Written evidence submitted by the Urology Trade Association (CBP0048)


About the Urology Trade Association


The Urology Trade Association (UTA) was established in 2007 to represent manufacturers and suppliers of urology products. The association seeks to:


      promote and sustain patient choice in access to continence products;

      increase patient and public awareness about continence issues; and

      ensure that patients are not placed at adverse risk by ill-advised policy decisions.


What capacity is available within the NHS to deal with the current backlog?


Prior to the pandemic, urology referrals had risen by nearly 20% over 20 years[1]. This is mainly due to the availability of better assessment and diagnosis, and increased patient expectation. A 2018 GIRFT report found that there are over 750,000 episodes of care each year[2] and emergency admissions due to a urinary tract infection had doubled between 2013 and 2018[3]. A higher rate of detection is a positive, but this often leaves urology services struggling to cope and patients left on waiting lists for outpatient services.


When the COVID-19 pandemic hit, there was a reduction in healthcare activity relating to urology patients. In England, the referrals of new patients with symptoms of urological cancer fell from 18,534 in February 2020 to 7,859 in April 2020 (a 58% reduction). This had not recovered to pre-pandemic levels by October[4], indicating that due to the cancellation of elective procedures to deal with COVID-19 cases, thousands of urology, stoma and urostomy patients were not being seen.


Dispensing Appliance Contractors (DACs) have been working behind the scenes throughout the pandemic to reduce the burden on the NHS. From processing and packaging medical devices in warehouses, speaking to patients with their free helplines and delivering products directly to patients, DACs have helped reduce the risk patients contracting urinary tract infections, which would require patients to remain in hospital beds. DACs have helped ensure that the safety and health of patients living with urinary incontinence is well managed by helping to liaise with nurses, arrange prescriptions, deliver products and answer any questions a patient might have.


During the pandemic, warehouses have been operating at full capacity, with employees still packing and processing orders from patients, ensuring that there are no delays. Additionally, DACs keep a detailed record of what has been dispensed to patients and when, which GPs, nurses, CCGs and other healthcare professionals are able to obtain and share among themselves. Most DACs provide a monthly call to patients to conduct a stock take, ensuring that patients have the correct number of medical supplies and topping up where necessary. At a time where budgets are constrained, effective management of patient supply has been paramount in safeguarding patient access to the products they desperately need.


The vital services DACs are offering in these challenging times, have effectively reduced the burden on the NHS, ensuring that the safety and health of patients living with urinary incontinence is well managed. During this coronavirus pandemic, DACs are bringing valuable additional capacity to an NHS which simply could not cope without them.



To what extent are the required resources in place, including the right number of staff with the right skills mix, to address the backlog?


Whilst DACs have been able to provide patients with an essential service during the pandemic, there is still a backlog of urology patients who require appropriate treatment sooner to prevent their condition from worsening. In order to help address this, the NHS should work with DACs, and other organisations who deliver CQC approved services, to help add capacity to the NHS and deal with the backlog.


Additionally, the NHS should continue to encourage supported self-management and education to empower patients to manage their conditions themselves. This will likely lead to better clinical outcomes and lower rates of hospitalisation. Self-management as a first line intervention for lower urinary tract symptoms (LUTS) can significantly reduce the frequency of treatment failure and reduce urinary symptoms[5]. Resources to support self-management should be easily accessible, of high quality and relevant to meet the needs of local patients.


What positive lessons can be learnt from how healthcare services have been redesigned during the pandemic? How could this support the future work of the NHS and care services?


The health system was unprepared for the pandemic from the perspective of DACs, who provided much needed capacity to the NHS in helping hundreds of thousands of patients across the country.


The small numbers of GP closures that occurred at the beginning of lockdown resulted in medical device manufacturers sending out appliances without prescriptions as we did not want patients to go without their essential appliances – there was no certainty at this stage that there would be a reimbursement by the NHS in England for items dispensed but it was a risk many manufacturers took.


The increased use of electronic prescriptions and repeat prescriptions since has helped in the process. In the case of PPE, manufacturers have had to procure their own supplies from other sources outside of NHS Supply Chain as we did not want to burden the NHS which was itself struggling to obtain their own stock.


What can the Department of Health & Social Care, national bodies and local systems do to facilitate innovation as services evolve to meet emerging challenges?


Clinicians should be encouraged to use NHS England’s guidance on Shared Decision Making (SDM), so that the needs of patients are appropriately considered. An all age, whole population approach would mean that patients are supported to stay well and are enabled to make informed decisions and choices when their health changes. This helps empower those with complex needs to manage their own condition and the service they use. This should be considered at every stage of the patient pathway and can be achieved through digital health tools, personalised care and support planning, social prescribing, and patient choice.



Sept 2021

[1] https://digital.nhs.uk/data-and-information/publications/statistical/hospital-outpatient-activity/hospital-outpatient-activity-2016-17

[2] https://gettingitrightfirsttime.co.uk/wp-content/uploads/2018/07/GIRFT-Urology.pdf

[3] h https://www.england.nhs.uk/wp-content/uploads/2018/07/excellence-in-continence-care.pdf

[4] https://www.england.nhs.uk/statistics/statistical-work-areas/cancer-waiting-times/monthly-prov-cwt/2020-21-monthly-provider-cancer-waiting-times-statistics/

[5] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1764065/pdf/bmj-334-7583-res-00025-el.pdf