Chronic Urinary Tract Infections

09:30:00

I beg to move, That this House has considered chronic urinary tract infections. It is a pleasure to serve under your chairship, Sir Desmond. I rise to speak about a horrific condition that has been ignored for much too long. For thousands of Britons chronic urinary tract infections turn ordinary lives into living nightmares. The pain and permanence of the illness has left thousands suffering on a daily basis. Having heard many of their stories it is clear to me that what they are living through is nothing short of torture. This speech is not just about a medical condition; it is about a scandal that highlights the systemic failure to take women’s pain seriously in this country. Over the last few months a brave community of patients have shared their stories with me—stories of trauma, suffering and desperation. I have been utterly heartbroken by what I have been told. The cruelty of the condition is matched only by the cold indifference that its sufferers have faced from our healthcare system. It is a national disgrace that thousands of chronic UTI sufferers have been so profoundly let down by modern medicine.

I congratulate the hon. Member on securing this important debate. As a physiotherapist I meet patients with chronic UTIs who tell me about the increasing urgency leading to incontinence. The stigma behind incontinence is disgraceful. Does he agree that we need a wider strategy? When it comes to UTIs we need to look at the other effects, such as people falling and the number of fractures that happen because people are rushing to go to the toilet. It is important to look at a wider strategy instead of just thinking of this as a single issue.

Absolutely. I thank the hon. Member for raising those related issues, which are so important to consider. I will come on to talk about the wider challenge of women’s health being treated without the importance that it requires. I understand that she is attempting to secure a debate on a similar subject, so I wish her the best of luck in that endeavour. Many of us have already heard of this illness and have heard people’s stories. I first learned about it from my constituent Phoebe, who has lived with a chronic UTI since she was three years old. Now in her mid-20s, she has become a tireless advocate for others suffering in silence. She shows remarkable perseverance and strength, even when the pain she lives with is beyond anything I can describe. Phoebe is here with us today, along with a number of other sufferers. It is my absolute privilege to stand in this place and speak for them and every other individual enduring such an awful condition. Will the Minister meet me, Phoebe and representatives of other campaign groups to hear how they have been let down by the system? A chronic UTI is not just a diagnosis; it is at present a life sentence of torture that eats away at every part of a person’s existence. The condition first develops when bacteria from an acute UTI become permanently embedded in the lining of the bladder. Left untreated, the infection becomes entrenched, wreaking long-term havoc on the rest of the body. I want to be absolutely clear: a chronic UTI should not be confused with the recurrent version of the condition. A patient diagnosed with a recurrent UTI might experience one or two infections over a six-month period. Although it is still serious, patients suffering from a recurrent UTI experience distinct intervals of relief from their symptoms. Chronic UTI sufferers live in constant and excruciating pain, with the infection never relenting. They are in agony every single day and every single night. Many sufferers have lived with the condition for decades, with the illness at present incurable. Chronic urinary tract infections can affect anyone at any age, but they disproportionately affect women. At the UK’s only NHS specialist clinic, which I will come on to later, 95% of patients are women; only 5% are men. Individuals living with a chronic UTI are often forced to urinate more than 20 times an hour. I have been told that each time they use the toilet, it feels like they are passing razor blades through their urethra. Their urine is bloody. Their bladders are so tender they struggle to walk, and their bodies are consumed by fever. In many cases, the prolonged infection spreads from the bladder to the kidneys and the bloodstream, causing sepsis, with complications for other organs. I have been told harrowing accounts of the agony caused by this illness. The pain has been likened to corrosive acid burning through the abdomen, glass shards lodged in the bladder and the feeling of mice eating away at the sufferer’s insides. Some liken it to scorching knives slashing forever at their stomach, or a hot cauldron constantly bubbling in their groin. The most common comparison I hear is that people’s bodies are perpetually on fire. To reiterate, the torment never stops—for the majority of patients, it is 24/7. These symptoms destroy lives overnight. The illness renders individuals severely disabled, often forced to live a life of bedbound isolation. The pain is so overwhelming that patients can lose their ability to sleep and become trapped in a cycle of exhaustion. Household chores become impossible, and individuals can lose the ability to care for their children. Sufferers often lose their dream careers, as they cannot function with their symptoms in the workplace. They are unable to work or afford costly bills for private medicine. Young adults living with the condition often have to forgo university studies, with the severity of their agony making their education unbearable. Romantic relationships break down, with at least one case of a marriage of over 40 years ending due to the illness. Sexual intercourse is virtually impossible due to the immense pain. Many people with the condition fear they will never be able to start a family. Patients face an utter loss of independence and, unsurprisingly, depression and suicidal ideation are daily struggles for the chronic UTI patient community. This brings me on to my second ask for the Minister: every healthcare professional in the UK must be properly briefed to recognise and treat a chronic UTI. Since 2022, the NHS website has formally recognised the existence of chronic UTIs, yet I have heard that many GPs and urologists still deny the existence of the illness. Patients suffering from chronic UTIs are left to fight for recognition and are misdiagnosed with conditions such as internal cystitis or recurrent UTIs.

