New research reveals rising costs of NHS continence services amid a ‘lost decade’

Future Health’s latest report finds that continence conditions, such as Overactive Bladder (OAB), are costing health services an estimated £3.7 billion a year and that this is set to rise to £5.2 billion by 2035. Service activity levels are currently below 2012/13 levels, representing a ‘lost decade’ for patients.

The research, commissioned as part of Future Health’s NHS pressures programme, is available here: FINAL REPORT October 2023

Other findings include:

• The estimated 5 million people in England with OAB today is expected to rise to over 7 million by 2035. 400,000 patients are already waiting for treatment for urological conditions, nearly double that before the pandemic
• Improved access to continence care for patients has wider benefits. Patients with continence conditions are more at risk of falls and other health complications. The research finds that there are an additional 22,604 falls leading to hospitalisation for older people each year as a result of OAB, costing the NHS nearly £250m
• With the last national audit completed in 2010, continence care has been sleepwalking towards crisis. The report calls for an urgent recovery plan for urological conditions overseen by a National Clinical Director and a new national clinical audit to better track patient care and improve accountability for performance

New policy research from Future Health reveals the growing costs of NHS continence services. The analysis, ‘Who’s counting?: the case for urgent action to improve continence care’, led by former Special Adviser at the Department of Health and Social Care Richard Sloggett – and commissioned by Astellas – finds that the current cost to the healthcare system in England is already estimated to be £3.7 billion and the report forecasts this to rise to over £5 billion by 2035.

There are 5 million people in England with OAB today and this is expected to rise to over 7 million by 2035, mainly driven by an ageing population. Over 400,000 people are already waiting for NHS treatment for urological conditions and hospital service activity levels have not returned to levels seen before the Covid-19 pandemic and are currently below 2012-13 levels.

Improving access to continence services can help reduce wider pressures on NHS services. People with continence conditions are more at risk of falls. The research calculates that there are an estimated 389,722 additional falls each year for those over 65 related to continence issues resulting in an estimated 22,604 hospital admissions, at a cost of £250m. Regionally, Dorset records the highest relative number (971 per 100,000 population) of continence issue related falls, nearly three times higher than in East London, with the lowest relative rate (372 per 100,000 population).

Patient experience of continence care across the country is highly variable.

Gloucestershire Integrated Care Board (ICB) recorded the highest rate of patients being seen within 18 weeks for urological treatment (84.2%), Birmingham and Solihull ICB recorded the lowest rate of just 37.1%. Per 100,000 people, Herefordshire and Worcestershire ICB has the highest relative number of people waiting for treatment (1043), two and a half times higher than South West London ICB which has the lowest relative number (477).

The research finds that there are an estimated 317,570 primary care appointments per month for patients with OAB, translating to 3.8 million appointments each year. At a regional level Staffordshire and Stoke has the highest estimated proportion – 1.5% – of primary care appointments relating to OAB. Birmingham and Solihull has the lowest estimated proportion – 0.85%.

Continence care is not a healthcare system priority. While some selective and welcome action is being taken through the Women’s Health Strategy, continence conditions are largely absent from the main national policy documents such as the Government Mandate, NHS Long Term Plan and various other post pandemic recovery service plans. The last clinical audit of services was undertaken in 2010. Clinical commissioning guidelines from 2018 have not been implemented.

The report calls for urgent action to recover services overseen by a new National Clinical Director and a rapid clinical audit to drive service access and improvement.

Richard Sloggett, Programme Director at Future Health said: “Our research highlights the challenges and growing costs facing NHS continence services. Hundreds of thousands of people are now waiting for treatment. Activity levels are below where they were in 2012/13 and there is a postcode lottery in access for patients. An urgent NHS recovery plan is now needed for continence services so patients can access the care they need.  This will require senior clinical leadership and accountability and better data on the state of services to track improvements. We cannot afford another lost decade for continence services.”

Dr Timir Patel, Medical Director, Astellas UK & Ireland said: “The pressures on the NHS will not be improved without research, such as this, to highlight where there are opportunities to benefit both patients and the system. This report should act as a catalyst to senior leaders to understand the true scale of the issue through better data and action to improve outcomes.”

Suzanne Evans, Business Director, Bladder Health UK said: “We know from speaking to patients the scale of the challenges people with bladder issues are facing in accessing NHS services. Patients are facing delays of months and in some cases years to get the care they need. This has wider personal impacts on people’s quality of life, relationships and wellbeing. This report is a welcome call to action and shows that poor care costs more and that costs are rising. Getting more patients the care they need will not only improve patient outcomes but help tackle wider pressures in the NHS. Both nationally and locally now is the time for continence issues to be a greater health system priority.”