Chronic Urinary Tract Infections

Ashley Dalton Excerpts

Wednesday 21st May 2025 Westminster Hall

[The Parliamentary Under-Secretary of State for Health and Social Care (Ashley Dalton)]

It is an honour, as ever, to serve under your chairship, Sir Desmond. I thank the hon. Member for Sutton and Cheam (Luke Taylor) for securing this debate. I would like to welcome and acknowledge Phoebe and all others in the Gallery. Of course, I put on record straightaway that I will ensure that a meeting takes place with the relevant Minister—we are just working out whether that will be me or somebody else, but I will ensure that it takes place.

I also recognise the contributions from other hon. Members here today. My hon. Friend the Member for Dudley (Sonia Kumar), who is no longer in her place, always brings her expertise as a clinician to this discussion and does much to raise awareness. The hon. Member for North Down (Alex Easton), who is also no longer in his place, talked about antibiotics and AMR, which I will come to later. The hon. Member for Strangford (Jim Shannon) and the spokesperson for the Liberal Democrats, the hon. Member for Chichester (Jess Brown-Fuller), spoke about Pharmacy First. Just to confirm, it does operate in England and is designed to ensure that women aged 16 to 64 can access treatment for uncomplicated UTIs. It is worth saying that the Government currently have no plans to extend that age group, as pre-16 or post-64 cases are not necessarily considered uncomplicated and would, we would argue, require a little more focus. My hon. Friend the Member for Watford (Matt Turmaine) recognised the desperation of many sufferers and highlighted the links to suicide.

Before I come to my speech and refer to some of the issues raised by the Front-Bench spokespeople, may I say that my hon. Friend the Member for Stoke-on-Trent South (Dr Gardner) and I have been very good friends for some years? I know how she suffers, and I recognise her courage. She is such a powerful voice on this issue, and I am delighted that she has done what was necessary and worked so hard to get to this place and to be that voice here. I congratulate her on that.

UTIs are very common, especially for women, but chronic UTIs are much rarer. However, the charity Chronic Urinary Tract Infection Campaign, CUTIC, estimates that up to 1.7 million women in the UK may suffer from a chronic UTI. That is a very large number of people living in discomfort. I commend CUTIC for its work bringing attention to the plight of chronic UTI sufferers.

It is important to make clear the distinction between a UTI, a recurrent UTI and a chronic or persistent UTI. A recurrent urinary tract infection is defined as having two or more UTIs within six months, or three or more UTIs within a year, with symptoms sometimes reappearing after a course of treatment, but regular treatment can eventually cure these. For a chronic UTI, the symptoms never go away, despite treatment. At most, they might slightly abate. A UTI can impact significantly on someone’s quality of life, making it hard to concentrate, sleep or exercise.

For someone with a chronic UTI, the pain and discomfort does not end. The physical and mental struggle is relentless. The contemplation of suicide is, as we have discussed, not uncommon among people suffering with chronic UTIs. They can have a negative impact on both intimate and social relationships, as well as self-esteem. That can be incredibly isolating. A population-based survey in England of women over 16 in 2015 found that 37% reported at least one episode of UTI in their lifetimes. Meanwhile, 29% of women reported more than one episode of UTI and 3% of women reported a history of recurrent UTIs in the past year.

Misogyny in health services is an issue that has been discussed in this Chamber before, and women’s health remains a priority for the Government. We have been let down for too long, but we are determined to change that, and women’s health will continue to be a major focus as we fundamentally reform the health service and get it delivering for patients once again. We are working with NHS England to take forward our women’s health strategy, and we have set out plans to use the independent sector to cut gynaecological waiting lists through our investment and reforms. We will make sure that the NHS can be there for all women when they need it. We are bringing through those commitments as part of our 10-year health plan.

It is vital that people with chronic UTIs receive support and compassion from the NHS in diagnosis and treatment. No one suffering with a chronic UTI should be made to feel ashamed or in any way at fault for their condition. Living with the condition is a struggle enough without having to bear the insensitivity of others. Chronic UTI sufferers merit the same understanding as anyone else with a non-communicable disease.

As stated previously, the reasons why some people develop a chronic UTI are not well understood, and neither is how to cure one once it develops. A long-term dose of antibiotics has been shown to work in some cases, but it is not consistently replicable, and it is not a risk-free approach. There are also the added complications of antibiotic resistance to consider when adopting such a treatment regimen. I will return to that point.

