Continence is an important component in a person’s health and well-being at any stage of life. Early assessment by an appropriately trained professional allows a patient centred care pathway to be followed.

The Renewed Women's Health Strategy for England, published in April 2026, recognises that these conditions are often normalised by women and girls themselves and by wider society, with many women viewing symptoms such as leaking as an inevitable part of pregnancy, childbirth, ageing or the menopause. It also recognises that many women feel too embarrassed to seek support, which can lead to delays in diagnosis and treatment. The Women’s Health Strategy is not condition specific, instead it focuses on systemic changes including redesigning services, improving diagnosis, and embedding women and girls’ voices so that care improves across all conditions. It sets out how the Government will make women and girls’ voices and choices central in healthcare, transform National Health Service performance in services that matter most to women, support all women to live healthy, prosperous lives and create an approach to research and development that works for and empowers women.

The Department updated the guidance for the products listed under Part IX of the drug tariff last year to introduce a process in which existing products, including continence products, re-apply to remain listed and are assessed by an expert panel, including input from patient representatives. Continence products are due to be assessed in 2028.

National Health Service organisations are accountable for their own procurement decisions and are expected to procure in line with public procurement law, NHS framework mandates, and NHS Commercial Standards, ensuring transparent, compliant, value-for-money purchasing with strong governance and lifecycle management.

The Department has published Value Based Procurement Standard Guidance, in line with commitments in the 10-Year Health Plan and Life Sciences Sector Plan, to improve the consistency of procurement processes across the NHS in England. The guidance also provides NHS buyers with a methodology to assess the overall quality of continence products including factors such as efficiency, patient experience and outcomes, and supply chain resilience.

Integrated care boards (ICBs) are responsible for commissioning continence services in their areas. These services include assessment, treatment, and, where clinically appropriate, the supply of continence products.

For Chichester residents, the Sussex Community NHS Foundation Trust (SCFT) is commissioned to provide continence care for both housebound and ambulatory patients. For ambulatory patients, SCFT is actively seeking an additional service location so that patients with catheters are able to access catheter care at a venue most suitable to them.

SCFT works closely with general practices in the area to understand those patients who need support at home. The continence care service is provided 24 hours a day, seven days a week by SCFT's community nursing teams, Urgent Community Response, and overnight service.

The Surrey and Sussex ICB and SCFT continues to work together to monitor performance and ensure this important support is available for local people.

The Department expects services to follow National Institute for Health and Care Excellence clinical guidance and the Royal College of Nursing standards. These emphasise that continence care should be safe, effective, and uphold dignity, including provision of products that meet clinical need and are of appropriate quality.

NHS England's Standardising Community Health Services guidance supports commissioners and providers to improve the design, commissioning, and delivery of community health services. The guidance recognises bowel and bladder care as a lifelong need for children with long term and life limiting conditions and it is the responsibility of the clinical teams to undertake a comprehensive assessment of the child’s bladder and bowel needs and to prescribe continence products accordingly. Local commissioners and providers will determine their own clinical pathways and operating models for community health services, including bowel and bladder care for children.

The guidance is available at the following link:

https://www.england.nhs.uk/long-read/standardising-community-health-services-core-component-descriptions/

The data held on referrals to gynaecology services is not broken down by the reason of referral. This means it is not possible to identify referrals specifically for female urinary incontinence, either for the total population or for women from minority ethnic backgrounds.

Work is underway to improve how this data is collected and reported. This includes recording the reason for referral and, as more care moves from hospital to community settings, recording the place of treatment. These improvements are intended to give a clearer view of who is being referred and treated, which will in turn support action to identify and address any inequalities in access for women from minority ethnic backgrounds.

The data held on referrals to gynaecology services is not broken down by the reason of referral. This means it is not possible to identify referrals specifically for female urinary incontinence, either for the total population or for women from minority ethnic backgrounds.

