National Institute for Health and Clinical Excellence (NICE)
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Advice from NICE aims to improve commissioning of paediatric continence services

NICE has published its latest commissioning guide - on ´commissioning a paediatric continence service´. The guide draws on recent NICE guidance on the management of bedwetting and nocturnal enuresis in children and young people and on the diagnosis and management of idiopathic childhood constipation. The commissioning guide supports commissioners to redesign services in order to improve outcomes for children and young people and to help the NHS make better use of its resources.

Continence problems are prevalent in children and young people, particularly in younger children. If the conditions are not appropriately managed and become chronic they may result in referral, treatment and/or surgery in secondary care. It is estimated that providing effective assessment and management of continence problems in primary and community settings could reduce emergency admissions by up to 80% and significantly reduce consultant-led outpatient appointments. There is also the potential to reduce costs further by reducing the demand for continence products such as nappies or pads.

Illustrated with examples from the NHS, the NICE commissioning guide identifies the potential benefits of effectively commissioning a paediatric continence service, including:

  • Greater awareness of continence problems resulting in improved identification, early intervention and faster referral-to-treatment times.
  • Reducing costs resulting from inappropriate referrals to paediatricians and preventing unplanned hospital admissions for children and young people with abdominal pain caused by chronic constipation.
  • Improving clinical outcomes and quality of life for children and young people and their families through evidence-based treatment that promotes continence, preventing unnecessary long-term reliance on nappies and pads and the need for surgery

The commissioning guide contains:

  • An indicative benchmark rate for a paediatric continence service, which is estimated to be 0.8% or 800 per 100,000 population aged 19 years and under per year.
  • A commissioning and benchmarking tool which commissioners can use to determine the local level of service needed for the provision of a paediatric continence service.

Dr Penny Dobson, MBE, Chair of the Paediatric Continence Forum and member of the topic-specific Advisory Group which developed the guide said: "Continence problems in children and young people can have a significant impact on their behaviour, emotional wellbeing and social life, as well as being very stressful for their parents or carers. But despite the fact that these problems are common, there is evidence that the need and demand for continence services in some areas is significantly under-resourced when compared with services for other conditions with a comparable prevalence, such as asthma and otitis media. The purpose of this guide is to ensure that the right services are commissioned, not just to improve outcomes for children and young people with continence problems, but also to enable commissioners to release resources or generate savings through service redesign and by identifying treatments and interventions that do not add value."

While the commissioning guide draws on existing NICE recommendations, it does not constitute formal NICE guidance and is intended as a tool to help the NHS improve patient care through effective commissioning of services.

About the commissioning guide

1. The NICE guide on commissioning a paediatric continence service is available on the NICE website at

2. The guide is the fifth commissioning guide published by NICE in the last 6-months - the others being:


3. Details of all the 35 NICE commissioning guides published to date can be found on the NICE website at

About NICE

4. The National Institute for Health and Clinical Excellence (NICE) is the independent organisation responsible for providing national guidance and standards on the promotion of good health and the prevention and treatment of ill health.

5. NICE produces guidance in three areas of health:

  • public health - guidance on the promotion of good health and the prevention of ill health for those working in the NHS, local authorities and the wider public and voluntary sector
  • health technologies - guidance on the use of new and existing medicines, treatments, medical technologies (including devices and diagnostics) and procedures within the NHS
  • clinical practice - guidance on the appropriate treatment and care of people with specific diseases and conditions within the NHS

6. NICE produces standards for patient care:

  • quality standards - these reflect the very best in high quality patient care, to help healthcare practitioners and commissioners of care deliver excellent services
  • Quality and Outcomes Framework - NICE develops the clinical and health improvement indicators in the QOF, the Department of Health scheme which rewards GPs for how well they care for patients

7. NICE provides advice and support on putting NICE guidance and standards into practice through its implementation programme, and it collates and accredits high quality health guidance, research and information to help health professionals deliver the best patient care through NHS Evidence.

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