Nursing & Care News | Blog | Secure Healthcare Solutions

Some conditions reshape a person’s entire life through daily, minor, or ordinary routines. Neurogenic bowel is one of them. For those living with neurological conditions across the UK, it is a reality that millions navigate every single day – often in silence, and often without the support they truly deserve.

At Secure Healthcare Solutions, we believe that understanding a condition fully is a first step toward managing it with confidence. This guide is for their families, carers, and those who are living with neurogenic bowel.

What Is Neurogenic Bowel?

Neurogenic bowel is a condition or dysfunction in an individual with neurological disease or injuries, failing to evacuate the bowel or failing to contain the stool. This is not a condition but rather a consequence of damage or a disease affecting the nervous system.

The bowel is a sophisticated organ. It follows a series of nerve signals between the brain, the spinal cord, and the muscles of the gut, which keep the bowel functional and allow us to maintain control over when and where to empty the bowel. The profound impact of neurogenic bowel on the quality of life deserves an open conversation about how it changes your daily routines.

Neurogenic Bowel Symptoms

The bowel, without nerve control and normal functioning, can swing between extremes. Living with neurogenic bowel, maintaining a shifting landscape of symptoms can be challenging.

Neurogenic symptoms that affect your daily routine:

Constipation: It is the most common effect of neurogenic bowel. A UK postal survey of spinal cord-injured individuals found that up to 30 minutes was spent on each bowel care episode by 58% of respondents, with 22% spending between 31 and 60 minutes, and 14% spending over an hour.
Faecal Incontinence: This symptom causes the most psychological burden on a person, causing unexpected and unwanted passing of stool. Within the spinal cord injury population, 75% experience faecal incontinence.
Abdominal Symptoms: Neurogenic bowel dysfunction often causes a range of upper and lower abdominal symptoms such as cramping, pain, nausea, and a general feeling of discomfort in the abdomen.

Neurogenic Bowel Causes and Risk Factors

Neurogenic Bowel can cause different symptoms in each individual, which is why understanding its causes and risk factors is important. The cause is always a neurological disruption of the brain nerves that control the bowel.

This disruption can occur in many ways:

Spinal Cord Injury: The spinal cord acts as the main communication bridge between the nervous system and the bowel. The injury due to traumatic or non-traumatic causes can interrupt the communication. Spinal cord injury, both traumatic and non-traumatic, has an estimated prevalence of 15 per million in the UK.
Multiple Sclerosis(MS): MS is a progressive condition that affects the brain’s central nervous system and disrupts the brain signals. Within the MS population, it is usually estimated that a minimum of two-thirds suffer from bowel symptoms.
Parkinson’s: The loss of nerve cells in Parkinson’s disease weakens the autonomic nervous system, which governs bowel functions.
Stroke: The brain damage from strokes can result in constipation and faecal incontinence, sometimes resulting in permanent symptoms.
Neurological Conditions: Brain injuries and various forms of peripheral nerve damage can all lead to neurogenic bowel dysfunction.

Types of Neurogenic Bowel Dysfunction

Neurogenic bowel is typically classified into two types of dysfunction based on which part of the brain’s nervous system is damaged:

Upper Motor Neurone (UMN) / Reflexic Bowel

Reflexic Bowel occurs when the sacral region of the spinal cord (above S2-S4) is damaged. It affects the enteric nervous system, which connects the brain and the bowel’s own local network.

Due to this condition, the bowel retains automatic reflex activity, and voluntary control is lost. This results in constipation and hard stools. This is the type most commonly associated with cervical and thoracic level spinal cord injuries.

Lower Motor Neurone (LMN) / Areflexic Bowel

Areflexic bowel occurs when damage affects the sacral spinal cord or peripheral nerves, leading to the bowel. The bowel loses muscle tone, and the stool cannot move effectively, causing severe constipation. The anal sphincter may also become weak, which can lead to accidental stool leakage.

Understanding which type of dysfunction a person has guides everything from the techniques for bowel care to the medications prescribed and the management of outcomes.

How Neurogenic Bowel Is Diagnosed

Diagnosis of neurogenic bowel is a process rather than a single test, which may require a range of assessments and a thoughtful conversation between the patient and their clinical team.

Clinical History: Patient’s bowel history is taken carefully, exploring the nature, consistency, and frequency; symptoms such as bloating, pain; the impact on daily life. Assessment of prior bowel function is complete.
Neurogenic Bowel Dysfunction (NBD) Score: The NBD Score is a validated questionnaire that identifies the severity of the symptoms and is useful for initial assessment.
Imaging and Specialist Tests: In some cases, imaging such as plain abdominal X-rays may be used to assess faecal loading. Anorectal manometry, colonic transit studies, and neurophysiological tests may be arranged for more complex cases or where surgical intervention seems necessary.
Multidisciplinary Assessment: For many people, the most effective diagnostic and management pathway is delivered through a multidisciplinary team. In the UK, specialist centres such as spinal cord injury units typically have established pathways for this kind of comprehensive assessment.

Neurogenic Bowel Management

To manage neurogenic bowel, we need to find the right daily routine. A predictable, effective, and dignified routine that allows a person to get on with their life with as much independence and confidence as possible.

Conservative Management: The Foundation: The first-line approach includes:
- Regular bowel routines timed after meals.
- Suppositories and enemas to stimulate bowel emptying.
- Digital rectal stimulation (DRS) for reflex bowel evacuation.
- Digital removal of faeces (DRF) for severe impaction.

Transanal Irrigation (TAI)
- TAI uses warm water introduced into the bowel through a rectal catheter or cone to achieve controlled evacuation. It improves symptoms and quality of life in many patients when conservative methods fail and is supported by NICE guidance in the UK.

Medications
- Laxatives for constipation.
- Anti-diarrhoeal agents (e.g., loperamide) for faecal incontinence.
- Treatment should be tailored to the individual’s neurological condition.

Bowel Care Support at Home

Bowel care is a deeply personal territory that requires a level of trust, skill, and sensitivity. For people with neurogenic bowel, the majority of their care takes place at home, with the support of their family member or professional carer. Life with neurogenic bowel can be lived fully and actively if practical and professional help is given with the right management plan.

At Secure Healthcare Solutions, we provide specialist bowel care in Wolverhampton and across the West Midlands for people living with neurological conditions. Our compassionate, highly trained carers deliver personalised support that promotes comfort, dignity, and independence. If you or a loved one needs specialist care at home, we’re here to help.

Dementia can be very challenging and has many types and different conditions in each individual. It is generally caused by damage to brain cells. If you feel anxiety, agitation, and confusion after a certain period of time in the day or in the late evening, you are not alone. This is a common feature of dementia recognised by clinicians across the UK.

This guide will help you understand what sundown syndrome is, how to handle the difficult situations for the person with dementia or for those helping them.

What Is Sundowning in Dementia?

Sundowning, often called sundown syndrome or late-day confusion, occurs in the late afternoon and evening in people living with dementia. This is a cluster of symptoms caused by dementia.

Around 9,00,000 people in the UK are currently living with dementia. One out of five people with Alzheimer’s disease has sundowning. Around 20% of people with dementia have a chance of having sundown syndrome. Sundowning can persist from late afternoon into the night, lasting till early morning. Summer days can be harder as well, due to long hours of light.

It can also happen in a person without dementia who is experiencing delirium, a temporary state of confusion caused by infection, hospitalisation, or medication reaction. Same-day GP assessment is recommended if there is confusion about the cause of sundowning dementia.

What Are the Symptoms of Sundowning?