Management of the condition is at the discretion of the responsible clinician, based on their specialist training and experience. Patients who remain symptomatic despite investigations and treatment by specialist urological services can be referred onwards to tertiary services. Again, I emphasise that all patients with chronic UTIs should be afforded compassion and support as part of their care. As the hon. Member for Sutton and Cheam, who secured this debate, said, there is no NICE guidance specifically on chronic UTIs. The existing guidance provides advice on pain management and hydration. The local NHS is expected to have regard to NICE guidance in providing care and advice to patients.

The UK Health Security Agency has begun work in this area, alongside NHS England, primary care and patients, to develop resources to support clinicians in managing UTI conditions. At the moment, that is for recurrent UTIs, and we agree that more research is needed. To address the uncertainty, research is being undertaken. Through our National Institute for Health and Care Research, we are supporting work to understand the research gaps on UTIs. This happens through a James Lind Alliance priority-setting partnership, led by Antibiotic Research UK, Bladder Health UK and the Urology Foundation. The partnership will publish its findings in spring 2026.

The Department, through the National Institute for Health and Care Research, is funding research to improve the diagnosis and treatment of urinary tract infections, including chronic UTIs. The research includes the development of antimicrobial-impregnated catheters to reduce episodes of catheter-associated UTIs, as well as something called the TOUCAN study to evaluate the rapid point-of-care UTI diagnostic tests in GP surgeries. Recently the NIHR invested £3.1 million into improving primary care antibiotic prescribing programmes.

I want to return to antimicrobial resistance and why it is an important consideration. The first five-year national action plan for AMR in 2019 set out a comprehensive “One Health” approach to address AMR, acting across humans, animals, food and the environment. A further five-year plan was published in March 2024. The UK Health Security Agency has also been working with colleagues from NHSE, primary care settings and patients to develop resources to support clinicians through the TARGET antibiotics toolkit. This toolkit training is currently being rolled out in multiple NHSE regions as part of an intervention to improve the management of common infections, including UTIs, in primary care. We need to build on these successes and ensure that antibiotics use is supported by evidence. AMR is a significant health threat, and an estimated 7,600 deaths were attributable to AMR in the UK in 2019.

The Lib Dem spokesperson, the hon. Member for Chichester, spoke about dementia and the added complications that that can lead to. Diagnosing UTI can be especially difficult in older people who often present with atypical or non-specific presentations, and it can be difficult to assess lower urinary tract symptoms in older patients with dementia. In care home settings the resident might not initially present as acutely unwell. They might present with increased lethargy, diminished appetite, reluctance to drink or just not be their usual self. Tools such as RESTORE2 can support care homes to alert a primary care clinician that the resident might be unwell and would benefit from an early clinical review. Care home staff encourage residents to keep hydrated, although that can be challenging in residents with dementia, as we know.

The Department is funding research into dementia and chronic urinary tract infections via the National Institute for Health and Care Research. The StOP UTI project at the NIHR Applied Research Collaboration in Wessex sought to identify effective strategies for preventing and recognising UTIs in care homes and has done some work to embed activities into care routines. It concluded that a systems-wide approach was necessary. In July 2024 the NIHR published a call for research applications to improve diagnosis of UTIs in older adults. Stage 2 applications are being considered by the funding committee this month.

The Lib Dem spokesperson also talked about community pharmacy and the 10-year plan, which will cover all conditions and is a strategic overview of how we will improve the NHS for everybody. I can confirm that the 10-year health plan is on track to be published next month.

The shadow Minister, the hon. Member for Sleaford and North Hykeham (Dr Johnson), talked about research programmes and guidance. I think I have referred to most of those things in my speech. If I have not, I am more than happy to write to her after this debate. She also touched on prevention. The UKHSA is working with NHS England to run a targeted campaign around UTI prevention in older adults. The campaign will include messages and materials that can be used to support older adults to adapt behaviours, which should reduce the risk of developing a UTI, including messages that suggest they talk to clinicians about treatment options if they have recurring UTIs.

In conclusion, I want to highlight our work to make a health service that is fit for the future. We hope that our focus on the three shifts to develop a modern NHS will help to address many of the challenges in navigating the health service faced by those with long-term conditions, including chronic UTIs. Our shift from hospital to community will help to drive more joint working between neighbourhoods in primary care, pharmacies, community health and social care, in order to help people to manage their conditions. As I have said, shortly we will publish our 10-year plan for health, which will set out how we will make our NHS fit for the future. I thank the hon. Member for Sutton and Cheam once again for securing this debate to raise awareness of this important but often overlooked issue.