Establishing a Children’s Continence Advisory Service in Orkney: A Collaborative Journey

Orkney School Health Team had observed a steady increase in the number of children experiencing continence issues across the region. Families were seeking advice, treatment, and access to suitable products — yet there was no dedicated pathway in place to support them. Historically, paediatric patients had been referred into the adult continence service, where products were often issued without the child being assessed in person. While this approach may have met some immediate needs, it did not account for the complexity of continence care in children — where developmental, behavioural, and medical factors often require tailored support.

The limitations of this system became increasingly evident to the School Health Team, who recognised the urgent need to develop a dedicated children’s continence advisory service. However, for the small team based at The Balfour Hospital — in one of the UK’s most remote island communities — this presented a significant challenge. They lacked a clear model to follow, had limited experience in paediatric continence care, and were operating within tight financial and logistical constraints.

Who was involved?

Thisbe Sinclair – School Nurse
Hannah Leslie – Trainee School Nurse
Alison Reid – Staff Nurse
Marie McGregor – Nurse Advisor Ontex
Sunni Liston – Nurse (ERIC)

Taking the First Steps

The initiative was spearheaded by three committed nurses: Thisbe Sinclair (School Nurse), Hannah Leslie (Trainee School Nurse), and Alison Reid (Staff Nurse). Driven by a shared determination to improve care for local children and families, they began exploring options for setting up a new service. However, with no clear starting point and limited local resources, they soon realised they would need external support.

After conducting initial research, the team reached out to Ontex, a continence care supplier with experience in supporting healthcare services across the UK. Their first point of contact was Marie McGregor, Ontex Nurse Advisor, who quickly became an important partner in the project. Marie worked closely with the team to understand their needs, challenges, and goals, and began arranging regular support meetings to guide them through the process of building the service from the ground up.

Marie also connected the School Health Team with Sunni Liston, a specialist nurse affiliated with ERIC, the national children’s bowel and bladder charity. Sunni brought essential insight and clinical experience, helping the team understand best practices for setting up a paediatric continence service in a remote context. Together, Marie and Sunni helped the School Health Team select a product formulary appropriate for children, provided training on how to use and assess the products, and shared guidance on referral pathways, care planning, and ongoing review processes.

“It was all very challenging in the beginning — we didn’t know where to start. But with Sunni and Marie’s support, we managed to identify the best products for our children and created a formulary that works for all of us. It’s been great to see what we’ve achieved in such a short time.”
— Thisbe Sinclair, School Nurse

Navigating the Challenges of Remote Healthcare

Several of the barriers faced by the team were unique to Orkney’s geography and infrastructure. As a rural and remote community, Orkney does not benefit from the dense healthcare networks found on the mainland. Patients and families may need to travel significant distances — including by ferry or air — to attend appointments. This makes regular face-to-face assessments particularly difficult, especially for children and families already under strain.

The team adopted a pragmatic approach: the initial assessment would be conducted in person to ensure the child received appropriate, well-fitted products. Following this, reviews and adjustments could often be managed via telephone, with reassessments arranged as needed. This hybrid approach helped balance quality care with practical realities, ensuring that children received support without overburdening families or staff.

“We’ve learned so much about how to run a continence advisory service, and how we can best support children, young people and their families through this process. It’s been a steep learning curve, and one that we will continue gaining knowledge in!”
— Alison Reid, Staff Nurse, School Health

Building Confidence and Capacity

For the School Health Team, the experience of building a service from scratch has been both challenging and empowering. The partnership with Ontex and ERIC not only brought expert knowledge and training, but also gave the team the confidence to make clinical decisions, communicate effectively with families, and advocate for the needs of children in their care.

Impact on Families and the Wider Community

Though still in its early stages, the new children’s continence advisory service has already made a meaningful difference to local families. Children are now receiving assessments appropriate to their age and needs, with care plans tailored to support their independence, dignity, and long-term development.

The success of this project has also opened the door to wider conversations about children’s health in Orkney, and there are hopes that the service can be expanded further to include more education and early intervention support for schools and families.

“It’s been very helpful to know that Ontex have been there to support us on this journey. Setting up the continence service was something we’d been wanting to do for a long time — we just didn’t have the support or know-how to make it happen.”
— Hannah Leslie, Trainee School Nurse

Ongoing Support and Future Plans

Marie McGregor and the Ontex team continue to provide ongoing support to Orkney School Health Team, with regular check-ins and updates on product developments, best practices, and clinical guidelines. ERIC also remains a key partner, offering expert advice and access to a broader network of paediatric continence specialists.

The Orkney team now looks ahead to strengthening the service further, exploring ways to embed continence education into school nursing, community outreach, and partnership work with the Health Visiting team. They hope to share their experience with other rural teams, showing that — with the right support and determination — even small, remote services can deliver high-quality, child-centred care.

If you would like to receive continence training from Ontex please contact us at [email protected]

For more information on Ontex products, please visit https://ontex.com