Does the hon. Member agree that part of the issue is the use of antibiotics, to which UTIs are becoming immune? The medical profession cannot keep up with treatments, and there is a case for better education of the general public in terms of sanitisation. I know it is possible to get UTIs in different ways, but it would be helpful to educate and remind the population about sanitation.

The hon. Member is absolutely right. Many of our modern medicine practices are designed around avoiding the build-up of antibiotic resistance. The intention is to allow high-dose, effective antibiotics to be available when required, yet so many sufferers tell us that when they go to the doctor because they require those antibiotics, they are denied them. If this is not a case where those effective antibiotics must be used, even though resistance must be avoided, there cannot be a better example of the mismatch between intention and practice. I will come on to that in more detail, but I thank the hon. Member for making that point. The misdiagnosis of chronic UTIs does not lead to effective treatment and compounds sufferers’ agonising pain with awful frustration. At their most vulnerable and weak, they are being forced to prove that what is happening to them is real. That is Kafkaesque, and it is totally wrong. The key problem appears to be that specific National Institute for Health and Care Excellence guidelines do not exist for chronic UTIs in England, and Scottish Intercollegiate Guidelines Network guidelines do not exist for the condition in Scotland. NICE guidelines for acute and recurrent UTIs exist, but as I have outlined, they are not fit for purpose for this chronic condition. How can GPs and urologists provide and recommend proper care, as the first point of contact with the patient, when there are no clear clinical guidelines? Without guidelines, many medical professionals are practically blind to the condition. They cannot prescribe the right antibiotics to relive patients’ pain because chronic UTIs are not even on their radar. Chronic UTI specialists do exist, and they recognise the condition and can help treat symptoms, but without proper guidance GPs and urologists, unintentionally or not, block patients from reaching them and refuse their requests for referral. Many chronic UTI sufferers have post-traumatic stress disorder from their interactions with medical professionals, never mind the suffering from the condition itself. I have heard stories of patients being essentially gaslit by medical professionals, told that the concern is all in their heads, denied antibiotics and given antidepressants instead. It seems that some GPs and urologists have dismissed the illness as a women’s problem and have told patients just to deal with the pain. That is not medicine; it is misogyny. I urge the Minister to push for the creation by NICE and SIGN of guidelines on chronic UTIs that are distinct from those on recurrent UTIs. That is long overdue and will hopefully bring to an end those kinds of interactions between suffering patients and GPs, but that alone will not be enough. There have to be better treatment offers for chronic UTI patients further down the pipeline. Right now, there is just one NHS specialist clinic in the entire country: the lower urinary tract symptoms clinic at Whittington hospital in London—one clinic for a nationwide illness. It offers fantastic support for patients, but waiting times are too long. We all know that waiting lists are far too high across the NHS— I commend the Government for their approach to bringing waiting lists down generally—but for chronic UTI sufferers forced to compete for the time of a solitary clinic, the effect is even more pronounced. Sufferers wait months, even years, for help if they are lucky enough to secure a referral in the first place. Even once patients get to the clinic, relief is still not guaranteed. The LUTS clinic offers long-term, high-dose antibiotics that can treat the symptoms, but they bring only partial relief, leaving many dragging themselves through life exhausted, drowsy and still in pain. That is not really living; it is enduring. Worse, the antibiotics do not work for everyone: about 30% of patients cannot tolerate them at all. Imagine the despair of being in that 30%. The situation would be scandalous enough if it were simply the case that, in desperation, many chronic UTI patients turned to private healthcare, spending thousands of pounds that they do not have just to access the bare minimum of care, but it is more awful than that. Some are forced to go to even more extreme lengths and choose risky, experimental procedures just to lessen their suffering. They fly abroad and pay unlicensed doctors more than £30,000 to have their bladders surgically removed. Let me say that again: people are choosing to have their organs ripped out in foreign countries because mainstream healthcare in the UK offers them nothing. For some, those risky surgeries offer relief, but for many the infection is already in their kidneys, and they return from the operation bladderless and with multiple complications. Some suffers, with few options left, make a choice that should haunt us in this House. Rather than live another day like that, they take the most extreme choice of all: to take their own life. That is not how people should be living in modern Britian, and that is why we should spare no expense in researching better treatments and, of course—as so many dream—a cure. I argue that the Government have an obligation, no matter the prevailing economic circumstances, to expedite the day that that becomes a reality. Promising medical trials already under way in the UK show real potential to transform how we treat chronic UTIs. Those treatments are ready to progress to human trials; the only thing standing in the way is funding. I urge the Minister to look into the roadblocks to getting more funding to the trials, and to come forward at the earliest opportunity with a plan to put conditions that are under-diagnosed and under-prioritised, such as chronic UTIs, at the front of their research agenda for this country’s biomedical research industry. I would be happy to put the Minister in touch with some of those working at the cutting edge of treatment in this field. I have told the story of chronic UTI sufferers and their longing for relief—a relief the Government can help them seek if they back their cause—but I remind the House that the condition exists in a much wider context: health issues that mainly impact women are consistently neglected and routinely dismissed. We know that women wait longer in accident and emergency departments. We also know that just 5% of global health research goes towards conditions that exclusively or disproportionately affect women. Even though 15% to 20% consult doctors for chronic pain, it was only this year that the Royal College of Obstetricians and Gynaecologists introduced an optional training module on chronic pain for trainee doctors. Inquiries such as Paterson and Cumberlege laid bare the systemic failures in how women’s health is treated in this country, but implementation and cultural change have lagged far behind the words. I have wondered many things since I first heard stories of chronic UTI sufferers, but nothing has unsettled me more than the lingering thought that if more men were affected by the disease, we would have had better treatments decades ago. That is an oft-used cliché but it comes up time and again. The Minister has heard today about the scale of unimaginable pain that those with chronic UTIs experience. She has heard about the broken diagnostic system that stops too many sufferers getting the help they need. She has heard about the roadblocks to developing better treatments that are standing in the way of relief. I simply reiterate my asks. Will she and her officials meet me and these brave sufferers to hear more about the specific actions that the Government need to take to clear the roadblocks? Will they commit to pushing for the NICE guidelines to be brought up to date to reflect the latest understanding of this disease? Will they outline what steps they are taking to combat the wider problem of the neglect of women’s health issues? Chronic UTI sufferers deserve so much more.