Work is underway to improve how this data is collected and reported. This includes recording the reason for referral and, as more care moves from hospital to community settings, recording the place of treatment. These improvements are intended to give a clearer view of who is being referred and treated, which will in turn support action to identify and address any inequalities in access for women from minority ethnic backgrounds.

The data held on referrals to gynaecology services is not broken down by the reason of referral. This means it is not possible to identify referrals specifically for female urinary incontinence, either for the total population or for women from minority ethnic backgrounds.

Work is underway to improve how this data is collected and reported. This includes recording the reason for referral and, as more care moves from hospital to community settings, recording the place of treatment. These improvements are intended to give a clearer view of who is being referred and treated, which will in turn support action to identify and address any inequalities in access for women from minority ethnic backgrounds.

The data held on referrals to gynaecology services is not broken down by the reason of referral. This means it is not possible to identify referrals specifically for female urinary incontinence, either for the total population or for women from minority ethnic backgrounds.

Work is underway to improve how this data is collected and reported. This includes recording the reason for referral and, as more care moves from hospital to community settings, recording the place of treatment. These improvements are intended to give a clearer view of who is being referred and treated, which will in turn support action to identify and address any inequalities in access for women from minority ethnic backgrounds.

The National Institute for Health and Care Research (NIHR), the research delivery arm of the Department, funds and supports a range of research to support women’s health conditions, including pelvic organ prolapse.

In May 2023, the NIHR commissioned a £1.6 million study to develop a validated patient reported outcome measure for prolapse, incontinence, and mesh complication surgery, to better understand the short and long-term health impacts of pelvic mesh surgery. This study has now been extended until January 2028 with findings available shortly after. Further information is available at the following link:

https://fundingawards.nihr.ac.uk/award/NIHR152187

The NIHR continues to welcome funding applications for research into any aspect of human health, including the use of vaginal mesh to treat pelvic organ prolapse. Applications are subject to peer review and judged in open competition, with awards being made on the basis of the importance of the topic to patients and health and care services, value for money, and scientific quality.

The Department has not made a specific assessment as integrated care boards are responsible for commissioning continence services in their areas. These services include assessment, treatment, and, where clinically appropriate, the supply of continence products. Decisions on the type and quantity of products are made by clinicians following individual assessment, in line with National Institute for Health and Care Excellence guidance on incontinence and professional standards.

NHS Supply Chain supports trusts with the procurement of continence products through value-based procurement initiatives to ensure products are safe, effective, and cost-efficient. Further information on continence commissioning is available at:

https://www.england.nhs.uk/commissioning/continence/

Integrated care boards are responsible for commissioning continence services in their areas. These services include assessment, treatment, and, where clinically appropriate, the supply of continence products. Decisions on the type and quantity of products are made by clinicians following individual assessment, in line with National Institute for Health and Care Excellence guidance on incontinence and professional standards.

The NHS Supply Chain supports trusts with the procurement of continence products through value-based procurement initiatives to ensure products are safe, effective, and cost-efficient. Further information on continence commissioning is available at the following link:

https://www.england.nhs.uk/commissioning/continence/

Integrated care boards (ICBs) are responsible for commissioning continence services in their areas. These services include assessment, treatment, and, where clinically appropriate, the supply of continence products. Decisions on the type and quantity of products are made by clinicians following individual assessment, in line with National Institute for Health and Care Excellence guidance on urinary and faecal incontinence and professional standards.

NHS Supply Chain supports trusts with the procurement of continence products through value-based procurement initiatives to ensure products are safe, effective, and cost-efficient. Local continence services in Wandsworth are delivered by community providers such as the Central London Community Healthcare NHS Trust, which offers specialist assessment and management for housebound patients and those in care settings. Further information on continence commissioning is available at the following link:

https://www.england.nhs.uk/commissioning/continence/

The 10-Year Health Plan will shift care from hospital to community, and will thereby help to drive more joint working in neighborhoods between primary care, pharmacies, community health care, and social care to help people to manage continence at home, helping them to have access to the right self-care, the right professional support so they aren’t passed from service to service, and reducing their need for emergency admissions to hospital.

