Children’s Continence Commissioning Guide featured in the Association for Continence Advice (ACA) newsletter

February 10, 2020 in Uncategorized

The Paediatric Forum’s Children’s Continence Commissioning Guide was featured in last winter’s edition of the Association for Continence Advice newsletter.

The article gives an overview of the guide and encourages readers to make commissioners aware of it. The article also explains  some of the work that the PCF does in identifying areas of poor commissioning and reaching out to the MPs from those areas.

Read the Children’s Continence Commissioning Guide’s feature in the ACA newsletter here. 

Integrated paediatric continence services Guide to significantly improve children’s lives and save NHS costs

September 3, 2019 in Uncategorized

Read the Children’s Continence Commissioning Guide 2019.

The Paediatric Continence Forum has launched  its new Guide (September 2019) on how to commission and run integrated, nurse-led, community-based paediatric continence services. These are clinically effective, improve the lives of children and their families and generate significant cost savings for the NHS.

Bladder and bowel (continence) problems affect more than 900,000 children and young people in the UK, with a significantly negative impact on their health, wellbeing, education and emotional and psychological development. However services in this area of child health remain fragmented and inadequate, with too many children attending A&E/ admitted for acute constipation and urinary tract infections, or are referred inappropriately to already overstretched paediatric outpatient departments. This unhappy situation could be sorted out much earlier and more effectively in the community.

A central premise of the Guide is that all children from birth to 19 with continence difficulties should have access to an integrated Community Children’s Continence Service (CCCS).

This research-based Guide gives a clear description of what a “good” service looks like and how it should be run. It includes; an appropriately resourced multidisciplinary team led by a children’s continence nurse specialist and clear and effective care pathways to other key services. Also included are good referral pathways to and from universal school nurse and health visitor services at Level/Tier 1- services which provide an important role in the early identification of problems with toilet training and the onset of continence difficulties.

Read the Children’s Continence Commissioning Guide 2019.

Dr Penny Dobson MBE Chair of the Paediatric Continence Forum, said:

“The PCF is concerned about the increasing pressure on paediatric continence services across the UK. Our 2017 FOI survey found that only 41% of CCGs and Health Boards commission all four continence services ( bedwetting, daytime wetting, constipation/soiling and toilet training).Services in many areas are therefore  fragmented and inadequate.

This clear and informative Guide is an opportunity for commissioners to create positive and effective clinical services for this all too often neglected group of children, as well as make savings for the NHS. By doing so commissioners will also fulfil the terms of the NHS Long Term Plan, by; reducing A&E attendances; creating an integrated and collaborative structure for service delivery and, most importantly, responding to the needs and wishes of all children, including those with learning and physical disabilities”  

Read the Children’s Continence Commissioning Guide 2019.

Read and give Feedback

Here is the literature review of the Commissioning Guide.

We welcome your feedback on the Guide and if you would like to share your own experiences of service development, do contact us by email

Case Studies

A Decade in the Making: Development of a comprehensive, nurse led, community based, Children and Young People’s Continence service across West Sussex.

Developing Continence Support at Level 1 and a complementary Children’s Continence Pathway

Service Development in Waltham Forest

Dr Penny Dobson MBE, PCF Chair, appears on BBC Wales – April 2019

August 30, 2019 in Uncategorized

 Dr Penny Dobson MBE, Chair of the Paediatric Continence Forum, recently appeared on BBC Wales to discuss the growing lack of support for children living with bladder and bowel continence issues.

“I think many will be suffering in silence,” she said.

“It’s a neglected area of child health but the effects on the child and the family – if it’s not addressed at an early stage – can be devastating.”

“Continence problems have a known link with mental health difficulties,” Dr Dobson added.

“Children can feel different, it affects their self-esteem, they can’t always go on social activities and it affects them at school. Bullying is a problem for many children with continence problems.”

You can read the full article here.

Incontinence: ‘Lack of support’ for older children says Dr Penny Dobson

April 30, 2019 in Uncategorized

Guidelines from the UK’s National Institute for Health and Care Excellence (NICE) say that people with bladder and bowel problems from birth to 19 years old should have access to integrated, community-based paediatric continence service led by a specialist nurse.

In 2017, just one of the seven Welsh health boards provided the recommended service, according to a Freedom of Information inquiry by a campaign group, the Paediatric Continence Forum.

Across the UK, the figure was 41% – two out of every five equivalent bodies.

Research by BBC Wales suggests the situation in Wales has improved recently to reflect the UK average, with three health boards – Aneurin Bevan, Betsi Cadwaladr, and Cardiff and Vale – saying they provide the recommended service.

The other four boards said children were supported through a range of services such as school nurses, physiotherapists and consultants.

