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Friday 24th October 2014

B&BF consensus statement on inadequate access to SNS for overactive bladder

The Bladder and Bowel Foundation (B&BF) representing individuals struggling with bladder and bowel incontinence would like to express grave concern over the lack of commissioning policy for Sacral Nerve Stimulation (SNS) for Urinary Incontinence across England.

The current situation has resulted in a number of areas unable to offer SNS for Urinary incontinence. Whilst cases can be referred to the Individual Funding Request panel many are not. The current situation is impractical for both individuals and clinicians and has resulted in widespread confusion and distress amongst patients who read about a proven* treatment but are denied access to it in many areas of the country. The current situation has been acknowledged by James Palmer, Clinical Director Specialised Commissioning and Linda Doherty, Women & Child Programme of Care Manager.

NICE CG 171 states that: “SNS should be considered for women with proven detrusor overactivity (DO) whose OAB has not responded to conservative management including drugs”:

1. They cannot/do not wish to carry out clean intermittent catheterisation (CIC)
2. When the first botulinum toxin A (200 IU or 100 IU) treatment has had no effect.

Patients suffering from this severely debilitating condition should be assessed to see if they may be suitable for a potentially *transformational treatment. B&BF believes that the current lack of commissioning policy for SNS contravenes the NHS Constitution stated objective of ‘putting patient’s first’ ( In many areas referral to treatment times will now be increased by over a year – for many resulting in loss of employment, inability to carry on daily activities and a consequent severe reduction in overall quality of life. (*See attached reference list)

“No treatment means no job. No job means no money. No money means no mortgage. No mortgage means losing my home – the hidden costs of my condition are huge.” Tara 41
“I have been told that there is a treatment that may help me – my doctor cannot refer me for it locally. How can I access this treatment that is available elsewhere?” Jacqueline 48

B&BF would like NHS England to confirm the following:

1. B&BF respectfully request that NHS England agree to address the situation as a matter of priority.
2. B&BF would ask NHS England to clarify the treatment options that are currently available to these patients in the absence of a straightforward commissioning policy for SNS?
3. B&BF would like to see a robust commissioning policy for Urinary Incontinence in Women, endorsing NICE guidelines, in place by April 2015.

This Consensus Statement has been shared with and endorsed by the Executive Committees of the Section of Female, Neurological & Urodynamic Urology of The British Association of Urologists (BAUS), The Pelvic Floor Society (TPFS) and the United Kingdom Continence Society (UKCS)