Sundowning has different effects on different people, and even the symptoms can vary every day. It is often described as changes in mood or personality as the sun goes down. Understanding the range of symptoms can help identify and support the condition early on:

Behavioural Symptoms

Restlessness, gets agitated, or walks back and forth
Repeated questioning
Aggressive behaviour (Verbal or rarely physical)

Psychological and Emotional Symptoms

Becomes distressed or anxious suddenly
Sudden mood changes (anger, tearfulness, irritation)
Suspicious thinking, believing people are not who they are, etc.

Cognitive Symptoms

Difficulty in communication, finding the right words
Worsened confusion or disorientation
Unable to recognise familiar surroundings

Physical Symptoms

Sleep problems, falling asleep or staying asleep at night.
Wringing hands, fidgeting, rocking
Becoming hungrier in the evening

What Causes Sundowning in Dementia?

The precise course of sundowning has not yet been identified; however, research in this area continues. There is also a growing clinical consensus that it arises from a combination of neurological, psychological, and environmental factors.

Here are some widely supported explanations for the causes of sundowning:

Disrupted Circadian Rhythm

Circadian rhythm regulates the body’s sleep and wake cycle, so in people with Alzheimer’s or any other form of dementia, which damages the brain, involving the hypothalamus, which is responsible for Circadian Rhythm.

This disruption can cause people to have difficulty distinguishing between day and night, resulting in sundowning dementia.

Reduced Light and Increased Shadows

Environmental changes can be profoundly disorienting for a person with dementia as the daylight fades, dimming lights and darker places.

Neurodegeneration and Brain Changes

Dementia causes progressive damage to a person’s brain. It affects a person’s ability to process emotions, manage behaviour, and information. So, in the evening or as the day ends, a person becomes more fatigued and vulnerable to sundowning.

Fatigue and Cognitive Exhaustion

Dementia demands more mental stress to navigate throughout the day; it can affect your body and mind. By afternoon, this cumulative fatigue can become overwhelming, reducing the brain’s capacity to handle simulations.

What Triggers Sundowning?

Neurological changes are a common reason for sundowning, but day-to-day triggers can help determine if an episode will occur or how severe it will be. Identifying these triggers can be the most practical step families of caregivers can take.

Physical Triggers

Hunger
Physical pain
Side effects of medication or medications wearing off in the evening
Dehydration (most common in older adults)

Environmental Triggers

Daylight fading, dim lights and shadows indoors
Changes in usual routine
Crowded or noisy environments

Emotional Triggers

Unresolved stress or anxiety
Feeling ignored, rushed or misunderstood
Loneliness, boredom, or lack of meaningful engagement

How to Manage Sundowning in Dementia

There is no single treatment that cures sundowning, but a range of evidence-informed approaches can significantly reduce the frequency and severity of episodes.

The following are tips to manage sundowning dementia:

Maintain a consistent daily routine
Maximise daytime light exposure
Adjust indoor lighting as the day progresses
Schedule demanding activities earlier in the day
Manage stimulation carefully
Address physical needs proactively

Evening Routine Tips to Help Calm Symptoms

A thoughtful evening routine can transform sundowning hours into calmer hours to help calm your sundowning symptoms.

You can create a calm and familiar environment by keeping familiar objects, such as loved ones’ photos and cherished ornaments. Play familiar music at low volume; music creates a calming effect. Engage in activities that make you feel connected to your cherished moments or positive memories. Also, having a pet can make you feel reassured.

While taking care of a person with sundowning dementia, avoid arguing or trying to make them understand the situation; speak simply. Offer gentle reassurance and distractions rather than confrontation. Keep the bedroom quiet and at a comfortable temperature, free from stimulating screens or lights. Discourage long daytime naps and taking tea or caffeine after evening.

Sundowning often ends with a long and demanding day for family carers. Reaching out for support, whether from family, a local carer support group, or a professional organisation such as Dementia UK or the Alzheimer’s Society, is not a sign of weakness but an essential part of sustaining the care you provide.

When to Speak to a GP or Dementia Specialist

Sundowning dementia is a common aspect of dementia; there are circumstances where immediate medical attention is needed.

Seek Same-Day GP Advice If:

Significant changes from the usual pattern
Delirium requires urgent assessment
Infections, such as a urinary tract infection, can cause acute and dramatic deterioration in people with dementia
Intensified rapid hallucinations
If a person refuses to eat and drink or take medications
Risk of harming others or themselves

In the UK, you are entitled to an annual review with your GP if you have dementia. Carers should take notes about sundowning dementia patients’ episode triggers and factors that have a severe effect on the patient. These notes can help the GP assess the sundowning symptoms and causes.

Dementia Care and Support at Home

For many people in the UK, staying at home is strongly preferred. Research consistently shows that familiar surroundings, established routines, and the presence of known faces are among the most powerful factors in reducing confusion and distress in people with dementia, including sundowning. Achieving safe and sustainable home care, however, often requires a combination of family support, professional care, and access to specialist expertise.

When selecting a home care provider, families should look for providers whose care staff have specific dementia training, and who can demonstrate experience in managing behavioural symptoms such as sundowning.

Secure Healthcare Solutions in Wolverhampton provides specialist dementia care tailored to the needs of individuals and their families across the UK. Our care professionals are trained to understand the complexities of dementia behaviour, including sundowning, and to respond with the calm, consistent and person-centred approach that makes a genuine difference to daily life.

References:

https://www.dementiauk.org/
https://www.alzheimers.org.uk/

Every year, around 15,000 people in England and Wales require a tracheostomy – and for many of them, going home means taking this clinical need with them. Suctioning is at the heart of that daily care. Do it well, and life stays manageable. Miss the signs, or rush the technique, and things can deteriorate faster than most people expect.

Whether you’re a community nurse visiting a patient for the first time post-discharge, a family carer who’s just been handed a portable suction machine and a care plan, or an HCA freshening up your knowledge – this guide walks you through the tracheostomy suctioning procedure from start to finish: what it is, why it matters, and how to do it safely.

What Is Tracheostomy Suctioning – and Why Is Tracheostomy Airway Management So Critical?

Tracheostomy suctioning is the clinical procedure of passing a sterile catheter through a tracheostomy tube to remove secretions and maintain a patent airway. It is one of the most fundamental aspects of tracheostomy airway management.

When someone has a tracheostomy, their airway bypasses the nose and mouth entirely. The nose normally warms, filters, and moistens incoming air – without it, secretions thicken, pool in the trachea, and many patients simply cannot cough them clear. The tracheostomy stoma and tube itself can also increase mucus production, adding to the burden.

Left unmanaged, those secretions block the tube, drop oxygen levels, and quickly become a breeding ground for infection. In our experience at Secure Healthcare Solutions, carers who understand why they’re suctioning – not just how – respond far more calmly when a patient becomes distressed.

Signs That Tell You Suctioning Is Needed

The key signs that a tracheostomy needs suctioning include:

Audible bubbling or gurgling from the tracheostomy site
A drop in oxygen saturation (SpO₂) from the patient’s normal baseline
Visible secretions at the opening of the tube
Increased breathing effort — use of accessory muscles, restlessness
The patient pointing to their throat or appearing to struggle
Coughing that isn’t shifting anything

There is no fixed suctioning schedule. Frequency is based entirely on clinical assessment – some patients need it several times a day, others far less. Always encourage the patient to cough first; an effective cough is preferable to suction.

Open vs. Closed Tracheostomy Suctioning: Which Applies to Your Patient?

In community and home care settings, open suctioning is the standard method. If your patient is on a home ventilator, their care plan will specify closed suctioning – and you will have been trained on this before discharge.

Open suctioning disconnects the patient from any humidification or ventilator circuit. It works well but carries a slightly higher risk of deoxygenation and infection if technique is poor.

Closed (in-line) suctioning keeps the catheter within a sealed system – no disconnection, less contamination risk, less oxygen loss. Used primarily for ventilated patients.