09:46:00

It is an honour to serve under your chairship, Sir Desmond. I am not well today for the very reason that we are here. I may need to sit down during my speech if that is okay. I am deeply grateful to the hon. Member for Sutton and Cheam (Luke Taylor) for securing this incredibly important debate. [Interruption.]

This is a difficult subject for those who suffer from this condition. I will give an example in my speech, as one of my staff members suffers from it. We are deeply indebted to the hon. Member for Sutton and Cheam (Luke Taylor) for bringing this forward. It is important to hear personal stories from sufferers, such as the hon. Member for Stoke-on-Trent South (Dr Gardner), and that they are given the opportunity to express themselves on the importance of this issue to them personally and to all our constituents.

As hon. Members may have guessed, this debate is not only important to thousands of women across the country—according to the Chronic Urinary Tract Infection Campaign, about 1.7 million women suffer from chronic UTIs—but incredibly personal to me. I have suffered from UTIs as a result of menopause for more than 10 years, and received a diagnosis of chronic UTI in 2023. I do not think many people realise how debilitating and excruciating chronic UTI can be. At my worst, I wondered how I could go on. I even changed from a beloved lecturing job to one at NICE because I wanted to change things from within, and it is why I am an MP now. I have tried almost everything; I was even considering—as a final step before the final, final step—having my bladder removed. Although my NHS consultant gave me Hiprex—methenamine hippurate—thank God, which is life-changing for me, he finally shrugged his shoulders and said that I would just have to live with this condition. In desperation, I tracked down a specialist who worked in private practice. How lucky I was to have the money. I can confidently claim that Dr Catriona Anderson saved my life, which I do not say lightly. Chronic UTIs can lead to hospitalisation—I have been twice—and sepsis and death. I have a long list of all the drugs that I am on, but I will not read it out. I believe this is another case of how women’s medical conditions continue to be misunderstood, under-researched and underfunded. To illustrate that point, there is a belief that UTIs are more serious in men than in women. I acknowledge that men’s physiology—men have a longer urethra than women—means that they are less likely to develop a UTI, although the possible presence of an enlarged prostate means that they may experience restrictive urine flows and develop a UTI. That is certainly the case in older men. Consequently, all men are recommended seven-day courses of antibiotics compared with the three-day courses that women are recommended. By the way, there are three antibiotics to treat UTIs. Trimethoprim and nitrofurantoin are the top ones, but I am allergic to them, so I am on cephalexin when I need it. There is a lack of acknowledgement that poorly treated UTIs can lead to bacteria becoming embedded in bladders. Incidentally, a much shorter journey in women means that the diligence afforded to men is not afforded to women. In addition, women’s immune response to pathogenic bacteria in the bladder is oestrogen-dependent, and so it is also age-related. Lack of official recognition of chronic UTIs means that women do not receive treatment equal to what men. I am a molecular biologist, but I will not bore Members by setting out the different types of receptors in the urethral lining of the bladder. I will further illustrate this point in simpler terms. A campaigner told me how her doctor, who repeatedly prescribed her three-day antibiotic courses for her chronic UTI, prescribed her husband, when he presented with a UTI for the first time, a month-long course, which would entirely clear the infection, of course, and minimise risk of recurrence. That says it all. Incidentally, chronic prostatitis is recognised by NICE. As has been mentioned, for many women—approximately 70%—three-day courses will be sufficient, but for rest of women, three-day courses clear only some bacteria. Those that remain are relatively resistant; they then increase in population and there is recurrence. Essentially, repeated short courses establish a system of natural selection for resistant bacteria. It also means that the remaining bacteria then have time to invade the bladder and become embedded, finally leading to chronic UTIs. So, patients are stuck in a loop. The use of the useless urine dipstick test, which is no more accurate than the toss of a coin, and of the midstream urine test, which is even worse, means that infections go undetected. As a result, no antibiotics are prescribed until the infection gets worse and, finally, a short course of antibiotics is prescribed. However, the infection is still not fully cleared, so the loop starts again. The infection then becomes embedded in the bladder wall and chronic UTI develops. Short-term antibiotic courses often do not treat chronic UTIs, because dormant populations of bacteria exist within the bladder wall. Your life revolves around desperately trying to convince doctors to prescribe a course that you know will work for you. I am due to move house soon and I am petrified of having to move GPs, which would mean again starting this battle of trying to convince a GP to take me seriously. I understand concerns around antibiotic resistance and the medical hesitancy in prescribing longer courses of antibiotics. However, the solution is not to minimise antibiotic use; it is to get the diagnosis right, treat thoroughly, recognise the existence of chronic UTIs and prevent their development. I am concerned by the lack of research and guidelines for diagnosis and treatment of chronic UTIs. We could prevent them all together if we get things right. I am particularly excited by the UTI vaccine, which is not currently available in the UK. Prevention of UTIs would not only save the NHS countless hours and money, but save people from living miserable lives. In April, the Minister for Care said in a response to a written question: “there are no current plans to train GPs and urologists on recognising the symptoms of chronic UTIs”. Also, current NICE guidelines do not contain guidance for chronic UTIs. This situation must change. Too many women are being left in unbearable pain without a proper diagnosis or appropriate medication. I will be very quick now, Sir Desmond; you have been very patient with me. About 50% of all antibiotics are prescribed for UTIs. However, each year there are thousands of deaths from UTIs and approximately 200,000 A&E admissions are due to UTI-related illnesses. The cost of UTIs to the NHS, as well as to people’s lives, is huge. This issue is personal for me. It is also personal for the millions living with the pain, frustration and isolation of chronic UTIs. Will the Minister meet me and others, including campaigners, to discuss how we can improve diagnostic tools, develop guidance and ensure that people suffering from this condition receive the care that they deserve? Thank you for your indulgence, Sir Desmond.

