Every three to five years, the NHS Lancashire and South Cumbria ICB reviews its clinical policies to ensure they reflect the latest evidence-based guidance and best practice. We are currently reviewing the following policies and would welcome your views on the proposed changes.
Sacral neuromodulation (SNM) is a treatment in which a small device sends gentle electrical signals to the nerves in the lower back (sacral nerves). This can help people with certain bladder problems when other treatments haven’t worked.
Under the current policy, SNM is only offered to patients with idiopathic chronic non-obstructive urinary retention, which is a condition that prevents people from being able to completely empty their bladder. Even then, it is only allowed if:
· It is done in a specialist unit
· The care team is experienced in bladder dysfunction
· The patient has a successful trial period with a temporary device
You can read the full wording of our current policy here https://www.healthierlsc.co.uk/application/files/8016/7576/5525/LSCICB_Clin32_Policy_for_Sacral_Neuromodulation_v1.1.pdf
The proposed policy expands access and aligns with NICE recommendations. If approved, the new policy will allow SNM for:
· Chronic non‑obstructive urinary retention (men & women) – same criteria as now
· Overactive bladder in men – when conservative treatments have failed
· Overactive bladder in women, if:
o Reviewed by a local/regional multi-disciplinary team (specialists from different fields working together to make joint decisions)
o Non‑surgical treatments and medicines have not worked
o Botulinum toxin A (a medicine) has not worked or is not acceptable to the patient
Overall, this will improve access to the treatment for more people.
The new wording in full
Sacral neuromodulation (SNM)* is routinely commissioned in:-
1. Idiopathic, chronic non-obstructive urinary retention in men or women if all of the following criteria are satisfied:
a. The treatment is being carried out in a specialist unit
AND
b. The clinical team are experienced in the assessment, treatment and long-term care of patients with bladder dysfunction.
2. Overactive bladder in men with detrusor overactivity whose symptoms have not responded to conservative management (in line with CG 97).
3. Overactive bladder in women if ALL of the following criteria are satisfied:
a. They have been reviewed by a local or regional MDT
b. they have not responded to non-surgical management, including medicines (in line with NG 123)
c. their symptoms have not responded to botulinum toxin type A (unless the woman is not prepared to accept the risks of needing catheterisation associated with administration of botulinum toxin type A).
Patients who are eligible for SNM must also satisfy all of the following additional criteria:-
· Have achieved a good response to a short trial phase using an external (temporary) device.
· The long-term implications of therapy, including the need for the initial test phase (above), the risk of failure, the long-term commitment, the possible need for surgical revision and/or device removal and potential adverse effects, have been discussed.
Sacral neuromodulation (SNM) is not routinely commissioned for constipation.
Exclusion: Management of faecal incontinence is outside the scope of this policy, as this is commissioned by NHS England.
Please note this survey closes at midnight on 29th March 2026