Whichever method applies, maintaining adequate humidification via an HME (heat and moisture exchanger) is essential – it reduces secretion thickness and makes suctioning less frequent and less traumatic.

Choosing the Right Tracheostomy Suction Catheter Size

The correct tracheostomy suction catheter size should not exceed half the internal diameter of the tracheostomy tube – this is the standard rule across NHS trust guidelines. As a practical guide, most adult patients in the UK will use sizes 10, 12, or 14 FG, but the exact size must always be confirmed from the patient’s tracheostomy passport, where it is documented by the discharging hospital team.

The Tracheostomy Suctioning Procedure: How to Suction a Tracheostomy Safely

Before you begin, explain what you’re about to do. Even patients who can’t respond verbally are aware, and a calm explanation reduces distress for everyone in the room.

Wash hands and put on gloves, apron, and eye protection
Check equipment — suction pressure set to 80-120 mmHg for adults, correct catheter size
Assess first — check SpO₂, listen, observe. Is suctioning actually needed right now?
Pre-oxygenate if indicated — as per the care plan
Attach catheter to suction tubing without activating suction
Insert gently using a shallow technique — to the tip of the tube or 1-2 cm beyond. Deep suctioning risks carina trauma and is not recommended in community settings
Apply suction on withdrawal only — rotating motion, no more than 10-15 seconds per pass
Rest between passes — 20-30 seconds minimum, watch SpO₂ recover
Repeat if needed — maximum 3 passes; beyond that, stop and reassess
Flush and dispose — sterile water flush, single-use catheters discarded after the episode
Document — colour, consistency, volume, patient tolerance, SpO₂ before and after

A note on saline instillation: routine use of saline before suctioning is no longer recommended by current UK guidance unless specifically directed by the patient’s care team.

Complications of Tracheostomy Suctioning – and How to Stay Ahead of Them

The main complications of tracheostomy suctioning – hypoxia, mucosal trauma, infection, cardiac arrhythmia, and patient distress – are mostly preventable with correct technique.

Hypoxia — limit suction duration, pre-oxygenate where indicated
Mucosal trauma or bleeding — correct catheter size, never force the catheter
Infection — strict Aseptic Non-Touch Technique (ANTT) every time; never reuse single-use catheters
Vagal response / cardiac changes — deterioration mid-procedure: stop immediately
Anxiety and distress — talk throughout; never work in silence

Escalate immediately if:

SpO₂ remains low after suctioning
Frank blood in secretions
Catheter cannot be passed
Tube appears blocked and won’t clear

→ Call 999. The emergency tracheostomy box lives at the bedside for a reason.

Tracheostomy Care at Home: What Families and Carers Need to Know

Family members and home carers can perform tracheostomy suctioning safely – and in the UK, they are trained by specialist nurses before discharge. You should not go home without that training and the right equipment in place.

A few things experienced home-care teams know well:

The Tracheostomy Passport — a formal NHS document developed in line with National Tracheostomy Safety Project (NTSP) guidance — records tube type, catheter size, humidification needs, and emergency instructions. It goes everywhere with the patient.
Secretions that change colour, thicken significantly, or develop an odour suggest possible infection — contact the GP or community team promptly.
Home suction machines need regular checks. Know who to call if equipment fails out of hours.
If secretions suddenly thicken, check the HME filter is in place and functioning.
In the longer term, some patients are assessed for decannulation — removal of the tracheostomy tube. This is a specialist multidisciplinary decision, not a community one.

Tracheostomy Care in Wolverhampton: How Secure Healthcare Solutions Can Help

Tracheostomy suctioning looks straightforward on paper – but the judgment around when to act, how to read the patient, and when to escalate takes experience. That’s something no checklist fully replaces.

At Secure Healthcare Solutions, we provide specialist tracheostomy care in Wolverhampton and across the surrounding community – from suctioning and airway management to tube changes and dedicated home care plans. Our trained team supports patients and families through every stage of tracheostomy care at home, so hospital discharge feels like a transition, not a cliff edge. Get in touch with our team today to discuss your needs.

References:

https://tracheostomy.org.uk/
https://www.nhs.uk/tests-and-treatments/tracheostomy/

Skin irritation around a stoma can start with something that seems small: a faint itch under the pouch, a slight sting during cleaning, or a red patch that appears after a leak. But peristomal skin can deteriorate quickly if faeces or urine sits against it. A systematic review found that peristomal skin complications affect between 36.3% and 73.4% of people following stoma surgery, which shows how common these problems can be.

The skin around a stoma is called peristomal skin. It should not feel sore, itchy, wet, burning or painful. If it does, it is usually a sign that something needs attention, such as a leak, poor pouch fit, trapped moisture, adhesive damage or irritation from a product.

For mild skin irritation, remove any leaking pouch, clean the skin gently with warm water, dry it completely and check that the pouch opening fits closely around the stoma. If irritation continues, worsens or the skin becomes broken, contact your stoma care nurse.

How to Treat Skin Irritation Around a Stoma

The most important part of treating skin irritation is finding the cause. If the same sore patch keeps returning, look carefully at where it appears. A ring of soreness close to the stoma often suggests output is touching the skin. Redness in the shape of the adhesive may suggest trauma from removal or sensitivity to a product.

When you first notice irritation:

Remove the pouch gently. Support the skin with one hand and slowly peel the adhesive away with the other.
Check the back of the pouch. Look for output under the flange or baseplate.
Clean with warm water only unless advised otherwise. Avoid scrubbing sore skin.
Dry the skin fully. Even slight dampness can stop the pouch from sealing properly.
Check the pouch opening. It should sit close to the stoma without rubbing it or leaving surrounding skin exposed.
Do not patch over a leak. Extra tape may hide the problem while output continues to damage the skin underneath.

In practice, one of the most useful checks is the back of the removed pouch. If the same area of adhesive is repeatedly damp or eroded, it often shows where the seal is failing. This can give a stoma care nurse clearer information than simply saying the pouch “keeps leaking”.

Barrier films, stoma powders and protective seals can be helpful in some situations, but they are not a cure-all. Too much powder or product can prevent the pouch from sticking. If you are unsure how to heal sore skin around a stoma, ask your stoma care nurse before changing products.

Common Causes of Skin Irritation Around a Stoma

Leakage is one of the most common reasons for sore skin around a stoma. Stoma output can be irritating, especially if it sits under the pouch adhesive. Once the skin becomes sore or moist, the pouch may stick less well, which can cause more leakage.

A poorly fitted pouch is another common issue. The stoma can change size after surgery, during weight changes or if the shape of the abdomen changes. Skin folds, scars, swelling, a flush or retracted stoma, and a parastomal hernia can all affect the seal.

A common pattern in home care is soreness returning in the same place, such as one side of the stoma or underneath a skin fold. This often suggests a fit or body-shape issue rather than a general skin problem.

Other causes include removing the pouch too quickly, trapped moisture or sweating, using too much powder or barrier product, sensitivity to adhesives, hair follicle irritation, existing skin conditions, or possible infection.

Itchy skin around a stoma can be an early warning sign. In home-care settings, carers often notice that people mention itching before they see an obvious leak. If itching keeps returning under the same part of the pouch, it is worth checking the seal and discussing it with a stoma care nurse.

How to Prevent Skin Irritation Around a Stoma

Good stoma skin care is built around routine and observation. The aim is to notice small changes before they become painful.

Check the skin at every pouch change. Look for soreness in the same place, damp skin, adhesive residue or signs that output has crept under the baseplate. Empty the pouch before it becomes too heavy, as the weight can pull on the seal.

Regularly remeasure the stoma, especially after surgery, weight changes or changes in abdominal shape. A template that fitted well a few months ago may no longer be right.