09:54:00

It is a pleasure to serve under your chairship, Sir Desmond. I commend the hon. Member for Sutton and Cheam (Luke Taylor) on his presentation of this debate on subject matter that some, such as the hon. Member for Stoke-on-Trent South (Dr Gardner), have personal experience of. Others, including me, have staff members who have had this condition, and some have family members who have had it—I understand that my friend the hon. Member for North Down (Alex Easton) has experienced that. This is an opportunity to speak on behalf of sufferers in my constituency of Strangford and across this great United Kingdom of Great Britain and Northern Ireland. The NHS estimates that some 14 million people in the UK experience some form of urinary incontinence. That figure is expected to rise because of an ageing population with often very complex health issues. That is a fact of life. Those of a certain age—I am one of them—find that their health issues are multiple. That is the nature of age; it takes its toll. Inadequate continence care can lead to serious complications, with urinary tract infections among the most common and concerning outcomes. NHS data showed that there were more than 1.8 million hospital admissions involving UTIs between 2018-19 and 2022-23. The majority involved patients aged 65 or older. The admissions include both those directly caused by UTIs and those for other reasons but where a UTI was also present. As a leading cause of emergency admissions, UTIs place substantial strain on NHS resources, while diminishing patients’ dignity, experiences and outcomes. I wish to highlight that this issue affects both men and women, as well as children. The hon. Member for Sutton and Cheam referred to a three-year-old girl, so children are affected by chronic UTIs. A member of my office staff, one of our young girls, came to work with me when she was 16. She has been there for a long time, so I must be doing something right; she has not left me to go elsewhere where the money is better. Perhaps the conditions and the time off are better as well. I understood the chronic pain that my staff member had, but also the need to be flexible at times—whenever she was not well, she obviously needed time off. She attended a fair few hospital appointments for a chronic UTI, and it was a very difficult time. She was on antibiotics for six months. I wondered, “Is that possible?” But in this case it was, because the infection was so chronic. Ultimately it cleared. Also, on 1 January this year she got married, so her life is going in the right direction now—thank goodness for that. The issue was exacerbated at the time by the difficulty of getting GP appointments and specialist referrals. The chronic pain just seemed to exist forever, even with the help of antibiotics. Eventually she got to the end of that six-month period and she is now in much better health. I want to mention what we are doing in Northern Ireland, because obviously that will be part of any debate in which I speak. In Northern Ireland we have something, and perhaps the Minister will say to me in a few minutes, once I tell her what it is about, “Well, we’re already doing that.” If they are, that is good. I was very relieved when Northern Ireland rolled out the Pharmacy First scheme, especially as the scheme covers advice and treatment for uncomplicated urinary tract infections in the local pharmacy, so without having to wait for a GP appointment. If the Minister tells me that the Government have not done that yet, can I say that it is another Northern Ireland first? And if the Minister is not aware of it, may I say, to be helpful in this debate, that perhaps it should be done here as well? The pharmacist may test the patient’s urine to help to determine whether a UTI is present. How does the scheme work? What happens when a person goes to their local pharmacy in Northern Ireland? In some cases, self-care advice may be all that is necessary. In other words, they will get a bit of advice. The pharmacist will find out what the symptoms are and explain the situation to the person, and perhaps will be able to respond fairly quickly. As I said, in some cases self-care advice may be all that is necessary, but the community pharmacist is also able to supply the patient with medicines to relieve pain—in some cases there can be chronic pain—and, if applicable, antibiotics. In all cases, women will be advised on what to do if their symptoms worsen or do not resolve. The Pharmacy First UTI service means that women can be assessed and treated much