Communications & Engagement Team 1st Floor North Point Cardinal Square 10 Nottingham Road Derby DE1 3QT Tel: 01332 888080 Fax: 01332 868 898 www.southernderbyshireccg.nhs.uk Our ref: 06/15 Wednesday, 25 th February 2015 Re: Freedom of Information Act Request Thank you for your email dated 6 th February 2015 requesting information from NHS Southern Derbyshire Clinical Commissioning Group. You asked us to provide the following information: We kindly request you provide us with a copy of your care pathway (or pathways) for paediatric continence (bedwetting, daytime wetting, toilet training, constipation/soiling). This will help us to improve the quality of paediatric continence services nationally. I can provide the following information: Please find below the NHS Southern Derbyshire Clinical Commissioning Group Care Pathway for Paediatric Continence and Flowcharts for s in both Derbyshire County and Derby City. I hope that the information meets your requirements. Should you have any further enquiries or queries about this response please do not hesitate to contact me. However, if you are unhappy with the way in which your request has been handled, you can raise any concerns you might have by contacting Helen Dillistone, Director of Corporate Development, at the following address: 1 st Floor North Point, Cardinal Square, 10 Nottingham Road, Derby, DE1 3QT. Telephone: 01332 888174. If you remain dissatisfied, you can apply to the Information Commissioner, who will consider whether NHS Southern Derbyshire Clinical Commissioning Group has complied with its obligations under the Act, and can require NHS Southern Derbyshire Clinical Commissioning Group to remedy any problems. You can find out more about how to do this, and about the Act in general, on the Information Commissioner s website at: www.informationcommissioner.gov.uk. Complaints to the Information Commissioner should be sent to: FOI/EIR Complaints Resolution, Information Commissioner s Office, Wycliffe House, Water Lane, Wilmslow, Cheshire, SK9 5AF.
Pathway for Toilet Training- Derby City Introduction All children should be given the opportunity to become continent. There are increasing numbers of children entering school who are not fully toilet trained. Some of this is due to changes in modern parenting practices, i.e. the use of disposal nappies, which means the child has less opportunity to be wet, therefore does nor make the connection between full bladder feeling and being wet. Also children are entering school earlier, the September after they are four, instead of raising five. There is also increasing number of children being diagnosis with a disability. Many children with disabilities can become continent with the correct support and advice. Children with communication and learning disabilities have the same physical development as children within the normal parameters for development, however struggle to become toilet train due to the cognitive understanding of the signals from the body.
UNIVERSAL ADVICE/SCREENING FOR CHILDREN WHEN What Happens Who Core programme - advice 13 months start conversation Changing in bathroom Fluids intake What is constipation/normal bowel habit Health Visitor 2 2½ yrs check proactive approach Parent seeks assistance School entry questionnaire Getting started - take nappy off - change in bathroom - talk positively about wee/poo - position on toilet supported feet, comfortable, observe parents using loo - change standing up - putting poo down toilet - who to contact - assessment of readiness for toilet training Identify if there are any existing conditions affecting bladder and bowel Delayed toilet training pathway Constipation pathway Getting started see above Follow up night time wetting Follow up daytime wetting Family visitors Children Centres Nursery staff Ensure GP is aware Identify need and refer for any specialist support Health Visiting GP Practice Nurse School Nurse Resources: Toilet training http://www.derbyshirehealthcareft.nhs.uk/our-services/childrens-services/further-information-childrens-services
Delayed Toilet Training due to Global Development Delay (including Learning Disability) Paediatrician input for development delay 2 2½yr check Readiness for Toilet Training Assessment Repeat review cycle Structured support for pro-active toilet training Frequent review SLT referral OT referral - positioning - seating - etc Physio referral for positioning control Effective? Yes Effective? No Refer to Specialist support Clinical decision to prescribe products - indicators? Review - look for signs of readiness
Flowchart for Children` s continence referrals Areas covered Derby City, Erewash, Amber Valley, Dales & Southern Derbyshire CAMHS Parents Gp`s School nurse/ Health Visitor Social Care Informal telephone advice Teachers Schools Joint visit with healthcare worker to provide further advice and consultation care plan Decision Made Advice only Formal made to service
GP`s Community Paediatrician Royal Derby Paediatrician School nurse CAMHS Health Visitor Out of area Paediatricians / Doctors Formal Other healthcare professionals Eg : OT`s Toilet training / continence products Decision Made Wetting Discuss further with Health visitor School nurse Constipation / soiling Secondary nocturnal enuresis that is not responding to treatment / daytime wetting Primary nocturnal enuresis Accepted if S/N H/V Unable to manage Accepted Accepted Passed to School nurse
Flowchart for referrals to the Children s Continence for Night time Wetting for GP`s (Derby City) Contact from family requesting help Give general advice re drinking amount recommended by NICE guideline including a third of intake to be in school day, avoiding constipation, regular toileting during day and before bed. Remove pull-ups Age sex drinks per day 4-8 female 1000-1400ml 4-8 male 1000-1400ml 9-13 female 1200-2100mls 9-13 male 1400-2300mls 14-18 female 1400-2500mls 14-18 male 2100-3200mls No Is the child wetting more than twice per week? Yes Continue with general advice (poor drinking is the most common problem) Has the child previously been seen by the school nurse? Ask parents to contact again if no improvement in 6-12 months No Refer to school nurse for initial support Yes Refer to Senior nurses for children s Continence