Nursing organisations are calling on NHS commissioners to fund more specialist nurses to help drive much needed improvements in paediatric continence care.
The call, from the Paediatric Continence Forum, comes as two sets of national guidance on the topic have been published.
Clinical commissioning groups have failed to drive improvements in paediatric continence care, according to the forum, which includes specialist nurses and representatives from the Royal College of Nursing and the Community Practitioners’ and Health Visitors’ Association.
“Too many NHS community treatment services in this area remain unfit for purpose”
A Freedom of Information request by the forum in August suggested many CCGs were failing to provide proper integrated paediatric continence services for children and young people with continence problems.
Only 32% of responding CCGs commissioned all four main continence services – bedwetting, daytime wetting, toilet training and constipation/soiling – with just over 22% of these said they commissioning services that were fully “joined-up”.
This picture shows little improvement since CCGs took over responsibility from primary care trusts in April 2013. A similar study undertaken by the forum in 2011 found 25% of PCTs commissioned the four main services and about 12% of these described their services as “joined-up”.
Little over a third (39%) of CCGs who responded to the 2014 information request said they had plans to commission new paediatric continence services or review their existing provision.
The forum said this suggested many CCGs were relying on universal services, such as school nurses and health visitors, to handle childhood continence problems, rather than ensuring access to properly trained continence professionals.
The National Institute for Health and Care Excellence launched accredited commissioning guidance last week to address these deficiencies.
This guidance recommends that the four main continence services should be “joined-up” and run by dedicated paediatric continence professionals.
The forum itself also published new guidance – the Paediatric Continence Commissioning Guide – last week, which it says provides clear advice to commissioners and healthcare professionals on how to commission integrated, community-based paediatric continence services.
The guide has been accredited by NICE and was formally launched alongside the institute’s guidance – the Nocturnal Enuresis Quality Standard – which highlights key quality improvement areas for the management of bedwetting in children.
Forum chair Dr Penny Dobson said: “Too many NHS community treatment services in this area remain unfit for purpose. Much more work needs to be done to improve this situation.”
Fiona Smith, the RCN’s adviser in children and young people’s nursing, said: “Specialist nursing care can make a real difference to a child’s life, enabling them to take part in everyday activities such as attending school and playing sports.
“Paediatricians value children’s continence nurse specialists as key members of the team who help improve management of continence issues and reduce the need for repeated hospital appointments and attendance at emergency departments,” she said.
“This guidance must lead to better commissioning of children’s continence services, including the children’s continence nurse specialists who provide vital care and support,” she added.
Rosalind Godson, professional officer for CPHVA, said: “All the evidence shows that these children can be helped and supported to become continent and thereby save resources from the NHS and social care services’ budgets.”