sooner, without having to wait for a GP appointment—like the young girl in my office—for a month, two months, six weeks or whatever the case may be. Not only will patients not need an appointment, but community pharmacies are more likely to be open after normal working hours, at weekends and on bank holidays. Newtownards, my major town, has a number of pharmacies, which take turns staying open at the weekend; there is always access to a pharmacy in Newtownards and, indeed, other major towns in the Province. The UTI management service expanded to more than 400 community pharmacies in 2024-25, following positive evaluation of the pilot, which involved 60 pharmacies and started in July 2021. That success convinced the Northern Ireland Department of Health to make the pilot bigger and showed that we could do more. Between March 2022 and April 2023, 3,500 women in Northern Ireland used the pilot service. Following assessment, more than 85% were diagnosed with a UTI and received appropriate advice and treatment from a pharmacist. That is positive, but for those with chronic UTIs, like the hon. Member for Stoke-on-Trent South, the pharmacy does not cut it and the GP can only do so much. There are different levels of response: community pharmacies in Northern Ireland provide an automatic response to those who have a urinary infection, rather than a chronic UTI, but sometimes things are much more complicated. The waiting list to be seen for a UTI in Northern Ireland is long, and the average waiting time for urology appointments varies significantly, depending on the health and social care trust and the urgency of the case. For example, in the Belfast health and social care trust, the wait in a red flag case—the most urgent—might be nine weeks, which is more than two months and far too long; a non-urgent case could wait 76 weeks, and a routine case could wait 180 weeks. Those are horrendous and completely unacceptable waiting times. Throughout the United Kingdom of Great Britain and Northern Ireland, there needs to be access to specialised care, innovation, new and modern technology, and new ideas, rather than a six-month course of antibiotics and a hope for the best. Men, women and children need more, and it must be provided. I look forward to the Minister’s response. She responded positively to last week’s debate, and I am sure that today she will again indicate her wish to make lives better. This debate gives her the opportunity to do so, and to help those who have been waiting so long for an end to their health issue. We can do better—and we must.

10:02:00

It is an honour to serve under your chairmanship, Sir Desmond. I thank the hon. Member for Sutton and Cheam (Luke Taylor) for securing this important and emotional debate. I also thank other hon. Members who have made contributions on this deeply upsetting subject, as well as the members of the public who have travelled to be in the Gallery. Having heard about this condition, I know that some of them must have had incredibly difficult journeys to get here, so I thank them for their efforts. Research from 2019 showed that 83.3% of cases of reported UTIs in primary care involved women, and that UTIs were most common in women over the age of 65, as we have heard. In 2023-24, there were 679,399 hospital admissions involving a UTI diagnosis. Hon. Members have touched on suicidal ideation, and it is important to note that suicides have happened as a result of the suffering caused by this condition. It is therefore imperative that it is taken seriously and that we act on it. Suffers are bedbound, unable to work, unable to sleep and unable to leave the house or socialise, all while they experience debilitating pain. A Watford constituent of mine has had to give up her job at a school, where she worked for more than two decades. Imagine what that feels like when our lives are so defined by the careers we undertake. It is nothing short of tragic. The condition has impacted her personal life as well, and she had to take remedial action even to attend her own daughter’s wedding. What sufferers want is, first, the development of effective pain relief, which goes without saying, given the contributions that have been made already; secondly, research and funding for new and speedy treatment options; thirdly, the introduction of accurate testing at primary care level; and finally, as has been touched on, a meeting with the relevant Minister so that she can fully understand the nature of living with this condition. Overall, what they want can be defined as a cure.

