the NHS; furthermore, anecdotal evidence suggests that catheters are being washed and re-used by a proportion of catheter users who find the option to re-use their catheters useful in certain circumstances e.g. when travelling to minimise the number of items to be carried or when a sterile catheter is unavailable. Re-using catheters at least some of the time (mixed method) has the potential to provide more convenient and preferred options for some users.  Before promoting multi-use catheters we need to test whether reusing catheters is as safe and acceptable to users as single-use only.

The aim of this research programme is to compare mixed catheter use (a combination of single and multi-catheter use) with single catheter use only. We plan to do this using the most rigorous method of a multi-site randomised controlled trial (RCT). However, before we can ask people to re-use catheters, preliminary work is required to:

  • Develop, and test methods of reusing, storing and lubricating catheters to find the most effective (microbiologically sound) and user-friendly ones.
  • Develop ways of measuring catheter acceptability and preferences for multi-use/single use catheters, and verify published symptoms of infection.
  • Find out how and why catheters are selected and prescribed to plan for future changes in practice.
  • Carry out a clinical trial to find out whether the ‘mixed package’ is as good as using only single-use catheters in terms of urine infection, acceptability, preference and costs.

At the end of the programme we plan to have:

        I.            One or more evidence-based, user-friendly methods for using reusable catheters

      II.            A short questionnaire to measure acceptability of catheter technique, an understanding of user preferences and better information about the symptoms that patient think indicate a urine infection

    III.            A plan to implement change of practice (if merited)

    IV.            Robust evidence as to whether the mixed package is as good as the use of single-use catheters only in terms of urine infections, acceptability, preference and cost-effectiveness.

This 5 year study, which is funded by a Programme Grant for Applied Research from the National Institute for Health Research (NIHR) and is led by Professor Mandy Fader from the University of Southampton, has just commenced. We will be posting more information as the study progresses.

How can you help? We are looking for people who re-use their catheters for intermittent catheterisation and are willing to be interviewed, and who live in the southern counties (London, Surrey, Kent, Sussex, Dorset, Hampshire, Wiltshire) or the Glasgow area; please feel free to pass our contact details to  anyone who you think might be interested in finding out more about this research. Contact: m.macaulay@ucl.ac.uk Tel: 020 3549 5417

Bermingham S, Hodgkinson S, Wright S, Hayter E, Spinks J, Pellowe C 2013. Intermittent self-catheterisation with hydrophilic, gel-reservoir, and non-coated catheters: a systematic review and cost-effectiveness analysis. BMJ 2013; 345:e8639 pg1-16.

Buckley B, Grant A, Tincello D, Wagg A, Firkins L. 2010.  Prioritizing Research: Patients, Carers, and Clinicians Working Together to Identify and Prioritize Important Clinical Uncertainties in Urinary Incontinence. Neurourology and Urodynamics 29:708-714

Moore, K.N., Fader, M. & Getliffe, K., 2007. Long-term bladder management by intermittent catheterisation in adults and children. Cochrane database of systematic reviews (Online), p.CD006008.

Nice 2012 Prevention and Control of Healthcare-Associated Infection in Primary and Community Care. NICE Clinical Guideline 129 guidance.nice.org.uk/cg129




What would Flo say?       Update Icon

News and Comment from Roy Lilley 

Talk to the DH and they will tell you there are more nurses than there are daffodils smiling in the spring sunshine.

An extra 2,400 hospital nurses have been hired since Francis and over 3,300 more nurses working on wards since May 2010.  The bit that is missing is; 'more' doesn't mean 'enough' and enough doesn't mean enough of the 'right sort'.

The RCN says; The NHS has lost nearly 4,000 senior nursing posts since 2010.  The 'missing' nurses include ward sisters, community matrons and specialist nurses.  They've gone because they cost more; drop them and you save loadsamoney... quicker.

According to the latest data, November 2013; the NHS was short of 1,199 full time equivalent registered nurses compared with April 2010.  The RCN says; '... hidden within wider nursing workforce cuts is a significant loss and devaluation of skills and experience'... just under 4,000 FTE nursing staff working in senior positions.  Band 7 and 8 have been disproportionately targeted for workforce cuts.  It looks like nursing is being de-skilled. (Must look graph). 

