Millions of people across the UK are facing shortages of essential continence products due to rationing by NHS trusts, a coalition of leading health charities has warned, forcing many to pay out of their own pockets to maintain basic dignity.
The stark reality of what charities term a “pad gap” is revealed by Freedom of Information data obtained from 110 NHS trusts. It shows that more than half (53%) impose a daily cap on the number of incontinence products a patient can receive. Of these, 34% limit provision to just three products per day, while the remaining 66% cap it at four.
This is frequently at odds with clinical need. Research indicates that healthcare workers expect to fit up to five pads a day for patients with incontinence. With an estimated 14 million people in the UK living with the condition—affecting around 34% of women, over 2 million men, and more than 6.5 million adults with bowel incontinence—the scale of the shortfall is vast.
The Personal Cost of Rationing
The consequences of this rationing extend far beyond clinical logistics into profound personal indignity. According to an open letter from organisations including the Royal College of Nursing (RCN), Prostate Cancer UK, and Bowel and Bladder UK, the impact is both emotional and physical.
Millie Baker, executive director of Bladder Health UK, stated that people are enduring the shame of persistent body odour, constant anxiety about visible leaks, and painful skin damage caused by prolonged contact with urine. “Some avoid relationships, limit clothing choices, or withdraw from everyday life out of fear and embarrassment,” she said. Disturbed sleep, emotional distress, and increased risk of infection are common, stripping away confidence, autonomy, and wellbeing.
This chimes with broader evidence that incontinence can lead to a marked loss of self-esteem, depression, social isolation, and reduced independence, affecting relationships and employment. For many, the financial burden compounds the distress. With products rationed, individuals and families are forced to use their pensions or Personal Independence Payment (PIP)—a benefit designed to help with extra costs of long-term illness—to purchase pads, while struggling to cover other basic costs.
Professor Alison Leary, deputy president of the RCN, said the effective rationing means both patients and staff suffer. “Patients do not get the dignified care they need and nursing colleagues feel they are not meeting patients’ fundamental needs,” she said.
A Systemic Issue with Deep Roots
The problem is not new. A 2008 audit found the most common adult pad allowance was four per day, with few services employing clear criteria for issuing products. A 2015 national audit of continence care for older people also identified widespread rationing, a lack of written policies, and limited staff training.
Financial pressures within trusts appear to be a key driver. Some trusts, such as Central London Community Healthcare NHS Trust which has a maximum daily limit of four pads, have reported overspending their continence product budgets. The NHS spends an estimated £233 million annually on continence care, but campaigners argue this is not translating into adequate provision.
Guidance from the Association for Continence Professionals and the RCN states that the number of absorbent products provided must meet assessed clinical need and maintain independence. NHS England’s own “Excellence in Continence Care” guidance from 2018 provides evidence-based resources, yet a postcode lottery persists, prompting calls for a single UK-wide assessment tool with clear criteria.
A Potential Path Forward
A significant shift in policy may offer hope. The government is introducing “value-based procurement” (VBP) across the NHS, which requires trusts to consider products that improve patients’ quality of life, not just upfront cost.
Pilot schemes have shown promising results, including improved patient experience, reduced leakages, better skin health, and reduced staffing time. A pilot in Lincolnshire care homes demonstrated that cheaper, generic pads could lead to a higher overall cost of care due to increased leakage and laundry. The health and hygiene company Essity, which campaigns for VBP, estimates that choosing the cheapest products alone costs the NHS an extra £520 million annually.
This campaigning has influenced a policy change, with new NHS guidance now stipulating that patient experience and outcomes must be prioritised ahead of cost for all medical supplies. Charities have hailed this as a “once in a generation opportunity to improve health outcomes.”
In the meantime, other initiatives aim to address specific facets of the crisis. Prostate Cancer UK’s “Boys need Bins” campaign advocates for sanitary bins in men’s toilets for discreet disposal. Organisations like The Hygiene Bank partner with companies to address “incontinence poverty,” while community projects like The Pad Project UK focus on recycling and redistributing products to reduce waste and need.
With millions facing daily indignity, the push for systemic change through VBP and consistent assessment is underscored by an immediate reality of shortage, rationing, and profound personal toll.