10:05:00

It is a pleasure to serve under your chairmanship, Sir Desmond. It is also a pleasure to see the Minister in her place. I thank my hon. Friend the Member for Sutton and Cheam (Luke Taylor) for securing today’s debate and for being a champion for both his constituents and the wider population suffering with UTIs. Although I will not mention all the contributions this morning, I must mention that of the hon. Member for Stoke-on-Trent South (Dr Gardner), whose speech was not only passionate, but well informed and very personal. It is the hardest thing to share a personal story, and I commend her for her bravery this morning. Urinary tract infections are far more common than many realise and far more serious than many assume, and women are 30 times more likely to suffer from a UTI than men. They are agonising and can, in some cases, even be fatal. Between 2018 and 2023, 1.8 million hospital admissions in England involved UTIs, not to mention the no doubt countless GP appointments. Chronic urinary tract infections, where symptoms do not go away, are a particularly distressing form of this condition. My hon. Friend the Member for Sutton and Cheam spoke about sufferers being in bedbound isolation and unbearable pain, preventing them from living their lives and often from attending important family events and moments that should be celebrated, because this condition can be so debilitating. Short courses of antibiotics often fail, and urine tests can come back negative, even when the patient is in clear discomfort. That is because chronic UTIs can be caused by bacteria entering the lining of the bladder, which makes them much harder to detect and treat. The diagnostic tools available to us are simply not good enough. Midstream urine cultures are still considered the gold standard for diagnosing acute UTIs, but recent research shows that MSUs miss a wide range of bacteria, which leaves many sufferers undiagnosed, untreated and often feeling disbelieved. Like most women, I am grateful that I do not suffer from regular UTIs, although I do remember the panic as a child when I was in absolute agony. I do not know whether this is oversharing, but I remember my mum running in with a milk bottle of cold water to pour on me while I went to the toilet, just to take an element of that pain away for me, as a young child experiencing something I did not understand. I have seen how a UTI can be particularly debilitating for those living with dementia. I experienced that with my nana during her final years. She could not identify that she was experiencing pain, so it fell to us, as her family, to recognise the symptoms. Her carer would test her urine most days, as she became so prone to infections. Those can cause sudden and alarming changes in behaviour, known as delirium, which is often exhibited as confusion, agitation, hallucinations or sudden withdrawal. My nana ended up being hospitalised for some severe UTIs in her final months. Her hallucinations were quite often enjoyed by the family, and I particularly remember one where she was very cross at me for coming to her hospital late at night with an entire choir, singing to her and waking up the whole ward. That obviously did not happen, but in her delirium she was absolutely convinced that I had not respected her sleep. Such symptoms are often mistaken for the progression of dementia, leading to the underlying UTI going uncured. Social care has a key role to play in UTIs, but only 45% of care workers receive any sort of dementia-specific training. We were incredibly lucky that the carer we had for my nana was dementia-trained and recognised the signs of UTIs before they got too bad. Families are also vital in this process, especially when someone cannot advocate for themselves. As my hon. Friend the Member for Sutton and Cheam mentioned, when patients are so exhausted from having to fight a system that does not believe them, families often have to step in and be their advocates. People cannot do this alone. Too often, UTIs are dismissed as short term or minor, but for many people, particularly those with underlying conditions, they are anything but. We welcome the NHS’s recognition of chronic UTIs as a legitimate condition since 2022, but too many people still suffer in silence or are dismissed, misdiagnosed and left without adequate support. That is why we urge the Government to explore ways to improve diagnosis, particularly for chronic UTIs. Further research is desperately needed. The Liberal Democrats are calling for a significant expansion in the capacity of the Medicines and Healthcare products Regulatory Agency, and for a comprehensive agreement with the European Medicines Agency. We must ensure that new treatments can reach UK patients without delay, especially as we currently rely on three different strands of antibiotics to treat UTIs, as the hon. Member for Stoke-on-Trent South said. Those who suffer regularly are at risk of developing antimicrobial resistance, which then makes treatments less effective. If they are also allergic to certain strands, they are incredibly limited in the antibiotics they can receive. The hon. Member also mentioned that there is a UTI vaccine in other countries, which I am very interested in. Continuity of care is equally important. Everyone with a long-term condition such as a chronic UTI should have access to a named GP. That would help to build understanding, avoid delays and improve outcomes, especially for those whose symptoms may be dismissed or misunderstood. Lastly, I want to touch on the role of community pharmacies, which the hon. Member for Strangford (Jim Shannon) mentioned. The Pharmacy First scheme, which was introduced in England in January last year, has the potential to relieve pressure on GPs and to provide quicker treatment for uncomplicated UTIs, but many pharmacies are struggling to meet the consultation targets required to access funding. Ongoing financial and operational pressures are undermining the very service that we need to provide, and in the year to date we have lost the equivalent of four community pharmacies a week. My questions to the Minister are as follows. What steps is her Department taking to support community pharmacies in delivering the Pharmacy First service, especially those struggling to meet the increase in consultation targets, and to ensure that patients with UTIs can access timely, local and effective care? Pharmacy First is currently available only for those with UTIs between the ages of 16 and 64. Is there a plan to widen that age range? Given the known limitations of current testing methods, will the Minister also outline what steps are being taken to ensure that better diagnostic tools are made available? Is there any plan to introduce a UTI vaccine? Finally, will chronic UTIs be included in the 10-year health plan, and is that still on track to be published in June?