If the evidence of my in-box is to be believed nursing is not just being de-skilled, it is being denuded.  Time and time again I hear stories of nurse patient ratios of 9,10,11,12,even 18 and often quickly beefed up for the benefit of the CQC.

"Let each person tell the truth from their own experience."  Florence Nightingale.

Funnily enough, I am writing this on a plane where the cabin-crew to passenger ratio is a matter of law.  I see no reason why the nurse to patient ratio shouldn't be a matter of law.

The Chief Nurse doesn't agree.  She's faffing-about with her half-dozen C's and ignores the risk that one nurse looking after a dozen or more vulnerable patients is a risk to the Six C's.  She speaks, unthinking, with her master's voice...  I hope she's ready to explain the inevitable.. the next Mid-Staffs.

"The very first requirement in a hospital is that it should do the sick no harm."  Flo Nightingale again.

There's a wilful blindness to what's going on; on the wards and at the 'high-end' of nursing; nurse specialists.  If the RCN is right (and this H&SCIC FoI confirms) it is a madness that their numbers are reducing.

Nurse Clinical Specialists are highly skilled and there is overwhelming evidence that better skilled nurses are better for patients, and reduce admissions, re-admissions and waiting times, free-up consultant's, improve access to care, educate and share knowledge with other health and social care professionals and support patients in the community.

"Were there none who were discontented with what they have, the world would never reach anything better."   

Fabulous Flo again.

Yup, I'm discontent Flo!  There are only 2 types of post-reg' training programmes; Specialist Community Public Health Nurses and a Specialist Practice Qualification and for all practical purposes, degree entry-level.  We know they work (chronic heart failure for example and in Stoma nursing) so the default position should be; all patients, with long term conditions, should have access to a specialist nurse... but here we go again... there are not enough of them.

A new, free web-resource for Specialist Nurses caught my eye; help with job plans, annual reports and service summaries and I particularly liked the 'Speaking up for my Service' section.  I hope they and their managers do. 

"How little can be done under the spirit of fear." More Flo truth-to-power-talk.

Nursing is the Swiss Army knife of the NHS; versatile, multi-purpose, portable, one-stop.  Nurses build, work and fix services, flex them and extend their reach and cover.  But, we patronise them and squabble over their numbers. 

"Let whoever is in charge keep this simple question in her head (not, how can I always do this right thing myself, but) how can I provide for this right thing to be always done?" Yes, Flo again... in full flow!

It looks to me very like nursing is in a muddle, confused, a jumble.  No one seems to have a clue what is 'the right thing', the right numbers or the right training.  Nursing, the biggest group in the NHS workforce, lacks direction... leadership.  Buried in directorates, managed by administrators shoved around by everyone's agenda.   A Chief Nursing Officer (Carbuncle) and a Director of Nursing (DH), all chiefs but what about the Indians.  

Events, technology, finance, balance sheets, bed-sheets, need and resources pull nursing in different directions.  The profession needs to stop, catch its breath and think about its voice, role and purpose.

I wonder what Flo would say?       


  Contact Roy - please use this e-address  roy.lilley@nhsmanagers.net 

Know something I don't - email me in confidence


Urology Nurse of the Year

1st – Sarah Doyle, Advanced Paediatric Nurse Practitioner, Alder Hey Children’s NHS Foundation Trust

2nd – Nona Toothill, Urology Clinical Nurse Specialist, Airedale NHS Foundation Trust

3rd – Trona Campbell, Urology Clinical Nurse Specialist, Basingstoke

New funds for urological nursesUpdate Icon

March 2014

The Urology Foundation is delighted to announce the launch of two new funds for urological nurses.

Each year TUF funds research scholarships and research projects for urologists and urological nurses into prostate, bladder and kidney cancers, benign diseases and reconstructive urology. And each year this makes a real difference to patients, with real progress in care management and new treatment options.

While recognising the vital role research grants are for urologists, TUF also understands the importance of developing urological nursing. This is going to become more pronounced in the coming years as nursing continues to evolve and more specialist nurses will take over diagnostic and treatment tasks playing an ever more critical role in the patient experience.