However, Dr Penny Dobson, founder and chair of the Paediatric Continence Forum, claimed there was a “failure” of provision and the situation still needed “radical improvement”.

Dr Penny Dobson

“I think many will be suffering in silence,” she said.

“It’s a neglected area of child health but the effects on the child and the family – if it’s not addressed at an early stage – can be devastating.”

“Continence problems have a known link with mental health difficulties,” Dr Dobson added.

“Children can feel different, it affects their self-esteem, they can’t always go on social activities and it affects them at school. Bullying is a problem for many children with continence problems.”

If not properly assessed and treated, Dr Dobson said children could also end up in A&E with serious constipation, or kidney problems caused by urinary tract infection.

Where the full service provision does exist in Wales, parents claim it is overstretched.

Bethan (not her real name) is also in her first year at secondary school and has bladder incontinence which has led to anxiety problems.

“Only one friend knows, she’s really close. If I tell another friend she’ll probably tell everyone,” she says.

“Everyone will start asking – I don’t want to go through that hassle.”

Her mother says: “For young people, living with this is horrendous. There’s nothing funny about it. It affects their quality of life and they need support.

“Bethan has had times where’s she’s refused to go to school, leave the house or go anywhere because she’s hiding. That’s heartbreaking.”

She adds: “There’s not enough funding, not enough staff, not enough counselling services for children with bladder and bowel problems.

“It’s really important to remember that the children go to the clinic every couple of months and that’s the only chance they get to offload, to cry, to laugh and to bond with the health professional.

“It’s just so important to children’s general wellbeing.”

‘Lack of school support’

Children’s Commissioner for Wales Sally Holland said youngsters should have the same level of support wherever they live.

“If 40% of the health boards in Wales can meet the NICE guidelines, then there’s no reason why the others can’t as well,” she said.

Ms Holland added that families had contacted her with complaints about the lack of support in school.

“That reinforces the fact that this not just an issue in the home, it’s an issue wherever the child goes,” she said.

The Welsh Government said it expected health boards to deliver services in line with NICE guidelines.

“It is essential that children and young people with continence problems undergo a comprehensive assessment to identify underlying problems and ensure these conditions are diagnosed and treated by the appropriate clinician,” a spokesman said.

Weekly political news round-up – w/c 22nd April 2019

April 22, 2019 in Uncategorized

Although she promised to resign upon her Brexit deal being voted through, Prime Minister, Theresa May, kicked the notion into the long grass when the Brexit deadline was extended until the 31st October. This week, senior Conservatives ruled out changing their rules to allow for an early challenge to Theresa May’s leadership, but have asked the Prime Minister for more clarity about exactly how long she plans to remain in office.

Under current rules, MPs cannot hold a new confidence vote in her leadership until December – 12 months on from last year’s vote, which she won. The 1922 Committee rejected bringing forward this deadline at a meeting, but Chair, Graham Brady, said MPs need a “clear roadmap” about her future.

Meanwhile, Scotland’s First Minister, Nicola Sturgeon, said she wants to hold a second referendum on Scottish independence by 2021 if the country is taken out of the EU. She told Holyrood that she would introduce legislation soon to set the rules for another vote, but indicated that she would need the agreement of the UK Government before doing so. Downing Street have said previously that it will not grant a new Section 30 order, which underpinned the 2014 referendum, so Ms. Sturgeon now faces the challenge of making ‘IndyRef2’ a reality.

Elsewhere, The Brexit Party and Change UK: The Independent Party launched their European Election campaigns with a flurry of candidate announcements. Reports of unsavoury tweets, racism and misogynistic slurs quickly came to light – but not from where you might expect. Change UK, self-proclaimed progressives standing up for EU citizens, landed themselves in hot water after one of their key MEP candidates was discovered to have said derogatory remarks about Romanian nationals just two years ago. Although different from their usual candidates, perhaps not the change they were looking for.

Ann Widdecombe also joined the line-up of EU election candidates, cancelling her decades of faithful Tory membership to stand as a candidate for The Brexit Party. With no sign of a Brexit deal being agreed anytime soon, it looks like the UK is heading full-throttle towards electing a new batch of MEPs.


Pre-school children with chronic constipation ‘often picky eaters’

According to US researchers, care of children with chronic constipation should include consideration of sensory issues and possible referral to occupational therapy – claiming their findings are “revolutionary”.

They have found that pre-school children who are developing normally with chronic constipation have underlying sensory issues that contribute to difficulties with toileting behaviours.

These children were found to often be picky eaters who might be overly sensitive to food textures, tastes, or odours, according to the authors of the study. In addition to this, such children might also have an exaggerated response to noises, bright lights, or other senses that can be stimulated.