10:13:00

It is a pleasure to serve under your chairmanship, Sir Desmond. I congratulate the hon. Member for Sutton and Cheam (Luke Taylor) on an excellent speech that graphically explained how this condition has a horrific impact on those who suffer with it. I also congratulate him on securing this important debate to raise awareness. As we have heard, urinary tract infections are common infections affecting the bladder and kidneys, and the tubes connected to them. Anyone can get them, but they are particularly common in women. The NHS estimates that 14 million people in the UK experience some kind of urinary incontinence, too, a figure that is expected to rise due to an ageing population. Most urinary tract infections, although painful, clear up in a few days and can be treated with antibiotics. The earlier a urinary tract infection is identified, and the earlier a patient can receive appropriate treatment, the more they will be able to manage their condition, maximise their quality of life and reduce the risk of chronic infection. For many, UTIs are not a fleeting inconvenience but a chronic, recurrent, life-limiting illness. Short-term antibiotic treatments fail, standard urine tests might not detect infections, and persistent symptoms can severely diminish a patient’s quality of life. I hope this debate will raise awareness of the issue of chronic UTIs, which some patients have said have shaped their whole lives. We know that women are 30 times more likely to get a urinary tract infection than men, and that UTIs are agonising and occasionally fatal. NHS data shows that there were over 1.8 million hospital admissions involving UTIs between 2018-19 and 2022-23. UTI rates increase when women reach 45 and are in the perimenopause. Studies suggest that over half of all women will experience a UTI at some point in their lives, with many enduring recurrent infections. There are several physiological and hormonal factors that make women more susceptible to UTIs, including that they have a shorter urethra than men. Hormonal fluctuations during menopause lead to a decrease in protective vaginal flora, making older women more prone to infections. Pregnancy’s shifts in hormones and pressure on the bladder also exacerbate vulnerability. The Chronic Urinary Tract Infection Campaign estimates that up to 1.7 million women suffer from chronic UTIs, yet as we heard, this is a neglected area of research—indeed, women’s conditions in general are not as researched and treated as they ought to be. The last Government recognised the need to target women’s health conditions specifically and launched the women’s health strategy in 2022, which was successful in tackling issues that disproportionately affect women. Will the Minister commit to the continuation of that programme? I want to briefly discuss children—I should declare that I am a children’s doctor in the NHS. The hon. Member for Sutton and Cheam talked about his constituent, who was three when symptoms first occurred. Urinary tract infections are common in children; symptoms vary in severity and treatment requires different approaches depending on age, sex, and each individual patient’s condition. There are NICE guidelines on this issue, which also recommend imaging for children with UTIs, including a DMSA scan and an ultrasound depending on their condition. Can the Minister say what she has done to assess the number of children being treated for UTIs, the waiting times for scans, and whether there are sufficient radiology staff to both perform and report these procedures within the timeframes recommended by NICE? The Government have recently pointed to research being carried out by NHS England, along with the industry, to horizon-scan for new innovations in point-of-care tests for diagnosing UTIs, in order to guide better treatment options. With the impending abolition of NHS England, will that research continue, and if so, who will now be responsible for leading it? In 2023, the Department of Health and Social Care, NHS England and the UK Health Security Agency launched a campaign to raise awareness of UTI symptoms and available NHS treatments. Will the Government continue that initiative, to ensure ongoing public awareness of UTIs and prevent hospital admissions? Has the Minister evaluated that campaign’s success in improving early detection, reducing hospital admissions and reducing the incidence of chronic UTIs? For those suffering from UTIs, their first point of contact with the healthcare system is often their local pharmacy. Those services are conveniently located in the heart of many communities and are staffed by highly skilled professionals with years of experience under their belts. As we have already heard, the previous Government launched the Pharmacy First initiative, through which community pharmacists can treat women aged 16 to 64 with uncomplicated UTIs, offering rapid treatment and advice. A report from the Company Chemists’ Association in January 2025 found that nearly a third of all Pharmacy First consultations each week are for urinary tract infections. What assessment has the Minister made of the impact of Pharmacy First on people affected by UTIs and other common conditions? My hon. Friend the Member for Farnham and Bordon (Gregory Stafford) has called on the Government to provide financial incentives for GPs to work with community pharmacies to support referrals into Pharmacy First. As the spending review draws near, will the Government consider that proposal, so that more people affected by UTIs can access support from Pharmacy First? At the time of its inception, concerns were raised about the Pharmacy First initiative, relating to an increased risk of antimicrobial resistance to standard antibiotics. Now that it has been running for a year, does the Minister have any assessment of whether that is a risk that we should continue to be concerned about? The Chronic Urinary Tract Infection Campaign estimates that 20% to 30% of patients do not improve with initial antibiotic treatment. What research are the Government planning to carry out to see what further treatment can be offered to those patients? The hon. Member for Sutton and Cheam raised the issue of NICE and SIGN guidance. I can say as a clinician that both are very useful to doctors and other clinicians in guiding their practice, and they are written by experts in the field. Does the Minister plan to speak to those running NICE about whether specialists in this field could come up with some consensus-based, evidence-based guidance on chronic UTIs? As we have heard today, that could support patients who are suffering terribly. I want to touch on continence care. Adopting a personal, clinician-led approach to product provision can allow users to manage their conditions and lead to improved outcomes for both patients and the wider healthcare system. What steps are the Government taking to prioritise patient dignity and outcomes in continence care? The Government have also stated that support for those affected by UTIs is currently commissioned by integrated care boards. However, we know that ICBs are facing budget reductions of 50%, and many are planning to merge over the next two years. Can the Minister confirm whether the responsibility for supporting those affected by UTIs will remain with ICBs, or whether she intends for this function be transferred elsewhere? To close, UTIs can be managed with increased public awareness of symptoms and treatment, early diagnosis, preventive measures, research and improvements in NHS care. We have heard how life-changing that could be for many, particularly women. All those factors could reduce the burden of chronic and recurrent infections and ensure that every patient receives the care they deserve. I hope the Minister will take all this into account, because she could help to alleviate the suffering of many women and other people.