Helpful habits include:

Removing the pouch slowly
Drying the skin fully before applying a new pouch
Avoiding unnecessary product layers
Keeping supplies in a cool, dry place
Recording repeated leaks or irritation
Asking for a pouch review if leaks happen often

Small patterns matter. Repeated leaks overnight, after meals or during movement can give your stoma care nurse useful clues. Care teams also often notice that irritation is worse when pouch changes happen under pressure, such as before leaving the house or late at night.

When to Contact Your Stoma Care Nurse, GP or NHS 111

Contact your stoma care nurse or GP if irritation does not improve, keeps returning or prevents the pouch from sticking securely. You should also seek advice if the skin becomes painful, broken, wet, bleeding or weeping.

You should also request a review if you notice frequent pouch leaks, new ulcers, unusual skin growths or a sudden change in the stoma’s size, shape or position. If possible, take a clear photograph during a pouch change so your nurse can see what is happening.

Some symptoms may indicate a serious complication rather than routine skin irritation. Contact NHS 111, ask for an urgent GP appointment or seek urgent medical help if you experience severe abdominal pain, vomiting, signs of dehydration, lots of blood from the stoma or a high temperature.

You should also seek urgent help if your stoma stops producing output for much longer than normal, or if it suddenly becomes very dark, purple or black.

Practical Support With Stoma Care at Home

Skin irritation often becomes worse when small leaks are missed or when a pouch change feels rushed. Families may also feel unsure whether soreness is caused by the appliance, moisture, stoma output or the way the pouch is being removed.

A trained carer can support a calmer routine by helping the person change their pouch at the right time, checking for early signs of leakage and making sure the surrounding skin is fully dry before a new pouch is fitted. They can also record patterns, such as repeated leaks overnight, after meals or during movement, so these can be discussed with a stoma care nurse.

At Secure Healthcare Solutions, our care team often finds that people feel more confident when they have a consistent routine and know when to ask for clinical advice. Our personalised Stoma Care in Wolverhampton helps make daily stoma care feel less stressful while protecting dignity, comfort and independence.

Frequently Asked Questions

What cream is good for irritated skin around a stoma – and can I use Sudocrem?

Avoid ordinary creams including Sudocrem — they prevent the pouch from sticking and can make things worse. The right product depends on the cause. Ask your stoma care nurse before changing anything.

Is red skin around a stoma normal?

Temporary pinkness after removing the pouch may settle quickly. Persistent redness, discolouration, soreness, itching or broken skin is not considered healthy and should be assessed.

How do you treat raw or weeping skin around a stoma?

Raw or weeping skin should be assessed by a stoma care nurse. Avoid applying ordinary creams or dressings without professional advice.

Sources

https://pmc.ncbi.nlm.nih.gov/articles/PMC9819694/
https://www.nhs.uk/tests-and-treatments/colostomy/complications-of-a-colostomy/
https://www.colostomyuk.org/information/stoma-problems/sore-skinleakage/
https://ascnuk.org/

Do you try to avoid tasks or demands expected of you, or do you feel pressure or anxiety because of them? When this happens constantly rather than occasionally, it may relate to a kind of autism spectrum called Pathological Demand Avoidance (PDA). PDA is often misunderstood by clinicians, employers, and support services due to its different profile characteristics from other autism profiles.

In 1980, Professor Elizabeth Newson at the University of Nottingham first described PDA. Recognition of the profile in adults remains inconsistent in the UK, with the challenges adults face in obtaining a diagnosis and the specialist support pathways available.

What is PDA Autism in Adults? Understanding the Profile

Pathological Demand Avoidance (PDA) describes a pattern of autistic experience in which demand avoidance is not occasional but pervasive and present across all settings, throughout the day, and significantly impacts daily life.

We all avoid things that we don’t want to do sometimes. PDA differs because the avoidance is persistent and often outside the person’s control. When a demand or instruction lands on someone with Pathological Demand Avoidance, many individuals with PDA may experience demands as threatening or overwhelming and avoids it as a defensive reaction. Generally, the avoidance is driven by a stress and anxiety response rooted in a nervous system that perceives demands as threatening.

In the UK, PDA is recognised as a type of autism, unlike the DSM-5 and ICD-11 (medical manuals used around the world). The PDA Society, which is the main UK charity focused on PDA, along with more and more research studies, believes that PDA is part of the autism spectrum.

Common Symptoms of PDA in Adults

Adults with PDA develop sophisticated strategies to mask demand avoidance, such as being present as charming, articulate, and engaging in short bursts, making it harder to identify the autism profile.

Pervasive Avoidance of Demand: Avoiding emails, phone calls, work tasks, responsibilities, or even things they want to accomplish.
Sophisticated Avoidance Strategy: A person with PDA will not outright refuse, but will use distractions such as humour, redirecting conversations, and providing elaborate justifications, etc.
Demand Avoidance Extending to Self-Imposed Goals: When a person’s favourite task or things they enjoy doing turn into an obligation that can trigger avoidance in a person with PDA.
Intolerance of Uncertainty: When a person’s intolerance of uncertainty magnifies, such as not knowing what to do if certain tasks or demands are made.
Sensory Processing Differences: Environmental changes, noises, and sudden lights can make demands feel more stressful and make an adult with Pathological Demand Avoidance feel dizzy, nauseated, or have brain fog.
Social Masking and Performance: Appearing as socially confident in short conversations while experiencing intense internal distress, especially women.
Engagement with Roleplay and Fantasy: Roleplay and fiction can help individuals feel safer and less stressed while dealing with real-life problems or demands.
Identity and Control: A strong need for control or independence. Strict rules, demands, or unexpected situations can feel stressful or difficult to manage.

Why PDA is Often Overlooked or Misdiagnosed in Adults

Adults with a PDA profile are experiencing what the PDA Society has described as a mental health crisis, one that is substantially linked to years of misunderstanding, inappropriate support strategies, and systemic barriers.

This is the most significant recent dataset on PDA and the mental health briefing 2023 in the UK:

84% of PDA adults reported experiencing suicidal thoughts
82% of PDA adults have experienced severe anxiety in the previous year
71% reported that a poor understanding of PDA created barriers to support
Only 20 individuals found CBT-style approaches helpful without adaptations

If you or someone you know is experiencing severe emotional distress, support is available through a GP, NHS 111, or mental health services.

Navigating the UK Adult Diagnostic Pathway

The UK Adult Diagnosis Pathway: Getting an autism (and PDA) diagnosis as an adult

See your GP
GP referral
Triage and screening
Assessment appointment
Outcome and diagnostic report

There are three routes to the assessment of Pathological Demand Avoidance:

NHS Local: GP refers you to your local autism assessment service. It is free, but it takes years sometimes for your assessment to be completed.
Right to Choose: NHS-funded but with a private provider of your choice. Start with GP. Takes time, but ICB funding varies.
Private: Pay for a private assessment. No GP referral needed. This is a much faster process, and you don’t have to wait, but all the expenses are borne by you.

Managing Daily Life: Practical Strategies for PDA Adults

Many adults with PDA encounter advice that can feel unrealistic or difficult to apply in everyday life. However, many adults find that generic advice can be difficult to apply consistently in real-life situations. Rather than trying harder, reduce demands and build skills.

Here are some practical strategies for Pathological Demand Avoidance:

Make choices: Task, responsibilities, and demands convert these into choices
Shrink Demands: make a list of tasks that feel overwhelming or obligatory, and break it into small choices or make it optional.
Self-care is not an obligation: do things as you allow yourself, not something you must do.
Adjust work and employment: change work environment (work in a hybrid or remote environment), take flexible deadlines, avoid unnecessary team events, consider self-employment
Manage your PDA burnout: when demands pile up and anxiety rises, the brain’s nervous system crashes, resulting in burnout. Build flexible routines, remove obligation rather than pausing them.