In the new study by the Journal of Paediatrics, they assessed the differences in sensory processing patterns between 66 children, aged three to five years of age, with chronic constipation and a matched group of 66 controls. They also examined if and how the children’s sensory profiles correlated to the typical toileting behaviours of children.

Senior author, Dr. Mark Fishbein, from Northwestern University, said: “Our study is revolutionary, revealing that chronic constipation in young children accompanies heightened sensory sensitivity.

“In many cases, chronic constipation might be the first hint that the child also has some sensory issues and could benefit from occupational therapy. Feeding problems due to sensory sensitivities are especially common in these children and they are best addressed when kids are under five, before maladaptive behaviours become more entrenched.”

This news will interest PCF, given that knowledge of the link between chronic constipation and sensory sensitivity could transform clinical practice and provide further help for children with bladder and bowel continence issues.


NHS sees productivity grow twice as fast as economy

Productivity in NHS England has grown at twice the rate of the wider economy, despite reports that the Government is using ‘inefficiencies’ to justify further cuts.

Improvements in numbers of patients treated in the NHS each year have vastly outpaced investment in staff and budgets, a report by the Centre for Health Economics at York University found. For every £1 spent, the NHS delivered 16.5 per cent more care in 2016/17 than it did in in 2004/05. This compares to productivity growth of just 6.7 per cent for the wider economy.

With budget increases held to just 1 per cent a year as part of the Conservative Government’s drive to increase efficiency, staff have reportedly been left to work longer hours and more days.

“This is a huge tribute to the work of NHS staff, and the intrinsic efficiency of this country’s health service,” NHS England Chief Executive, Simon Stevens, said.

“This independent research confirms that NHS productivity has been growing at more than double of what was achieved by the rest of the UK economy, including the private sector.”

From April, the NHS is due to receive the first instalments of the £20.5bn additional funding promised by Theresa May. However, the investment is less than NHS England said was needed to overturn austerity measures imposed by the Government. Despite this, the Prime Minister has said it was only available on the basis that it “tackles waste, reduces bureaucracy and eliminates unacceptable variation”.

A spokesperson from the Department of Health and Social Care said: “The NHS Long Term Plan sets out a plan to make every penny of taxpayers’ money count and ensure the health service works hard to provide the best possible services and outcomes for patients in the most cost-effective ways.”

PCF will welcome this news, given that it demonstrates the NHS is making progress, despite ongoing budget cuts, to boost productivity and meet increased demand. Children with continence issues may find that they are seen quicker and more frequently as a result.


Councils place ‘unlawful hurdles’ in way of parents seeking SEND support

Councils with stretched budgets are allegedly putting hurdles in the way of parents seeking support for children with special educational needs and disability (SEND) by setting “unlawful” criteria to receive a needs assessment, The Commons Education Select Committee heard this week.

MPs were told that the recommendations of SEND experts were regularly being overridden by “somebody who is controlling a budget”. The Committee was hearing evidence as part of its ongoing inquiry into SEND.

One of the topics covered during the session was the high number of successful appeals against council decisions relating to education, health and care plans (EHCPs).

Alison Fiddy, the Chief Executive of the Independent Parental Special Education Advice, which offers independent legal advice on SEND, said: “If local authorities complied with the law and were able to justify their decisions not to carry out an assessment of a child’s needs when a request is made, that would also result in fewer appeals.”

Ms. Fiddy said that councils were engaging in “gatekeeping” when it came to SEND support. Her comments were backed up by Michael King, the Local Government and Social Care Ombudsman. “What we’re seeing is some local authorities introducing requirements that parents must meet before they will accept their duty to carry out a needs assessment.” he said.

The news that recommendations by specialist nurses are being overridden by somebody who is controlling a budget will be of great concern to PCF, given that the need for continence care provision will be overlooked on a financial basis and not one of necessity.


PCF attend Parliamentary Reception of the Urology Trade Association

February 7, 2019 in Uncategorized

Representatives from the PCF attended the Urology Trade Association’s (UTA) annual Parliamentary Reception last Thursday. The event, hosted by the UTA and sponsored by the Chair of the All-Party Parliamentary Group on Continence Care, Rosie Cooper MP, brought together urology device manufacturers, suppliers, charities, forums and Parliamentarians.

Speaking at the event, Ms. Cooper highlighted the need to protect patient choice and access to urology devices post-Brexit, as well as the need to ensure that any new government regulation on single-use plastics doesn’t negatively impact the availability and range of devices manufactured.   Guests also heard from former Minister of State for Health, The Rt. Hon. Philip Dunne MP, who spoke about the need to secure the right products for patients with continence issues.