Making sure we provide development opportunities for urological nurses to improve their knowledge of and skills in urology through education and training is key to ensuring nurses have the skills to do this. That is why we are supporting nurses to improve their knowledge of and skills in urology through education and training.

This year we have created two new funds that we are urging urological nurses and urologists to apply for. To request an application form contact ajames@theurologyfoundation.org


Further details are available on our website: http://www.theurologyfoundation.org/news/latest-news/new-grant-funding-available-2/


Update IconThe Urology Foundation Survey and Funding

13 Jan 2014


The Urology Foundation has been discussing introducing a couple of new funds that would be opened up to urological nurses. We are looking at offering a Smaller Research projects fund and an educational courses fund for urology nurses.

Hearing directly from the nurses as to how best we can help them and what would be of most benefit is absolutely crucial to making this a success. We really appreciate you being willing to help us promote the survey and gather feedback.

We have created a BAUN survey on survey monkey.

Complete the survey here: https://www.surveymonkey.com/s/5KMCHVR

Consultation on Revalidation and the Revised Code

08 Jan 2014

Have your say on revalidation and the revised Code.

This is part one of a two part, six month public consultation, which will run from January until July 2014. The consultation as a whole will address revising the Code (the standards of good nursing and midwifery practice) and implementing revalidation.

In part one, which runs from 6 January until 31 March, we are focusing our consultation on how the proposed model of revalidation can be implemented in a variety of employment settings and scopes of practice. This will help ensure the model we launch in December 2015 is flexible and fit for purpose. We will also use this part of the consultation to gather information to draft a revised Code and develop guidance for revalidation.

Read more on the Nursing & Midwifery Council website ...

Help Inform National Research on Erectile Dysfunction

11 Dec 2013

For your info, the first research article has been published – you can read it here - http://onlinelibrary.wiley.com/doi/10.1111/ijcp.12338/full

Prostate Cancer UK wants to hear your views on treatment of erectile dysfunction (ED)
As a nurse specialist working in the field of urology you will know that ED is a common side-effect of prostate cancer treatment and it is also one of the most difficult issues that men say they have to cope with as a result of treatment; yet men and clinicians often say that the necessary support and treatment for ED is not always available. 


Click here to view a supply update on OncoTICE ® (BCG 12.5 mg per vial containing 2-8 x 108 CFU Tice BCG)

Be Clear on Cancer - Blood in Your Wee Campaign

Further to the letter in March setting out provisional plans for campaigns to promote earlier diagnosis of cancer Public Health England, in partnership with the Department of Health and NHS England, has announced details of the next national Be Clear on Cancer campaign launching in October 2013.

Highlighting the most common symptom of kidney and bladder cancers, the campaign tells people to go and see their GP if they see blood in the urine, even if it’s ‘just the once’.

The campaign was successfully tested in the North of England earlier this year and details of this new campaign are available in the latest letter.

NMC Update

Please click here to view the latest email update from NMC., including information about professional indemnity insurance

Cancer Commissioning Toolkit

Release Communication - March 2013

The Cancer Commissioning Toolkit (CCT) has been updated.  Please find the latest release notes for the Cancer Commissioning Toolkit here.  There is now a Public View of the CCT and NHS users will initially see this page and can then log in via the log in option

National Cancer Action Team

Toolkit for Specialist Nurses

The NCAT is currently delivering a series of projects focussed on quality in cancer nursing.

NCAT has established a Quality in Nursing Group (NQiCN) responsible for supporting developments in nursing as a result of the Cancer Reform Strategy, Improving Outcomes: A Strategy for Cancer and national QIPP agenda (Quality, Innovation, Productivity and Prevention). 

NCAT has also established close links with the Chief Nursing Officer (England), professional development team and colleagues from both academic and charitable organisations to push forward the nursing agenda in cancer care.

For more information please click here

Prostate Cancer in BME Communities

11 Jan 2013

Raising Awareness and Improving Outcomes

This report showcases some of the best practice in England and it is hoped that it will be helpful to clinical experts, Clinical Commissioning Groups (CCGs), GPs, specialistnurses, other health professionals, commissioners andpolicy makers in providing an insight into how prostate.

Read the full report here [PDF, 3.4Mb, Provided Miranda Benney after her recent visit to the House of Commons] 

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