The closure of a nurse-led children’s continence clinic in Greenwich left vulnerable youngsters without the specialist support they needed, according to a local health watchdog.
Healthwatch Greenwich also criticised the way the closure of the paediatric enuresis service – which has since won a temporary reprieve – was handled. It claimed Oxleas Foundation NHS Trust failed to tell families that used it or inform local GPs, who were expected to take over.
“Lack of this service will increase issues of bullying for children at school”
The Greenwich Children’s Continence Clinic, delivered by a band 6 nurse working part time, offered three half-day clinics per week plus four drop-in session at children’s centres around the borough.
It was providing medical and emotional support to around 300 children and young people when it was closed by Oxleas at the end of August this year, according to a report published by the watchdog.
Local GPs were expected to fill in the service gap, but Healthwatch Greenwich questioned their ability to provide the specialist care needed.
“Whilst GPs are an integral part of the diagnostic process, there are real concerns regarding the capacity and skillset of GP practices to be able to manage a very specialist and sensitive area for parents and children,” said the report.
The healthwatch document cited evidence from a specialist bladder clinic showing the closure led to inappropriate referrals.
Dr Anne Wright, a consultant paediatrician in charge of the nearby Evelina London Children’s Bladder Clinic, said her clinic had started getting referrals from Greenwich GPs.
“These referrals are not appropriate for a tertiary setting and few general paediatric departments in secondary care have the expertise,” she said. “Previously, these referrals would have gone to the Greenwich Children’s Continence Clinic where they were very competently assessed and managed.”
“Few general paediatric departments in secondary care have the expertise”
Healthwatch Greenwich board member Lola Kehinde, who is also a specialist continence nurse, warned that losing the service would affect children’s wellbeing.
“This is a crucial service for children and for their development into adulthood,” she said. “Lack of this service will increase issues of bullying for children at school and it will affect their social skills.”
The watchdog’s report said the service was shut down and the specialist nurse redeployed after a new contract was awarded to the trust to provide 0-19 public health services by the local authority.
It appeared to have fallen by the wayside during the commissioning process for the new contract. According to the report , the council, which is not responsible for commissioning continence services, was not aware the service was delivered by Oxleas’ public health nursing team and the trust did not flag this up.
Meanwhile, the trust did not include the continence clinic in its bid because it was not part of the service specification.
“Unfortunately the service was closed by Oxleas without any notification to either service users or the GPs,” said the report.
Watchdog attacks closure of nurse-led children’s clinic
However, the trust has maintained it did alert the council and Greenwich Clinical Commissioning Group that the service was not included in the 0-19 service specification.
“As a provider of health services, we can only run services that we are commissioned, and therefore funded, to provide,” said a trust spokeswoman.
“As this service underwent a competitive tendering process, our previous contract for the children’s public health services ended and the continence service that was previously part of this contract was not included,” she said.
“We alerted both the CCG and the council that the clinic was not in the specification,” she said. “Interim arrangements were agreed to ensure the service was not interrupted and this was communicated to GPs jointly by Oxleas, the CCG and the council.”
The service has since been re-commissioned on a temporary basis, after concerns were raised by families, professionals and Greenwich Healthwatch. The trust spokeswoman said the CCG had confirmed funding until mid-February.
“This will allow us to work together to understand need and clearly specify and contract the service moving forward,” she said.
Healthwatch Greenwich said it was vital to ensure there was specialist provision available to families in some shape or form.
“Healthwatch Greenwich understands that a paediatric continence service is not a statutory provision,” said the report.
“However, it is our view and the view of several families and clinicians that the relative medical and emotional benefits to children combined with reassurance to families gained from a service costing less than £30,000 a year is significant value for money and something that should be commissioned in Greenwich,” the watchdog added.
“We are committed to ensuring Greenwich children have access to a high quality continence service”
The Royal Borough of Greenwich confirmed that the clinic had been re-instated but highlighted that there were other sources of support for families with continence issues.
“We have re-launched child health clinics, which take place in children’s centres across the borough, with a further 11 drop-in sessions also held in children’s centres,” said a council spokeswoman.
“Parents can get advice on a range of issues, including continence. School nurses also cover continence issues and are available in every school to offer advice and support,” she said.
“We are confident that any child, parent or carer who needs help and advice with children’s continence issues should be able to easily access this in Royal Greenwich,” she added.
A spokeswoman for NHS Greenwich CCG said the body was working with the trust and council.
“We are committed to ensuring Greenwich children have access to a high quality continence service and we are working with Oxleas and the Royal Borough of Greenwich to review whether the current service meets the needs of local families,” she said.