Dr Penny Dobson MBE, Chair of the PCF, attended with Vice Chair Nick Madden and the PCF’s clinical representatives. Members of the PCF engaged with manufacturers about the needs of young people, and the growing challenges faced by the paediatric continence sector. Most recently, this has included reductions to local government and public health funding, and the rise in demand for assistance and guidance from young people and families to charity members PCF.

Speaking about the event, Dr Dobson said: “It was a great pleasure to meet with members and companies of the UTA at its annual Parliamentary Reception. It is paramount that there is the range of devices available to help young people with bladder and bowel issues and to ensure that patients and clinicians have a full range of choices at their disposal to address continence issues. The PCF will continue to work with interested companies, supporters and clinicians to promote innovation across the urology sector, and disseminate information about bladder and bowel issues.”

Note to readers:

  • The Urology Trade Association (UTA) represents 95 per cent of urology device manufacturers and suppliers, and is one of the largest trade associations in the health sector.
  • The PCF continues to promote engagement with company members. More information can be found by contacting the PCF’s Secretariat, The Whitehouse Consultancy, at

Weekly political news round up – w/c 31st December

January 8, 2019 in Uncategorized

Political and Parliamentary Monitoring
Week Commencing 31st December 2018


The new year has provided many news outlets, think tanks, and analytical platforms with the opportunity to reflect on 2018, in doing so highlighting the main health news which grabbed the nation’s attention and reviewing and assessing how much has changed in terms of health policy. The Digital Health publication focused its attention on the growing technological challenges facing the NHS. In November, the Health & Social Care Secretary, Matt Hancock, confirmed that 500 NHS Digital staff would be made redundant as part of the organisation’s restructure, with the announcement coming just months after the Department of Health & Social Care committed to investing nearly half a billion pounds in to new technology.


The theme of restructuring was also prominent in the Health Service Journal’s review of 2018. The outlet’s most read stories included the plans from NHS England and NHS Improvement to create seven new “single integrated regional teams” to improve co-working, and calls for NHS Directors to stand down after an investigation by the NHS Counter Fraud Authority.


The year ahead will undoubtedly be dominated by the NHS spending review. The 10-Year Forward Plan outlining the health service’s priorities for the next decade was meant to be published at the end of 2018, but has since been delayed. It has already been announced that the Plan will include a new cancer strategy, but there is speculation that the Government is angling for a commitment from leaders at the Department of Health and Social Care that the extra money will also help reduce waiting-times, which have risen in recent years.


As ever, in the short term the new year will pose challenges for hospital admissions, with the number of emergency calls expected to rise in the event of a cold weather snap. Should demand on NHS services rise, and staff are diverted to work on the frontline, this will inevitably have an effect on day-to-day and planned services. The Secretariat will continue to monitor any developments.


The Secretariat wishes the PCF a prosperous 2019.




  • NHS will still be short of nurses in five years
  • First ever drop in teaching assistant numbers “concerning”
  • Act now to reduce health inequalities


New funding pledged to support children with SEND

The Education Secretary, Damian Hinds, has announced that an additional £350 million is to be allocated to supporting children with complex needs and disabilities. In an announcement published during the Christmas recess by the Department for Education, the Education Secretary announced that local councils will receive an additional £250 million over the next two years to provide “much needed support for children and young people with complex SEND.” This is in addition to £6 billion which the Department has already allocated for SEND support over the same time period.


The Secretary of State also announced that families will benefit from more choice over their child’s education through an extra £100 million investment to create more specialist places in mainstream schools, colleges and special schools. Additionally, more special free school meals will get the green light, as the Education Secretary confirmed that he will approve all high-quality bids in the current round of special and alternative provision free schools.


Speaking about the announcement, Mr Hinds said that “every school or college should be one for a young person with special educational needs.” The announcement comes just two months after a petition against special needs funding cuts was delivered to the Prime Minister by head teachers. Indeed, there remains speculation that despite the pledged extra funding, many local authorities and schools face growing deficits this year which require difficult funding decisions and the reduction in some services.


There is evidence that, in some cases, paediatric continence issues can be linked to physical, psychological or emotional development in children. With this in mind, any new money for children with SEND will impact on the work of paediatric continence experts, nurses, and those who assist in managing continence conditions.


Extra funding for social care makes NHS better prepared for winter crisis

The National Health Service has said it is “better equipped” to deal with the surge in demand for health services during the winter thanks to a multi-million-pound funding boost. Some £240 million of extra funding made available to local authorities over the last year means that older patients have been able to be discharged from hospitals at a quicker rate, thus freeing up hospital beds.


Councils in England also plan to deliver an additional 30,000 packages of care to older people over the next few months, meaning those at risk of being hospitalised can receive high-quality care in the safety and comfort of their own home.