National Institute for Health and Care Excellence guidance on continence care recommends commissioners and providers deliver high quality management of continence care provision delivered in an integrated way.

The Department has been working in partnership with NHS England and the NHS Supply Chain to develop national Value Based Procurement (VBP) Standard Guidance which will be published in early 2026. The guidance shifts the procurement focus from upfront cost to how a product can best deliver improved patient outcomes and value.

The Department is conducting live pilots to test the draft standard guidance, with National Health Service trusts and integrated care boards, from September to December 2025. Insights from the pilots will be used to refine the guidance and implementation plans ahead of final publication, including the support needed for NHS trusts to adopt the guidance.

Under the 10-Year Health Plan, those living with dementia will benefit from improved care planning and better services. Supporting this, the VBP Standard Guidance will enable the procurement of the most effective products that improve patient experience and outcomes, including for those living with dementia and requiring absorbent incontinence products, as well as improve NHS efficiency.

The Department has been working in partnership with NHS England and the NHS Supply Chain to develop national Value Based Procurement (VBP) Standard Guidance which will be published in early 2026. The guidance shifts the procurement focus from upfront cost to how a product can best deliver improved patient outcomes and value.

The Department is conducting live pilots to test the draft standard guidance, with National Health Service trusts and integrated care boards, from September to December 2025. Insights from the pilots will be used to refine the guidance and implementation plans ahead of final publication, including the support needed for NHS trusts to adopt the guidance.

Under the 10-Year Health Plan, those living with dementia will benefit from improved care planning and better services. Supporting this, the VBP Standard Guidance will enable the procurement of the most effective products that improve patient experience and outcomes, including for those living with dementia and requiring absorbent incontinence products, as well as improve NHS efficiency.

An Adult Bladder and Bowel (Continence) service is delivered via Birmingham Community Healthcare NHS Foundation Trust (BCHC) offering appointments for all residents in Birmingham, including in Sutton Coldfield, with a clinic facility in North Locality based at Sutton Cottage Hospital. The service offers face-to-face and virtual consultations and supports the community nursing service with patients who meet the housebound criteria with complex needs around continence management, catheter care or bowel management.

The service treats adults who are experiencing bladder problems or bowel dysfunction, with all patients receiving a high-quality clinical assessment and personalised care plan in line with best practice, and national driven guidance.

There are a range of investigations, including vaginal pelvic floor assessment, bladder ultra-sound scan or rectal examination, that are available through the service that helps to determine the best course of treatment, based on individual patient needs. Treatment may include lifestyle advice or interventions, pelvic floor exercises, bladder re-training, medication, specialist care or signposting to other appropriate services. The service also offers specialist clinics for young adults aged between 18 and 19 years old transitioning from Children's Services working in partnership BCHC’s Children's and Families Division. The service can be accessed by referral via a patient’s general practitioner (GP).

Housebound patients, including patients with psychological illness which prevent them from accessing a clinic, or following a treatment programme, will initially need to be referred to a Community Nursing service for assessment and treatment by the patient’s GP.

BCHC is currently scoping the use of containment products and ensuring they align with National Institute for Health and Care Excellence guidance recommendations. A consultation and engagement plan, quality impact and equality, human rights assessment will underpin any decisions on the future model.

The average patient waiting times for clinic appointments at Sutton Cottage is 10 weeks, but urgent referrals can be seen within two weeks.

GPs also can access secondary care specialist advice and e-refer a patient to University Hospitals Birmingham NHS Foundation Trust’s (UHB) specialist clinics for adults with incontinence, overactive bladder, stress urinary incontinence, or bladder pain.

As part of the system’s work to transform and standardise care, between October 2026 and March 2027, GPs across Birmingham and Solihull will start to have access to digital tools for clinical decision making and case management via online consulting rooms with UHB urology specialists to speed up and improve access in health and care.

