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Caroline Davies, Sarah Tomlinson, Claire Hurlin and Keryl Raynel

Hywel Dda University Health Board

This Bevan Exemplar project introduced a peer-led education programme for people living with low-level continence problems.


The Continence Service identified long delays for routine referrals to a Specialist Continence Advisor.

The waiting time was up to two years, leading to the problem becoming more severe and having more of an impact on a person’s health and wellbeing, potentially for the rest of their life.


  • To develop a programme in partnership with patients, NHS educators and Continence Nurse Specialists (CNS) to support early intervention and prevent long-term complications and unplanned admissions
  • To be able to deliver the programme in safe, comfortable environments in the community and to be more about health and wellbeing rather than a clinical appointment.
  • To be a peer-led patient education programme available for anyone living with low level continence issues, offering practical ways to manage continence issues on a day-to-day basis.


The team established a task and finish group, gathered relevant information and evidence and developed a manual for tutors to deliver from, along with documentation for those attending the course, including invitation letters and resource packs.

Staff and tutors were trained to deliver the programme, and piloted the session in partnership with the Continence CNS.

The programme has proven to be cost effective as group sessions can see 20 people in 2.5 hours, and not just people with continence problems.

Staff from nursing and care homes can attend and take their learning back to their place of work.

The programme demonstrated a reduction in Referral to Treatment Time. Running the programme frees up CNS time to see those with the greatest need.

Next steps

The programme has the potential to be delivered in a variety of ways:

  • In areas with Education Programmes for Patients: in the local community for people living with continence issues g. small group sessions in community halls.
  • Added to the end of other programmes delivered locally such as the Pain Management Programme in the community.
  • Targeted at Residential Nursing Homes/Supported Living/Day Service Centres or alternatives where a large group of people would be likely to be living with continence issues.
  • As an integral part of the Continence care pathway in Health Boards, by identifying all routine referrals and offering the education in partnership with a continence clinical nurse specialist. Before offering a high end clinical appointment and/or prescribe a medication without basic behaviours being addressed to establish the true level of continence issues in the patient.
  • Work in partnership with a GP cluster to deliver a programme as a joint venture.