The Department of Health and Social Care will be eager to avoid a situation like last year, when official figures showed ambulance queues and bed shortages hit their worst levels on record. Ambulance Trusts across England were provided with an additional £36 million in 2018 for 250 new ambulance vehicles. 100 had been delivered by Christmas Eve, with the expectation that more will be made available by Winter.


The news regarding extra funding to avert a winter crisis will be welcomed by PCF. Whilst it is unclear where the funds are coming from, and whether they are being diverted from other NHS services, the additional money is likely to ensure that staff who work in outpatient and non-A&E services will not be diverted, subsequently reducing the possibility of delays for patients needing treatment.


Children ‘second class citizens’ as staff redeployed

Seriously ill children are being treated like “second class citizens” by the NHS as scarce paediatric staff are pulled from emergency rooms to cope with winter pressures in adult service. Around 850 paediatric consultants are needed across the NHS to provide safe and sustainable care, according to the Royal College of Paediatrics and Child Health.


However, many nurses and consultants are now being diverted to other duties in adult services, meaning that entire wards are being closed because there are not the staff numbers in place to run them safely. Dr Simon Clark, workforce officer at the Royal College of Paediatrics and Child Health said that “if we do not have the beds, we cannot treat the patients and that means children are missing out on important care.”


The shortage of paediatric consultants is compounded by the staff recruitment crisis in the sector. There has been a 58 per cent drop in the number of European doctors applying to paediatric training in the last year, whilst those consultants working in paediatrics on average only work around 77 per cent of full-time hours. Professor Russel Viner, President of the Royal College of Paediatrics and Child Health, has said the NHS “urgently needs hundreds more” doctors.

The Paediatric Continence Forum will be concerned about this news. Given the growing demand for paediatric continence care services, as well as the delays in accessing care at ‘early’ stages from a GP or school nurse, further disruption to planned treatment could result in the quality of life of young people with continence issues falling.

Weekly political news round up – w/c 17th December

January 8, 2019 in Uncategorized

Political and Parliamentary Monitoring
Week Commencing 17th December 2018


This week, the Government revealed its eagerly anticipated immigration white paper, setting out how the UK’s border system will operate post-Brexit. The white paper, aspects of which will continue to be consulted on over the coming months, will prove influential as the National Health Service plans its services moving forward. The incoming Chief Executive of the King’s Fund, Richard Murray, called on the Government to “grasp the nettle of migration policy and allow in [to the country] many more health and social care staff from abroad.”


It is unclear whether the white paper lives up to Mr Murray’s demands, with many concerned that a £30,000 minimum wage cap, which sets the threshold for what is defined as a ‘skilled migrant’, could prove detrimental to the social care sector. Those earning under the £30,000 cap may find it difficult to secure long-term visas.  Although the Cabinet is still divided over what the exact cap should be, and further consultation is likely, the £30,000-figure has been touted as the preferred cap by the Home Office based on recommendations by the Migration Advisory Committee.


Given the average salary of a care worker is in the region of £20,000, and the starting salary of a nurse is in the region of £22,000, it is unsurprising that many in the health sector have raised their concerns over whether desperately needed staff from abroad will be able to gain access in to the UK. The Cavendish Council of health and care organisations said it was “extremely concerned” that visa proposals would prevent the health service and businesses accessing the number of care staff needed to sustain services.


For those health workers earning more than £30,000 (predominantly doctors, consultants and other specialists) the removal of the cap on number in the existing tier 2 visa route made the sponsorship system less bureaucratic for employers. This has since benefitted non-EU doctors attempting to gain entry in to the UK.


This is the last monitoring document of 2018. Monitoring will resume on Friday 4th January 2019. The Secretariat wishes the PCF a Merry Christmas, and a prosperous and peaceful New Year.



  • NHS will still be short of nurses in five years
  • First ever drop in teaching assistant numbers “concerning”
  • Act now to reduce health inequalities


NHS will still be short of nurses in five years

Ian Dalton, Chief Executive of NHS Improvement, has said it will be more than five years before the number of nurses the NHS needs are available. Speaking ahead of an anticipated long term plan on workforce strategy, Mr Dalton said that the shortfall in nurses was proving hard to solve and that he expected reaching breakeven would take at least five years.


Recent figures from NHS Improvement show that the number of vacant posts in the health service has risen by almost 10 per cent in the first quarter of the year, with more than 42,000 nursing posts being advertised across England and Wales. Mr Dalton, along with Simon Stevens, the Chief Executive of NHS England, have previously indicated that increases in staffing will be closely linked with additional resources provided to the NHS. Dame Donna Kinnair, the Acting Chief Executive of the Royal College of Nursing, said that “swift action” was required to avoid a recruitment crisis.