Lancashire and South Cumbria (LSC) Integrated Care Board (ICB) commissions several community bladder and bowel/continence services across Fylde and Lancashire. These services consist of specialist nurses and allied health professionals, who work collaboratively with primary care, secondary care and wider community nursing services to ensure there is comprehensive support and end to end treatment pathways for residents of Lancashire and South Cumbria.

Bladder and bowel services provide a holistic continence assessment, including routine observations, bladder scans and skin integrity checks, as well as reviewing past medical history, medication, mobility, carer support, and diet and fluid. They offer ongoing support and products for any bowel and/or bladder issues that are identified and may refer patients to specialist nurses for further support or district nurses for ongoing care. Self-care advice is always given, and independence is promoted during assessments, such as pelvic floor exercises for stress urinary incontinence, or bladder training and fluid intake advice for overactive bladder.

LSC ICB has a dedicated programme of work supporting the transformation of core community services in line with the Government’s 10-Year Health Plan, and bladder and bowel services are considered as part of the community transformation programme ensuring all residents of Lancashire and South Cumbria have access to evidence-based bladder and bowel care when and where they need it.

The community services are aligned to acute National Health Service trusts. Where there needs to be surgical management or specialist input, this is generally presented through a routine referral to urology, gynaecology or gastroenterology services. All localities across LSC ICB provide these services. LSC ICB is continually reviewing and working towards transformation of clinical pathways and services to manage demand as closer to home as possible via specialist multi-disciplinary teams within the community.

Across LSC ICB, there is also a urogynaecology programme that is developing the front-end of the gynaecology pathway for access to specialist women’s health physiotherapists rather than referrals direct to secondary care gynaecology services. This aims to reduce pressure in gynaecology services and to provide specialist assessments and treatments with reduced waiting times for patients.

Millions of men, women, young people, and children of all ages are living with bowel and bladder problems. All continence problems can be debilitating and life changing. They affect a wide range of care groups and can be a particular concern for the ageing population.

The National Institute for Health and Care Excellence (NICE) has published five guidelines on the management of urinary and faecal incontinence to date. These guidelines cover the management of urinary incontinence in people with neurological disease, the prevention and management of pelvic floor dysfunction, and pelvic organ prolapse in women. NICE has also published a further 14 products in relation to urinary incontinence and 12 in relation to faecal incontinence.

The Department has also commissioned NICE to produce late-stage assessment guidance on one-piece closed bags for colostomies and intermittent urethral catheters for chronic incomplete bladder emptying in adults. These late-stage assessments gather the views of clinical experts and patients to help NICE assess and compare the value of products in widespread use across the National Health Service.

The NHS must also have regard to the Excellence in Continence Care guidance, published in 2018. This provides advice for commissioners, providers, and healthcare staff on understanding and addressing continence needs within their local population. This guidance is supported by British Society of Urogynaecology. Further information on the Excellence in Continence Care guidance is available at the following link:

https://www.england.nhs.uk/publication/excellence-in-continence-care/

NHS England has also produced Safer Bowel Care for Patients at Risk of Autonomic Dysreflexia, a serious medical emergency that can occur in people with spinal cord injuries, which offers resources to support safer bowel care practice and highlights the importance of implementing the Excellence in Continence Care framework.

In addition to national guidance, the Nursing and Midwifery Council (NMC) has professional standards relating to bladder and bowel nursing care. The NMC Code places strong emphasis on the principle of “Prioritising People”, which sets out the expectation that registrants should always respond to individual patient needs.

NHS England is also developing a best practice catheter care pathway across all settings to be completed by the end of this year.

Our focus on the shift from hospital to community will help to drive more joint working in neighborhoods between primary care, pharmacies, community health care, and social care, to help people to manage incontinence at home, by giving them access to the right self-care, the right professional support, so they aren’t passed from service to service, and reducing their need for emergency admissions to hospital.