Accessing UK Support: PIP, Access to Work, and Social Care

Accessing PDA support in the UK for people with an autism profile can make their lives more independent, confident, and financially stable.

Apply for Personal Independence Payment (PIP)

PIP (Personal Independence Payment) is for people with conditions such as autism or PDA, who are facing everyday difficulties living.

Apply for a claim at the Department for Work and Pensions (DWP)
Fill the form, which assesses everyday activities, social interaction, and independent travel, etc.
Supporting evidence from healthcare professionals can strengthen the application.

Explore the Access to Work Scheme

Access to Work is a government-funded scheme, which you can apply for from your computer or smartphone online. For autistic adults who are employed or preparing for work, Access to Work provides workplace adjustments, travel support, or job coaching.

Request a Social Care Needs Assessment

Local healthcare services or councils can provide support. First, an assessment will look into your daily challenges to determine the proper care needs to improve your quality of life. Support may include home care, respite services, or community access assistance.

How Specialist Home Care Supports Independence for PDA Adults

With the right understanding, flexible support, and compassionate care, adults with PDA can build routines and environments that feel safer, more manageable, and empowering.

Secure Healthcare Solutions provides personalised autism support for adults in the UK, helping autistic adults live with dignity, understanding and greater independence. Their tailored approach focuses on building trust, encouraging confidence and supporting individuals through daily challenges in a calm, supportive and low-pressure environment.

Relapsing Remitting Multiple Sclerosis (RRMS) is a type of Multiple Sclerosis (MS) that affects a person’s central nervous system. According to the MS Society, over 150,000 people in the UK are living with MS.

RRMS can drastically change a person’s life. Occasional fatigue, dizziness, balance problems, and numbness in body parts, which we think are not of importance, can develop into a long-term neurological condition.

Relapsing Remitting MS is the most common type of MS, which shows its symptoms even in the early stages of the diagnosis. Although there is no cure for MS now, many people with RRMS lead stable, active, and fulfilling lives with the right treatment, care, and support.

What Is Relapsing-Remitting MS (RRMS)?

Relapsing Remitting MS is a type of MS where you have relapses followed by remissions. Around 85% of people diagnosed with MS are initially diagnosed with Relapsing-Remitting MS.

MS is a disorder characterised by demyelination, in which the body’s immune system attacks the central nervous system, causing white matter lesions that underlie the patient’s symptoms.
The most common form is Relapsing Remitting MS (RRMS), where the patient will have new signs emerge or worsening of the older ones. This is called a relapse, flare-up, or exacerbation.

The period between the relapses is a remission(Remitting) period in which the patient makes a partial or complete recovery. The symptoms of RRMS can vary depending on each person and which part of the nervous system is affected.

Relapsing Remitting MS Symptoms to Look Out For

MS symptoms can vary from person to person. Some experience mild or normal complications, while others may have severe complications and even have to visit A&E.

Types of RRMS symptoms you should look out for:

Fatigue

Around 80% of people with MS experience fatigue throughout the course of the disease. It is the most common MS symptom and can be physically draining and intense.

Blurred Vision

Pain behind the eye, double vision, or hazy sight are the earliest signs of RRMS. These symptoms may persist throughout the disease, but in some cases, they may resolve over time.

Numbness and Tingling

When RRMS relapse occurs, numbness in the legs and arms is the most frequent. The whole body feels an unusual sensation or tingling when moving the body. These can increase in the next relapses.

Muscle weakness and Balance issues

Living with Relapsing Remitting Multiple Sclerosis, you can feel off balance or find it hard to walk. Muscle function is also affected; you may feel muscle stiffness, cramps, etc.

Bladder problems

Urgency or late urination, constipation, or bowel difficulties may occur in RRMS. These symptoms can be embarrassing, yet they should not be ignored.

Emotional changes

MS symptoms affect a person’s mind and emotional state. An individual with RRMS shows signs of forgetfulness, trouble following instructions, etc.

A proper diagnosis for Relapsing Remitting MS is necessary to avoid confusing it with other neurological conditions.

Relapsing Remitting MS Diagnosis in the UK

Diagnosing RRMS can sometimes take time because it requires many medical tests, as different symptoms may resemble other neurological conditions. You should consult your GP for further clarification.

In the UK, diagnosis often involves:

Neurological examinations
MRI scans
Lumbar puncture tests
Blood tests to rule out other conditions

Many patients are referred to specialist neurology clinics through the NHS. MS nurses also play a vital role in supporting patients throughout diagnosis and long-term management.

Receiving a diagnosis can bring mixed emotions. Some people feel frightened, while others feel relief at finally understanding the cause of their symptoms.

Understanding How Relapses Occur

RRMS Relapse involves acute inflammation in the central nervous system, where the nerves fail to send signals to the body, creating a dysfunction or relapse.

To be considered a genuine relapse, the MS symptoms should:

Last for at least 24 hours
Occur after a period of stability
Not to be caused by infection, fever, or overheating

Generally, relapse can be managed at home with the help of your GP, MS specialist nurse, or other care professionals. In case of severe relapse, hospital treatment is recommended.

Relapsing Remitting MS Treatment Options

MS has no cure currently, but treatments can help reduce relapses and manage MS symptoms:

Disease-Modifying Therapies (DMTs)
Steroid Treatment During Relapses
Symptom Management

Steroids are only prescribed for severe relapses, for early recovery and inflammation. Medication and Therapies can help manage MS symptoms such as pain, bladder control, anxiety, etc.

DMTs are medications designed to reduce inflammation and lower the frequency of relapses. These treatments are commonly prescribed through specialist MS services within the NHS.

Different medications suit different patients depending on symptom severity, lifestyle, and overall health.

Signs You May Be Having a MS Relapse

MS relapse can happen after a full or partial remission (interval between relapses) of Relapsing Remitting MS, and sometimes you can be uncertain of the MS symptoms that triggered the relapse.

The following are the signs that can trigger a MS Relapse:

Lack of Rest
Infection
Heat and Exhaustion
Emotional Stress
Overheating

Infections such as urination infection, flu, and chest infections also worsen a relapse or trigger a relapse. Stress with prolonged anxiety or a chronic condition can create mental strain. MS Home care services in the UK and lifestyle adjustments can improve the daily life of an RRMS patient.

Daily Living Tips for Managing RRMS

Maintaining your everyday life with Relapsing Remitting MS is achievable with the following tips:

Have a healthy, well-balanced diet
Reduce Alcohol intake and smoking
Be active physically and mentally
Be careful of developing infections affecting swallowing, breathing, and circulation
Emotional support matters

To maintain MS symptoms, many individuals keep daily routines, regular rest periods, or sleep patterns, do mild exercise, prioritising tasks. These small habits build a solid foundation for a healthy lifestyle for RRMS patients.

RRMS Home Care Support from Secure Healthcare Solutions

Living with Relapsing Remitting Multiple Sclerosis can be overwhelming at times with physical, emotional, and lifestyle challenges that affect everyday life. Secure Healthcare Solutions in the UK provide professional carers and a patient-centred approach. We aim to help individuals living with RRMS continue leading safe, dignified, and fulfilling lives within the comfort of their own homes.

At Secure Healthcare Solutions, Wolverhampton, we understand that every individual’s experience with Multiple Sclerosis is unique. Our compassionate Multiple Sclerosis Care in Wolverhampton services are designed to provide personalised support tailored to each patient’s specific needs, whether it involves assistance with daily activities, mobility support, medication management, or emotional wellbeing.

Parkinson’s disease is often associated with movement symptoms such as tremor, stiffness and slower movement. However, the non-motor symptoms of Parkinson’s disease can be just as difficult for daily life, especially when they affect sleep, mood, digestion, memory, bladder control or confidence at home.