NHS Improvement has said that it will be working with those Trusts with the lowest retention rates to improve the training and opportunities available to staff. At the same time, NHS England said that it hoped that the recent recruitment campaign for the NHS would continue to be funded as part of the NHS’s long-term plan.


The news regarding the number of nursing vacancies will be of concern to the PCF. Delays in treatment can negatively affect the standard of living for those with bladder and bowel complaints, and can often create the ‘stop-go’ style of care which damages trusts in clinicians. The Secretariat  will continue to monitor recruitment and retention figures.


NHS’s long-term plan delayed until January

The HSJ has learnt that the NHS’s long-term plan has been delayed until at least January, with the political fallout over Brexit preventing the document from getting approval from all cabinet ministers. The plan commissioned by the Prime Minister when she announced the NHS’s £20 billion funding settlement in the summer – was initially expected to be published in November. Simon Stevens, the Chief Executive of NHS England, then said the plan would be delayed until early December. It is now understood that the document will not be revealed until 2019.


The plan is expected to set out the priorities for the NHS over the next five years – which are covered by the £20 billion funding settlement – and some targets for improvements over the next decade. A planning timetable sent to NHS Chief Executives suggests that the financial documents associated with the long-term plan will continue to take place over 2019. Responding to the news about the delay, Jonathan Ashworth, the Shadow Secretary of State for Health, said that patients “deserved better”.


Niall Dickson, Chief Executive of the NHS Confederation, which represents organisations across the healthcare sector, said the new plan must be “radical” but needed to avoid being “unrealistic”, adding that the current situation facing the NHS was “very serious”, with overstretched services. NHS England declined to comment on the delay, except to say that it was important to get the long-term plan right.


The Secretariat is prepared for the launch of the report early in 2019, and will inform the PCF of the exact date when it is released. The Secretariat will also provide expert insight and analysis in the announcement and the possible implications for paediatric continence care.


‘Catastrophic’ funding gap could pause district nurse supply for a year

The supply of district nurses coming into the NHS could drop to zero in 2021 unless the government provides additional funding, it has emerged. Health Education England’s national funding for the one-year postgraduate course is due to finish in 2019-20, with the government planning for the apprenticeship levy to provide funding for a part-time two-year course from 2020-21. However, nurses training through the apprenticeship route would only qualify in 2022, meaning no new recruits in 2021.


The Chief Executive of Queens Nursing Institute, Crystal Oldman, has said that this would be “catastrophic”, whilst NHS Providers said this would have a “severe” impact on the nursing workforce. As the PCF will be aware, district and community nursing is essential for supporting vulnerable people, including children and young people with bladder and bowel issues which may effect mobility or their ability to access treatments. At the same time, district and community nurses play a crucial role for those remote communities who may have little or no direct contact with major centres of healthcare.


In response to the news, a Department of Health and Social Care spokeswomen said, “we are working with HEE on funding for the specialist qualification for district nursing”, whilst earlier this year the Care Minister, Caroline Dinenage, said that the Government would offer “golden hellos” worth £10,000 to new post-graduates who wish to train as a district nurse.


The Paediatric Continence Forum will be concerned about this news. Given the growing demand for paediatric continence care services, the prospect of no district nurses entering the Health Service in 2021 risks exacerbating the challenges the Service faces in recruiting new staff.

Weekly political news round up – w/c 10th December

January 8, 2019 in Uncategorized

Political and Parliamentary Monitoring
Week Commencing 10th December 2018


In a tumultuous week in Westminster, Theresa May has won the backing of her party to stay on as Prime Minister. At nine o’clock on Wednesday evening, Sir Graham Brady, Chair of the 1922 Committee of backbench MPs, announced the result. In a blow to pro-Brexit Conservative MPs who had hoped to remove the Prime Minister, the result – 200 votes in her favour, 117 against – means she cannot be challenged in a similar vein for another year.


Emerging from 10 Downing Street late on Wednesday evening, the Prime Minister said she and her party had a “renewed mission” to deliver Brexit and unite the country. May flew to Brussels on Thursday to appeal to her fellow EU leaders to offer Britain a legally binding commitment that the backstop on the island of Ireland, which would be introduced in the event of a no-deal scenario in which new trade arrangements have not been completed, would be legally binding.


In private, it is believed that May confirmed to colleagues that although she would like to fight the next general election, she would step down before 2022. James Cleverly MP, a loyalist to the Prime Minister, said that May “recognises a lot of people are not comfortable with her leading us into a future general election.” In response to the vote, the Leader of the Labour Party, Jeremy Corbyn, urged the Prime Minister to “bring her dismal deal back to the House of Commons.”


Plus ça change, plus c’est la même chose. The more things change, the more they stay the same. At the end of a week of politicking, the Prime Minister remains secure in her position, and a vote in Parliament on a Brexit deal remains some weeks off.



