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The role that school nurses and health visitors play in identifying and referring children with bladder and bowel conditions has been recognised in commissioning guidance from Public Health England.

The guidance for commissioning the Healthy Child Programme 0-19 outlines that by identifying and referring continence problems, school nurses and health visitors can help children achieve their full potential.

It is comprised of four documents and was prepared by Wendy Nicholson, national lead nurse for children, young people and families.

Identification and referral

The second guidance document lists outcomes aligned with contributing year-on-year improvements to the wider determinants of health – one of which is the number of children and young people developing and achieving their potential, through improved rates of school attendance. The "identification of continence issues and referral to appropriate services” is listed as a suggested strategy to take this forward.

Joint working and collaboration

The guidance also states that "commissioning clinical support for enuresis or incontinence lies with NHS England and clinical commissioning groups”, emphasising that there will need "to be joint working and collaboration with local authority commissioners and providers of public health nursing services”

Paediatric Continence Forum welcomes guidance

The pressure group the Paediatric Continence Forum (PCF), of which ERIC is a member, has welcomed the guidance, saying it is "very positive as it formally outlines to local authorities that school nurses and health visitors have a role to play identifying and referring continence issues.”

School nurses provide an important preventative function by identifying problems early and referring children to specialists where necessary. Concerns have been raised about the impact on the school nurse service following the transfer of commissioning responsibilities for school nurses from central to local government in April 2015.

Some local authorities have withdrawn continence from the school nurses’ remit as a result in an effort to save money. Removing continence from their remit has already caused extra financial burden for the NHS through inappropriate referrals to emergency departments, outpatient clinics and tertiary care.

This guidance document takes a positive step to reverse this retrograde move by recognising the vital role school nurses play in early intervention.

Support for professionals

ERIC has created the Generic Children's Continence Pathway to help professionals working with children and teenagers to determine what help, support and treatment they should provide. Access the online version of the Children's Continence Pathway here.