Parkinson’s can involve more than 40 recognised symptoms, and everyone’s experience is different. For families and carers, understanding these “hidden” symptoms can make it easier to spot changes early, reduce risks at home and know when to ask for professional help.

What Are the Non-Motor Symptoms of Parkinson’s Disease?

Non-motor symptoms are changes caused by Parkinson’s that do not directly involve movement. While motor symptoms affect walking, balance, stiffness or tremor, non-motor symptoms can affect how a person sleeps, thinks, feels, digests food and manages everyday routines.

These symptoms are sometimes harder to notice because they are not always visible. They may also be mistaken for ageing, stress, medication side effects or other health conditions. This is why families and carers should look out for changes in mood, sleep, appetite, toileting, memory and confidence at home.

Top 10 Non-Motor Symptoms of Parkinson’s Disease

1. Sleep Problems

Sleep disturbance is common in Parkinson’s. A person may struggle to fall asleep, wake often during the night, experience vivid dreams, feel restless, or feel very sleepy in the daytime.

Support tips include keeping a regular bedtime routine, reducing caffeine in the evening and making the bedroom calm and safe. If the person gets up at night, good lighting, clear walkways and easy access to the toilet can reduce the risk of falls.

2. Fatigue

Fatigue in Parkinson’s is not the same as ordinary tiredness. It can feel overwhelming and may affect concentration, mood, motivation and the ability to complete daily tasks.

Families can help by planning important activities for times of the day when energy is usually better. Short rest breaks, hydration, gentle activity and support with washing, dressing or meals can help the person conserve energy.

3. Constipation

Constipation is a common non-motor symptom of Parkinson’s and may be linked to slower digestion, reduced movement, medication, diet or fluid intake. It can cause discomfort and may affect appetite and general wellbeing.

Helpful support includes encouraging fluids, fibre-rich foods and safe movement where appropriate. Families should monitor bowel habits and seek advice from a GP or pharmacist before using laxatives, especially if constipation is severe, painful or persistent.

4. Bladder Problems

Parkinson’s can cause urinary urgency, frequent toilet visits, night-time waking or incontinence. These symptoms can affect sleep, confidence and dignity.

Practical steps include keeping the route to the bathroom clear, using night lights and considering continence products or bathroom aids where needed. A GP should review new or worsening bladder symptoms to rule out infection or other causes.

5. Depression and Anxiety

Depression and anxiety are common in Parkinson’s and should be taken seriously. Depression may cause low mood, loss of interest or hopelessness. Anxiety may lead to worry, panic, fear of falling or reluctance to leave the house.

Support starts with listening without judgement. Encourage the person to speak with their GP, Parkinson’s nurse or specialist team. Routine, companionship, gentle activity and meaningful social contact can also help reduce isolation.

6. Memory and Thinking Changes

Some people with Parkinson’s experience slower thinking, forgetfulness, reduced concentration or difficulty planning tasks. This does not mean everyone with Parkinson’s will develop dementia, but changes should be monitored.

Useful support includes calendars, reminder notes, medication charts and simple daily routines. Sudden confusion should be treated as a warning sign, as it may be linked to infection, dehydration, medication changes or another urgent health issue.

7. Pain and Sensory Changes

Pain in Parkinson’s may include muscle cramps, stiffness, aching joints, nerve-type pain or unusual sensations. Pain can affect sleep, mood, mobility and independence.

A pain diary can help identify patterns, including whether pain is linked to medication timings or certain activities. Depending on the cause, support may include physiotherapy, posture advice, safer mobility support or a medication review with the specialist team.

8. Dizziness and Low Blood Pressure

Some people with Parkinson’s experience a drop in blood pressure when standing, known as postural hypotension. This can cause dizziness, light-headedness, fainting and falls.

Support tips include encouraging the person to stand slowly, sit down if dizzy and keep hydrated unless advised otherwise by a healthcare professional. Repeated falls, fainting or severe dizziness should always be discussed with a GP, Parkinson’s nurse or specialist.

9. Swallowing and Saliva Problems

Parkinson’s can affect swallowing, chewing and saliva control. This may cause drooling, coughing during meals, food sticking in the throat, weight loss or an increased risk of choking.

Meals should be calm and unhurried, with the person sitting upright. If swallowing becomes difficult, a GP or specialist team may refer to a speech and language therapist for assessment and advice.

10. Hallucinations or Changes in Perception

Some people with Parkinson’s may see, hear or sense things that are not there. Others may experience delusions or become suspicious. This can be distressing for the person and their family.

Carers should stay calm, offer reassurance and avoid arguing about what the person is experiencing. New, worsening or distressing hallucinations should be reported to a GP, Parkinson’s nurse or specialist team, especially if they appear suddenly.

Practical Support Tips for Families and Carers

A symptom diary is one of the most useful tools for families. Record sleep, mood, appetite, bowel habits, bladder changes, falls, pain, hallucinations, medication timings and any sudden changes in behaviour. This gives healthcare professionals clearer information between appointments.

Home safety is also important. Good lighting, clear walkways, safe footwear, bathroom aids and grab rails can reduce the risk of falls. For people with memory or thinking changes, simple routines and visible reminders can make daily life feel calmer and more predictable.

Families should also think about their own wellbeing. Parkinson’s can place emotional and physical pressure on carers, especially when symptoms change, or night-time support is needed. Respite care, companionship care and professional home care can give family carers time to rest while keeping their loved one supported.

When to Speak to a GP, Parkinson’s Nurse or Specialist Team

Speak to a GP, Parkinson’s nurse, neurologist or specialist team if symptoms are new, worsening, causing distress or affecting safety.

Urgent advice is needed for sudden confusion, repeated falls, fainting, choking, severe constipation, signs of infection, unexplained weight loss, distressing hallucinations or thoughts of self-harm.

In an emergency, call 999. For urgent medical advice when it is not an emergency, use NHS 111.

Parkinson’s Care at Home: How Secure Healthcare Solutions Can Help

For many families, Parkinson’s care at home can make daily life safer and more manageable while allowing the person to remain in familiar surroundings.

Secure Healthcare Solutions provides tailored care across Wolverhampton, Birmingham, Walsall, Dudley, Sandwell, Cannock, South Stafford, Telford and nearby areas. Support can include personal care, medication prompts, meal preparation, hydration support, continence care, mobility assistance, companionship, respite care, night care and live-in care.

Care plans can be adapted as needs change, helping families manage symptoms, reduce pressure and support independence at home.

If you are worried about a loved one’s Parkinson’s symptoms or need extra support at home, contact Secure Healthcare Solutions today to discuss a tailored Parkinson’s care plan.

Sources

https//www.parkinsons.org.uk/information/symptoms
https://www.parkinsons.org.uk/information/symptoms/non-motor
https://www.nhs.uk/conditions/parkinsons-disease/
https://www.nice.org.uk/guidance/ng71

Registering with a GP is an important step if you live in the UK or are staying here for a while. Your GP surgery is usually the first place to contact for non-emergency health concerns, repeat prescriptions, referrals, vaccinations, screening and ongoing care.

On 1 April 2026, NHS England Digital recorded 63,673,685 patients registered with GP practices in England, showing how central GP services are to everyday healthcare.

If you have moved home, arrived in the UK, started university, or are helping a loved one, this guide explains how to register with a GP in the UK in a simple, practical way.

How to Register With a GP in the UK?

To register with a GP in the UK, choose a GP surgery, check that it accepts new patients, complete an online or paper registration form, and wait for confirmation. In England, you do not need ID, proof of address, immigration documents, or an NHS number to register.

At a glance:

GP registration is free in England
Registration is usually confirmed within 5 days in England
You can register online via the NHS App, the NHS website, or in person at the surgery

Who Can Register With a GP?