  • NHS waiting lists for lung and bowel treatments double in eight years
  • Scottish GP workforce increases
  • Act now to reduce health inequalities


NHS waiting lists for lung and bowel treatments double in eight years

NHS waiting lists for patients in “excruciating pain” or with life-threatening conditions including lung cancers and bowel diseases have doubled since 2010, and the overall waiting list now stands at more than 4 million. Specialist treatments have been worse-affected by the ‘double whammy’ of tighter controls on health spending and the increase in the number of NHS staff vacancies.


Despite the commitment to another £20.5 billion of funding for the NHS from 2019, the investment rate is still just a quarter of the amount the Health Service relied on for decades. Rachel Power, Chief Executive of the Patients’ Association, said that the mixture of budget cuts and loss of staff meant “we risk returning to the days of unacceptably long wait for elective surgery”, adding that for some “those days are clearly here again already”.


Since its inception the NHS relied on average annual growth of around four per cent, but since 2010 spending on the Health Service has risen by just one per cent a year. Waiting lists fell to a low of 2.4 million in 2009-10, but have since climbed. Jonathan Ashworth, the Shadow Health and Social Care Secretary, said that the “staggering increases in waiting lists” had resulted in “patients waiting longer and longer in pain, distress and anxiety”.


In response to the news, a Department of Health and Social Care spokesperson said that “nearly 15,000 fewer people are waiting over a year for non-urgent operation compared to eight years ago.”


This news will be of great concern to the PCF. Without the expert staff and investment, many patients with bladder and bowel issues can go for long periods without the offer for suitable treatment. This can impact quality of life, and in the meantime may mean that some are not using the devices or short-term treatments best suited for them.


Scottish GP workforce increases for first time in a decade

Figures published by the Scottish Information Services Division show that there were 4,994 GPs working in Scotland at the end of September 2018 compared to 4,919 in 2017, representing a small but significant increase in the number of GPs working in the country. This is the first real increase in GP number Scotland has seen for a decade, and is part of a wider trend which has seen some surgeries close and ‘super surgeries’ expand.


Chair of the General Practitioners Council of Scotland, Dr Andrew Buist, welcomed the figures, but added that in the short-term it is “essential that we do everything possible to retain the GPs currently working”. A new GP contract introduced by the Scottish Government, has aimed to increase the retention rate by addressing working conditions.


The increase in Scotland has not been mirrored in other parts of the country. In England, GP numbers have only just stabilised after months of rapid decline, November figures show. At the time, Professor Helen Stokes-Lampard, Chair of the Royal College of General Practitioners, said that “the trajectory is on the up” and recommitted the organisation to work with the NHS to increase numbers.


As the PCF will be aware, having well-trained doctors available to diagnose and treat young people and children is essential for good care. With this in mind, the organisation will welcome the rise in the number of GPs, and the Secretariat will continue to monitor whether the increased number of staff will have an impact on delays to treatment.


Act now to reduce health inequalities, public health experts said

A group of thirty senior public health experts from England have written an open letter highlighting their concerns over the cuts to central government public health grants. Quoting the Northern Health Science Alliance’s Health for Wealth report, the experts, which include the Chief Executive Officers of multiple NHS Trusts, warn that more must be done if the country is to avoid exacerbating a postcode lottery of services.


The letter says “the government has future opportunities to halt the widening gap between rich and poor in the country”, adding that health inequalities can be tackled by “using next year’s spending review to reverse cuts to public health grants.” The letter comes in the same week that local authorities in Sunderland, Shropshire, South Shields and Durham have all announced that they are slashing the public health budgets for their areas.


The Paediatric Continence Forum will be concerned about this news. Given that school nurses are now funded by local authorities, to see that central government grants are continuing to fall in this area could negatively affect services.

Weekly political news round up – w/c 3rd December

January 8, 2019 in Uncategorized

Political and Parliamentary Monitoring
Week Commencing 3rd December 2018


The number of people accepted onto nursing courses in England continued to fall in 2018, despite the fact UK-wide acceptance rates hit a record high, the latest university application figures show. A new report by the Universities and College Admissions Service (UCAS) shows that number of applicants from England being accepted on nursing courses fell by 1.4% over the last year. This is the first time ever that acceptance rates have fallen two years in a row.


At the same time, the number of applicants to nursing courses across the UK declined for the second year running, with a 7.6 per cent decrease in 2018 on the back of 17.6 per cent drop the year before. Despite this fall in the overall number of applicants, places on nursing courses continued to be over-subscribed. In contrast to England, the number of acceptances in Scotland and Wales, two countries which unlike the Department of Health & Social Care in England, decided to retain bursaries for nursing students.


