Quality statement 4: Access to treatment

Quality statement

Children and young people who are bedwetting receive the treatment agreed in their initial treatment plan.

Rationale

Once a child or young person and, if appropriate, their parents or carers, have made an informed choice about using an alarm or desmopressin as the treatment for bedwetting, this should be agreed in their initial treatment plan. They should then receive the treatment in their plan. Bedwetting can put families under considerable pressure and once they have asked for help they need to receive treatment so they can resolve the problem. Any delay in their agreed treatment being available, for example as a result of local waiting lists or treatment policy, may put families under unnecessary pressure and have a negative impact on the outcomes for the child or young person.

Quality measures

Structure

Evidence of local arrangements to ensure that children and young people who are bedwetting receive the treatment agreed in their initial treatment plan.

Data source: Local data collection.

Process

a) Proportion of children and young people who are bedwetting who receive the treatment agreed in their initial treatment plan.

Numerator – the number in the denominator who receive the treatment agreed in their initial treatment plan.

Denominator – the number of children and young people who are bedwetting who have an initial treatment plan.

Data source: Local data collection.

b) Waiting times to receive initial treatment for bedwetting.

Data source: Local data collection.

Outcome

Patient satisfaction with the availability of initial treatment for bedwetting.

Data source: Local data collection.

What the quality statement means for service providers, healthcare professionals and commissioners

Service providers (such as GPs and NHS trusts) ensure that they have appropriate policies and resources to support healthcare professionals to agree initial treatment plans for bedwetting and to provide the treatment agreed in those plans.

Healthcare professionals (such as GPs, school nurses and community nurses) ensure that children and young people who are bedwetting have an initial treatment plan and receive the treatment agreed in their plan.

Commissioners (such as clinical commissioning groups, local authorities and NHS England area teams) ensure that they commission services with policies and resources to enable children and young people who are bedwetting to have an initial treatment plan and to receive the treatment agreed in their plan. This includes ensuring that services provide enough suitable alarms for bedwetting to meet demand.

What the quality statement means for children, young people, parents and carers

Children and young people who are bedwetting have an agreed plan for their treatment (such as using a bedwetting alarm or taking medication) and are able to get the treatment in their plan.

Source guidance

  • Nocturnal enuresis (NICE clinical guideline 111), recommendations 1.4.5, 1.8.1, 1.10.1 and 1.10.2.

Definitions of terms used in this quality statement

Initial treatment for bedwetting

An alarm should be offered as first‑line treatment unless it is considered undesirable or inappropriate (for example, if bedwetting is very infrequent, that is, less than 1 or 2 wet beds per week, or the parents or carers are having emotional difficulty coping with the burden of bedwetting or are expressing anger, negativity or blame towards the child or young person).

Desmopressin may be offered to children and young people older than 7 years if an alarm is undesirable or inappropriate, or if the priority for the child is to achieve a quick short‑term improvement in bedwetting.

Consideration of which initial treatment is most appropriate will depend on the child or young person's age, the frequency of bedwetting and the motivation and needs of the child or young person and their parents or carers.

An alarm or desmopressin may be considered for children aged 5 to 7 years. The decision about suitable treatment for 5- to 7‑year‑olds should take into account the pattern of bedwetting as well as the child's ability, maturity, motivation and understanding of an alarm, their wider living circumstances and the views of their parents or carers. [Adapted from NICE clinical guideline 111 recommendations 1.4.5, 1.8.1, 1.8.8, 1.10.1 and 1.10.2]

Equality and diversity considerations

Although some parents and carers may be willing and able to buy an alarm for their child, this should not be assumed. Children and young people whose parents or carers cannot afford to buy an alarm should not be disadvantaged by having to wait before they can get access to this treatment.

The type of alarm should be selected to meet the specific needs of children and young people with developmental or learning difficulties or physical disabilities.

The quality statement does not cover children younger than 5 years. The decision about whether to formally manage bedwetting in children younger than 5 years would be a clinical judgement; it would not be appropriate in all cases.