In England, anyone can register with a GP surgery. This includes UK residents, students, people who have moved to a new area, people staying temporarily, and visitors from abroad who need GP care.

This also includes people with no fixed address, refugees, asylum seekers and international students. If you do not have a permanent address, you may be able to use a temporary address, a shelter address or, in some cases, the GP surgery’s address.

You can usually register permanently if you live in the surgery’s practice area, sometimes called its catchment area. If you are away from home for a short stay, you may be able to register as a temporary patient for up to 3 months.

Some overseas visitors may need to check their right to other NHS services, as some hospital or specialist care may involve charges.

What Do I Need to Register With a GP?

Most GP registration forms ask for basic details, such as:

Full name and date of birth
Current or temporary address
Phone number and email address
Previous GP surgery, if known
NHS number, if you have one
Emergency contact details
Current medicines, allergies or health conditions
Carer details, if relevant

You do not need to know your NHS number. If you have it, include it. If not, the surgery can still deal with your registration.

Before sending the form, check your contact details and tell the surgery if you have accessibility or communication needs.

Can You Register Without Proof of Address or ID?

In England, you do not need to provide proof of address or ID to register with a GP. NHS guidelines are clear that surgeries cannot refuse your registration solely because you lack these documents. If you are homeless or without a fixed address, you can use a temporary address, a day centre, or the surgery address itself.

Step-by-Step: How to Register With a GP Surgery

Step 1: Find a GP Surgery Near You

In England, use the NHS “Find a GP” service and search by postcode. You can also check local surgery websites.

Look at whether the surgery accepts new patients, opening times, transport links, access needs and online services. You may also want to check whether the surgery accepts your address.

Some surgeries accept out-of-area registration. This can be useful if you want a GP near work, university or a relative’s home, but it may affect home visits and community services.

Step 2: Fill In the Registration Form

Many surgeries offer online GP registration through the NHS website, the NHS App, or their own website. If you prefer paper, ask the surgery for a form.

The form may ask about your health, medicines and allergies. NHS guidance says the online form usually takes about 15 minutes for each person.

Step 3: Wait for Confirmation

As of April 2025, NHS England confirmed that 98.4% of GP practices in England now offer online registration through the NHS App or NHS.uk – meaning that for most people, registration can be completed in minutes from home. After you send the form, the surgery should tell you whether you have been registered. In England, this is usually within 5 days, although it can take longer.

If you are changing GP surgery, you usually do not need to tell your old one. Your medical records should be moved after your new registration is accepted.

Step 4: Set Up Online Access

Once registered, ask about the NHS App or the surgery’s online services. You may be able to request appointments, order repeat prescriptions, view test results, update contact details and see parts of your medical record.

If you care for someone, ask the surgery about online access with permission.

Can You Register a Child or Someone You Care For?

Children under 16 are usually registered by a parent or guardian. Each child normally needs their own form.

You may also be able to help an older person, disabled person, or someone who cannot fill in the form themselves. If someone over 16 cannot make decisions about their care, the surgery may need details from a carer, relative, lasting power of attorney, or legally appointed person.

Can a GP Surgery Refuse to Register You?

A GP surgery may refuse registration if it is not taking new patients, you live outside its catchment area, or there is another reason allowed by NHS rules.

In England, if a surgery refuses you, it should explain why in writing within 14 days. If you think the refusal is unfair, contact your local Integrated Care Board, local Healthwatch, or Citizens Advice.

What If You Need Medical Help Before Registration Is Complete?

If you need medical help before your registration is confirmed, do not wait if the problem is urgent.

Use NHS 111 for urgent but not life-threatening advice. A pharmacist can help with many minor illnesses and medicine questions. For a life-threatening emergency, call 999 or go to A&E.

Conclusion

Knowing how to register with a GP in the UK can help you access the right NHS support more confidently. The process should be clear, fair and accessible, whether you are registering for yourself, helping a family member, or arranging care for someone with ongoing needs.

If you or someone you love needs professional support at home alongside NHS and GP care, Secure Healthcare Solutions is here to help. Our experienced team has been matching individuals and families with trusted healthcare professionals since 2015. Get in touch today and we will help you find the right level of care – with the continuity, dignity and compassion that every person deserves.

Sources:

https://www.nhs.uk/nhs-services/gps/how-to-register-with-a-gp-surgery/
https://www.england.nhs.uk/contact-us/common-questions/how-do-i-choose-and-register-with-a-gp/
https://digital.nhs.uk/data-and-information/publications/statistical/patients-registered-at-a-gp-practice/april-2026
https://digital.nhs.uk/services/register-with-a-gp-surgery-service/get-help-using-the-service/reasons-to-reject-a-registration
https://www.england.nhs.uk/2025/04/millions-more-patients-can-register-with-a-gp-at-touch-of-a-button/

For many people and their families across the UK, when care becomes more than occasional need or help, it turns into a more complex and overwhelming situation. It may be small things or tasks at the start, a missed medication, a fall, or confusion that becomes daily essential care.

Facing complex and significant ongoing health issues? NHS continuing healthcare (CHC) provides needed support and care for such cases. Fully funded by the NHS, it has the potential to remove not only the financial but also the emotional toll on people.

What Is NHS Continuing Healthcare (CHC)?

NHS Continuing Healthcare (CHC) is a package of free services for health and social care arranged and funded by the NHS. CHC is for individuals over the age of 18 who have complex ongoing care needs that arise from “primary health needs.” Unlike social care, it is not means-tested, meaning eligibility is not based on income or savings.

CHC care can be provided at home, in a care home, hospice, or community settings.

To receive NHS Continuing Healthcare, a person has to be assessed by integrated care boards(ICBs) through a legally prescribed process. This process is laid out by the National Framework published by the Department of Health and Social Care.

Who Qualifies for NHS Continuing Healthcare?

Eligibility for NHS continuing healthcare depends on whether a person has a primary health need such as long-term disability, progressive conditions, or near-death conditions. It is based on the nature and intensity of the care required rather than diagnosis, condition, and financial situation.

Key characteristics for NHS continuing healthcare:

Nature: type of care needed
Intensity: severity and frequency of the needs
Complexity: interaction of multiple conditions
Upredictability: unexpected deterioration risks

If eligible, the integrated care board(ICBs) handles commissioning, planning, and managing care for CHC.

NHS Continuing Healthcare Funding Explained

CHC is funded by the NHS. From 2015 to 2024, spending on NHS Continuing Healthcare increased from 4.3 billion dollars to 6.5 billion dollars, reflecting rising care costs and the growing complexity of needs among those eligible.

NHS covers all associated care costs, including:

Personal care (washing, dressing, daily assistance)
Nursing care
Care home stay with daily support
Medical equipment and supplies
Specialist therapies

This represents a substantial financial relief. Saving families tens of thousands of pounds annually.

CHC Assessment Process (Step-by-Step Guide)

The CHC Assessment process is not a single decision; it is a step-by-step process that includes many stages and tests. Integrated care boards (ICB) commission the local health services as part of the NHS organisations to test the eligibility of patients.

Generally, there is an initial checklist before a full assessment to confirm your condition. In case of the need for urgent care, your assessment can be fast-tracked.

Initial assessment for NHS continuing healthcare (A Checklist)

An initial assessment or a preliminary screening can be done by a nurse, a general practitioner(GP), a healthcare professional, or a social worker.

The outcome from the checklist tells you if you are eligible for a full assessment. The decision is given by the professional in writing with signature and date, and a copy of the checklist.

You can download a black copy of the NHS continuing healthcare checklist from GOV.UK (PDF).