10:21:00

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.

10:35:00

I start by thanking the hon. Member for Dudley (Sonia Kumar) for her contribution to the debate on the broader health inequalities for women, and I wish her the best of luck in securing the debate that she seeks. I thank the hon. Member for Strangford (Jim Shannon). He talked particularly about the strain on NHS resources that is caused by the lack of attention on this condition, which further compounds the challenges and backlogs in the system. I thank the hon. Member for Watford (Matt Turmaine) for his account of the impact of this condition on his constituent, who had to give up her job; that shows the terrible impact it has on people’s lives. I thank my hon. Friend the Member for Chichester (Jess Brown-Fuller) for talking about the challenges around the antibiotic regime, including antibiotic resistance, and the complexity of that issue. I thank the hon. Member for Sleaford and North Hykeham (Dr Johnson) for her contribution. Her focus on the treatment of children was particularly instructive, because, as we have heard, the challenge is stopping a UTI becoming a recurrent UTI, which then becomes a chronic UTI. That is a real focus on that in the treatment of children. There is also a focus on Pharmacy First to help by stopping UTIs in children from becoming an issue in the first place. That was a particularly insightful point. I also thank her for bringing her knowledge as a doctor to the debate. I thank the Minister for confirming that she will meet me and campaigners to further discuss the issues. However, I do not think that she gave a specific answer on how NICE and SIGN guidance would be updated to incorporate guidance on UTIs, but we can discuss that later, and I apologise if I missed it. However, I will really focus on the contribution from the hon. Member for Stoke-on-Trent South (Dr Gardner). She spoke heartbreakingly about her experience of this condition and about how it has driven her into politics. I look forward to working with her to try and raise awareness of this issue and keep it current, and to try to understand how we can help her and the incredibly brave campaigners who brought the condition to my attention, so that we can really see some action on all the various streams of work that we can propose in this place. Once again, I thank the Minister for being here to listen to the stories of sufferers and for responding to my points. I thank all hon. Members who took part in this debate, particularly pay tribute to the hon. Member for Stoke-on-Trent South for her bravery. I also thank campaigners, including Phoebe, who is in the Public Gallery today. Their strength and resilience have given us a chance in this place to try to take clear action to give them their hope back. Question put and agreed to. Resolved, That this House has considered chronic urinary tract infections.

10:38:00