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Update: Conference- Progress Through Partnership, Birmingham, 4–5 March

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First national standards for bladder and bowel care to improve good practice

Thirteen new national competencies (National Occupational Standards, NOSs) for bowel and bladder care were launched at the national ‘Progress Through Partnership’ conference in Birmingham last month.

These UK-wide competencies (Box 1) were presented to an audience of over 400 health professionals including continence and urology nurse specialists, continence advisers, physiotherapists and occupational therapists.

BOX 1. Continence suite of competencies

Competency number and title

CC01 Assess bladder and bowel dysfunction. Covers specialist assessment of bladder and bowel dysfunction.
CC02 Insert and secure urethral catheters.
CC03 Care for individuals with urethral catheters.
CC04 Manage suprapubic catheters.
CC05 Undertake a trial without catheter.
CC06 Enable individuals to carry out intermittent catheterisation.
CC07 Review catheter care.
CC08 Care for individuals using containment products.
CC09 Enable individuals to effectively evacuate their bowels.
CC10 Assess residual urine by use of portable ultrasound.
CC11 Implement toileting programmes for individuals.
CC12 Enable individuals to undertake pelvic floor muscle exercises.
CC13 Enable individuals with complex pelvic floor dysfunction to undertake pelvic floor muscle rehabilitation.

Finding the competencies

The competencies are available at On the home page click on completed competencies/projects. Go to end of page and click
on completed frameworks/suites and competence projects.


Dates for the workshops are available at

Guidelines to accompany the competencies will be available at the workshops or from Coloplast, email

The project to produce the competencies was a joint venture between the RCN and Skills for Health (SfH), supported by a grant from Coloplast.

At the launch, Sue Thomas, RCN policy adviser for long-term conditions, described the competencies as ‘valuable to practice, regardless of whether you work in hospital, the independent sector, the community or nursing homes’.

SfH is the sector skills council for the UK health sector. Its purpose is to help develop a skilled and flexible UK workforce so health and healthcare can be improved. One of its main functions is to develop NOSs and national workforce competencies (NWCs).

There are more than 2,500 competencies on its website covering a wide range of topics. NOSs are statements of competence describing good practice and are written to measure performance outcomes. They can be used by individuals, employers and education providers. They describe how a function, for example catheterisation, should be carried out but do not specify who should carry it out.

Competencies do not apply to diseases or conditions. For example, there is no competency for management of stress urinary incontinence, but there is a bundle of competencies to manage patients who have this condition.

The ways in which NOSs can be used are listed in Box 2.

Box 2. How NOSs can be used in practice

  • Individual development and appraisal.

  • Team development.

  • Role design.

  • Role redesign.

  • Service design, for example, developing a new service.

  • Education programme/curriculum design.

  • Evidence-gathering for KSF post outlines.

  • Measurement and evaluation of care.

The project to develop the continence NOSs began in 2006. The RCN project lead was Ray Addison, nurse consultant, bladder and bowel care at Mayday Hospital in Croydon.

All NOSs produced with SfH follow a standard methodology. This involves establishing a project group, scoping the topic, developing the competencies, field testing and signing off approval and validation.

Thirty sites registered to field test the continence competencies and 22 fed back their experiences. They used the NOSs in a variety of ways, including assessing performance, teaching and for reference and advice in implementing NICE guidance.

Speaking at the conference, Nikki Hale, senior fellow, competency development at the RCN, suggested that the competencies could improve patient safety through consistency, develop a flexible, responsive workforce to meet patient need, clarify team development needs and recognise specialist skills.

She described competencies as ‘building blocks that can be pulled together to create the roles we need for the future and allow nurses to become creatively fit for purpose’. The benefits are listed in Box 3.

Box 3. Some benefits of using competencies

  • Improves patient safety.

  • Helps with team-building, as competencies identify core functions that all staff share.

  • Matches competent staff to the requirement of patients.

  • Provides clearer training and development plans for the team.

  • Provides opportunities for career progression.

  • Recognises the work of a post-holder.

  • Helps to target resources.

  • Clarifies what specialist skills are.

Competency-based training and education is not new in healthcare but, until now, there has been no national framework for bladder and bowel care. This has led to problems when staff move between trusts.

Speaking at the conference about her experience of using competencies, Ann Yates, continence service director at Cardiff and Vale NHS Trust, said: ‘Competencies were not transferable between [organisations] and this can cause duplication in training.

‘Delays in care can occur if professionals move from one area to another and have to undergo skill training in areas where they may already be proficient.’

She also pointed to the problems of inconsistency in training between trusts and of identifying skills required by those who assess competence. It is hoped that a system of national competencies will help to solve some of these problems.

The next step of the project is to raise awareness of the standards and encourage practitioners to use them.

The RCN is running workshops throughout the UK during 2008 to help healthcare professionals understand how NOSs can be used in practice. Guidelines to accompany the competencies will be available at the workshops or by emailing

Competencies for paediatric continence are being compiled from existing SfH competencies by June Rogers, continence nurse specialist and service director at PromoCon. A paediatric distance learning booklet is being developed.

Mr Addison suggested at the event that competencies were required for bladder irrigation, bladder washout and catheter maintenance solution as well as a care bundle of NOSs for the management of diarrhoea. He noted that the competency suite ‘acknowledges continence care as a healthcare need and gives status to it as a specialist field in healthcare’. He added that the competencies ‘enable us to sing from the same hymn sheet’.

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