Full assessment for NHS continuing healthcare (A Decision Support Tool)

If the checklist is positive, a full assessment for NHS continuing healthcare is conducted by a multidisciplinary team (MDT) consisting of at least 2 professionals who are already involved in your care. You should also be introduced to or informed of the person coordinating your full assessment with the NHS continuing healthcare assessment.

The MDT team evaluates you within multiple care needs, listed below:

Breathing
Food and drink
Mobility
Communication
Continenece
Congition
Behaviour
Psychological and emotional needs
Other significant care needs

While conducting the assessment, the professionals mark the needs as “priority”, “severe”, “high”, “moderate”, “low”, or “no needs”. If you get 1 priority or severe needs in 2 areas, it is highly possible to be eligible for NHS continuing healthcare.

If you are marked with several other high or moderate needs with 1 severe need, depending on their complexity, nature, and risks, you might also be eligible. You are given a copy of the decision documents, along with clear reasons for the decision.

You can download a black copy of the NHS continuing healthcare decision support tool from GOV.UK (PDF).

Fast-tracked pathway for NHS continuing healthcare

The fast-tracked pathway is for people with a critical/urgent condition, such as a rapidly growing illness or a near-death situation. In these circumstances, you are eligible for NHS continuing healthcare via the fast-tracked pathway.

An appropriate care and support package can usually be put in place within 48 hours for such cases.

Common Reasons CHC Funding Is Refused

Some of the most common reasons for rejection:

Assessment failing

Missing or incomplete documents: Detailed care records, GP notes, or hospital reports and records; all data should be submitted without fail.
Ignoring “well-managed” needs: The assessor may not consider the risks if the high-quality care a patient is receiving at the time of assessment is withdrawn later.

Eligibility and interpretation issues

Confusion between health and social needs: People generally misclassify health needs as social needs, which are means-tested.
Narrow Interpretation of Criteria: Assessors may interpret the eligibility criteria (in the Decision Support Tool) too narrowly, focusing on the diagnosis rather than the overall intensity, complexity, and unpredictability of needs.

Specific situations

Dementia: People with rare dementia or younger-onset dementia find it difficult proving their eligibility because their symptoms differ from standard dementia profiles.
Withdrawing existing funding: During the annual review, if the CCG decides the person’s needs have decreased, CHC can be withdrawn.

If your application is rejected for NHS continuing healthcare, you have the right to appeal within 6 months of the deadline, which should be done by requesting a review of the decision and ensuring all evidence is included.

Conclusion

NHS continuing healthcare is one of the most comprehensive forms of support within the UK healthcare system. It can reduce both financial strain and emotional stress for individuals with complex care needs.

CHC is a powerful resource, but navigating it can be challenging. A lack of awareness, misunderstandings about eligibility, and failure to appeal decisions often prevent people from accessing the support they are entitled to. For those seeking professional guidance, healthcare providers such as Secure Healthcare Solutions, a trusted healthcare agency in Wolverhampton, can offer informed support and assistance in navigating the CHC process.

A 50-year-old woman, Amelia from Birmingham, had recently returned to her normal daily routine following stoma surgery. Months later, she discovered a bulge forming beside her stoma.

Like many individuals, uncertainty was felt about whether the change should be ignored or taken seriously. Although pain was not felt, a sense that something was not quite right remained.

Across the UK, this situation is commonly experienced, and such a bulge is often recognised as the first sign of a stoma hernia, also referred to as a parastomal hernia.

What Is a Stoma Hernia?

The word stoma comes from the Greek, meaning “an opening.” A stoma is created surgically to assist the body’s functions of the digestive and urinary systems.

A hernia is a condition in which internal organs of the body protrude through a weakened area in the surrounding muscle wall or tissue. As a result, a soft bulge may be formed.

Hernias develop in several parts of the body, including:

The abdominal region,
The groin and lower abdomen
The midline of the abdomen
Previous abdominal surgery incision sites
The lower chest through the diaphragm (in less common cases)

Research by the NHS shows that hernias most commonly develop after surgery, especially in cases involving the abdomen.

What Causes a Stoma Hernia?

A weakness in the abdominal wall around the stoma opening, resulting in a bulge, is known as a stoma hernia or parastomal hernia.

Several contributing factors are commonly identified:

Natural healing following stoma surgery
Weakness in abdominal muscles
Persistent cough and sneezing
Physical strain (Lifting heavy objects)
Excessive body weight
Weakening muscle health as you get older
Long-term constipation
Smoking
Infection around the stoma
Use of steroids

Even after a perfect surgery, there are still chances of a stoma hernia. Over time, changes in muscle strength and internal pressure can result in the development of a hernia.

Stoma Hernia Symptoms

A stoma hernia develops gradually; its symptoms may not be noticeable and can vary from person to person. Early signs are subtle and are only recognised over time.

The following symptoms are commonly found:

A soft bulge or swelling around the stoma
A visible bulge while you stand, cough or strain yourself
Feeling uncomfortable in your abdomen or experiencing heaviness
Difficulties with the application of a stoma bag
Notice changes in your stoma functions

Research has indicated that 75% of people with a stoma hernia experience complications such as pain, leakage, and skin irritation in the abdomen.

People are often more concerned about unpredictability, leakage, and managing the condition in social and daily life, rather than pain itself.

Is a Stoma Hernia Dangerous?

Around 30-50% ostomates (people who have had a stoma surgery) have a stoma hernia within the first two years or later. Stoma hernia grows gradually and differently, and is mostly manageable. If you neglect your condition, complications may arise.

The following warning signs should be carefully monitored:

Bulge size growth over time
Increased pain and persistent discomfort
The stoma stops functioning
A sudden swelling in the affected area
Signs of blockage in the stoma
Vomiting

People with a stoma hernia experience increased anxiety and difficulty with daily activities and independence. Ignoring these risk factors may worsen the situation, and in the worst case, you will need to be admitted to A&E.

Stoma care places a significant demand on NHS resources. Recent UK data suggests that spending on stoma and continence products alone is estimated at around £350 million each year, with additional costs arising from complications and ongoing care needs.

Treatment Options for Stoma Hernia

The treatment approach for stoma hernia differs from person to person, considering how severe the condition is and its effects on daily lifestyle. Most stoma hernias do not require immediate surgery.

Surgical treatment is often not suggested to older people due to the increased risks associated with anaesthesia. Even after surgery, a stoma hernia may recur. Instead, symptom management is recommended.

Non-surgical Management for stoma hernia:

Support belt designed for a stoma
Specialised support garments, including boxers, pants, and girdles
Exercise aimed at strengthening abdominal muscles, such as pilates
Avoid heavy lifting or strains on the body
Use of appropriately fitted stoma appliances
A qualified stoma care nurse can give the most suitable support

If you cannot manage a stoma hernia with non-surgical treatments and the first-line measure fails, or your condition becomes severe, you should consult with your GP.

To repair the stoma hernia, the surgeon will suggest either.

Incision Surgery: Repair the hernia via an open surgery in the abdomen
Laparoscopic Surgery: Reposition the stoma through a keyhole in the abdomen

The choice of surgery is proposed by the surgeon after considering the patient’s overall health, age, and severity of the hernia. Surgery does not guarantee permanent resolution, as recurrence of the hernia may still occur.

Stoma Care in Wolverhampton

For people like Amelia, the first moment of noticing a change can feel uncertain, and experiencing symptoms mentioned above, reassurance and support can be provided through specialised stoma care services.

In Wolverhampton, Secure Healthcare Solutions is a healthcare company offering care and support, including dedicated stoma care services, to patients at every stage of their journey.

These services typically include:

Consultations guided by GPs
Support from trained stoma care nurses
Personalised care plans tailored to individual needs

Through professional guidance, individuals are supported in managing their condition effectively and are encouraged to regain control over their daily lives.