13. Before we decide if we should investigate a complaint, we look at whether there are signs the organisation has got something wrong. We do this by comparing what should have happened with what did happen. We have done this, and we have not found any indications that something has gone wrong.
14. Ms R says in December 2024, the Service failed to meet Miss X’s continence needs, as it stopped the provision of her continence products and subsequently refused to reinstate this.
15. Ms R says it is unfair that the Service applied the guidance it used to Miss X and feels it should have made an exception because of her disabilities.
16. The Service response explained that Miss X is continent during the day and able to use the toilet, meaning she is aware of her bladder and bowel functions, despite her developmental delay.
17. It explained in line with guidance, its nursing team do not prescribe continence products to CYP who have achieved dryness during the day, even if they have a disability or additional needs. The only exceptions are where there are medical reasons like seizures or overnight feeds with associated incontinence, criteria which it says Miss X does not meet.
18. It said the Service had already tried treatments like desmopressin (medication which helped reduce overnight urine) and bedwetting alarms. It found Miss X’s anxiety was a key factor for her nocturnal enuresis of which it did not have the psychological expertise to manage.
19. It noted that CAMHS are supporting Miss X with her anxiety and are responsible for helping her with her nocturnal enuresis going forward. The Service said it had discharged her, while leaving the option for a re-referral open if needed.
20. We considered whether the Service correctly stopped the provision of Miss X incontinence products.
21. We looked at B&BUK guidance as well as resources from ERIC, which are widely referenced and recommended by NHS services. While this guidance is not statutory NHS policy, they are recognised as national clinical standards in decision-making for bladder and bowel care, including provisions for continence products for children and young people.
22. B&BUK guidance says CYP who have achieved daytime continence should not be considered for provision of nighttime products only, even if they have a disability or additional needs. It says provision of nighttime products should be discontinued when daytime continence has been attained. It also explains there is currently no statutory requirement to provide continence containment products.
23. The guidance says all CYP who have reached their fifth birthday and are dry during the day but wet at night should be offered assessment and treatment, unless there are clear reasons for night-time wetting other than nocturnal enuresis.
24. It also explains that assumptions about a child’s potential should not be based solely on a diagnosis of a condition that causes developmental delay, learning or physical disability, or a processing difference.
25. ERIC explains a bedwetting alarm is a highly effective way of training a child to become dry at night and is likely to be the ideal treatment for when children find it hard to wake to a full bladder. It also explains if a bedwetting alarm does not help or is not suitable for a child, treatment with medicines (including Desmopressin) is usually recommended.
26. From the information provided and from what Ms R and her representative told us, we can see when the Service stopped providing Miss X continence products when she was over the age of five, had achieved daytime continence, and was only wet during the night time. This appears to be in line with B&BUK guidance.
27. The information shows the Service attempted treatments such as a bedwetting alarm and medication to help with Miss X’s nocturnal enuresis which did not appear to help her symptoms. This appears to be in line with the information from ERIC.
28. The Service also referred Miss X to CAMHS for psychological support, and it and Ms R concluded that Miss X’s anxiety was the primary underlying reason in her nocturnal enuresis, with her continued dryness in the daytime.
29. In reaching a view, we have only considered if the Service followed the guidance available to it at that time and have not formed a view on the guidance used or its content.
30. Our view is that when the Service made its decision to no longer provide Miss X with nighttime products, it considered her age, her achievement of daytime continence, and that she continued to wet at night. It also appears the Service considered a clear reason of anxiety beyond nocturnal enuresis as advised by Ms R and did not base its decision solely on Miss X’s disabilities or additional needs. This is in line with B&BUK guidance.
31. We are pleased to see that alternative treatments of a bedwetting alarm and medication were provided to Miss X in line with ERIC recommendations, and that CAMHS is providing help and support for her anxiety and nocturnal ensures. We therefore find no indications anything went seriously wrong.
32. We understand how difficult this situation has been for Miss X and her family and recognise the anxiety and stress this has caused. We acknowledge the care and dedication shown in raising the concerns about Miss X through this challenging time.
33. We hope that our explanation has provided some clarity and reassurance about what happened and why these decisions were made. We sincerely wish Miss X and her family all the best moving forward.