The Council of Deans of Health, which represents universities providing nursing, midwifery and allied health professional courses, said it was concerned about the decline, with its Executive Director, Katerina Kolyva, saying it showed the need for “urgent” steps to boost student numbers. Last month, Health Minister, Stephen Hammond MP, indicated that the Government may be wiling to consider reintroducing bursaries or a new system of grants in England.



  • NHS funding hike must bring permanent end to GP crisis, says Chair
  • Cuts to public-health short-sighted, according to BMJ study
  • Secretary of State to consider safe staffing law in England


Secretary of State to consider safe staffing law in England

Matt Hancock, the Health and Social Care Secretary, has said he will look at the possibility of introducing safe nurse staffing legislation, it has been revealed. It is believed the first time a minister in England has openly said they are willing to look into the idea of enshrining safe staffing in law, with the Government have previously opposed such a move. The comments by the Secretary of State also come after a similar was introduced in Wales.


Speaking to members of the Royal College of Nursing (RCN), Mr Hancock said he would be “very happy” to look at proposals to introduce safe staffing laws. The admission comes after the RCN ran a high-profile campaign to call for legal minimum safeguards in the face of rising demand for services, falling numbers of staff, and rising vacancies. The law, as envisioned by the RCN, would make it mandatory for healthcare providers to have sufficient nurses on shift or available on projects to ensure patient safety.


Dame Donna Kinnair, acting Chief Executive and General Secretary of the RCN, welcomed the comments from Mr Hancock, saying that Mr Hancock was “right to make the workforce a top priority for a sustainable NHS”. Mr Hancock had attended the RCN summit to launch a new Government strategy to reduce violence against NHS workers.


Whilst the Secretary of State’s comments will be welcomed by the PCF, it raises several questions. It is unclear about whether it would apply to all nurses, or just those in A&E, and how the NHS would operate should it fail to meet the ‘safe standard’. As more details are released, the Secretariat will engage with inform the PCF of developments.


NHS spending on public health creating a postcode lottery of support

A new report published in the BMJ has highlighted that cuts to preventive health budget have affected some local authority activities more than others. Looking at the history of public health spending, the report examines the impact of reductions in spending by the Heath Service centrally, as well as local authorities, comparing spending in the decade 2000-2010 with 2010-2018.


Less emphasis is being put on public health now than at any point since Derek Wanless released his report in 2002, which placed the spotlight firmly on changing behaviours and improving public health with the aim averting more costly interventions at a later date. Since then, public health spending by central government has been scaled back greatly, with local authorities having bigger control over public health measures.


This, the BMJ article notes, has resulted in a postcode lottery with some councils allocating more funding to public health than others, and with the Local Government Association (LGA), which represents local authorities to central government, warning that some authorities are “salami slicing” services or digging into case reserves to make ends meet. “Some local authorities [are] showing they can cope better with austerity [than others]” the LGA says, adding that changing demographics and rising demand for services is increasing costs.


This report by the BMJ will further support the PCF’s calls for a review of how public health funding is allocated. Local authorities oversee school nurse funding, a health sector which has seen reductions in funding and provision over the last eight years.


Ofsted condemns ‘disjointed’ disability provision

Ofsted, the schools’ watchdog, has delivered a damning indictment of the education of children with special educational needs and disabilities. In her second annual report, the Chief Inspector of England’s schools, Amanda Spielman, warned that provision for pupils with SEND was often “disjointed and inconsistent”, with thousands missing out on vital support.


Her report, which captures the state of education in England, criticised the fact it took too long for many young people with special educational needs diagnoses, thus preventing them and their families accessing vital support. Her report highlights concerns around the step rise in the number of Education and Health Care Plans being delayed or refused. In 2017, there were 14,600 refusals by local authorities to carry out assessments, a third more than two years earlier.


The report also flagged the growing postcode lottery and disparity in the amount of provision and care offered by different local authorities, with a widening gap in performance and outcomes between the best and the worst local areas. Of the 68 inspections of SEND sites, there were serious failings in 30. Addressing an audience of education professional and policy experts in Westminster at the launch of her report, Spielman said that “there are still children who lag behind. Children for whom it seems the die is cast, even before entering nursery, and who never catch up in 12 years of schooling.”


Commenting on the report, a spokesperson for the Department for Education, said that the report also recognised that England has a “robust education system” where “parents can feel assured that the vast majority of schools, early years providers, children’s homes and local authorities provide a high level of education and care for young people, regardless of their circumstances.”


The Paediatric Continence Forum will be concerned about the findings of Ofsted’s annual report. Children with bladder and bowel issues and recognised disabilities linked to urology and continence issues are evidently not getting the support needed. If the PCF agrees, the Secretariat will engage with the schools’ regulator about the need to provide adequate support and facilities for those with disabilities.