More than half of 110 NHS trusts that responded to freedom of information requests placed a daily cap on incontinence products, according to data cited by a coalition of nursing, health and carer organizations. The limits can leave patients and families buying additional pads when a fixed allowance does not meet an individual's needs.
The findings underpin the coalition's “End the Pad Gap” campaign. Signatories include the Royal College of Nursing, Prostate Cancer UK, Bladder and Bowel UK, The Urology Foundation and Dementia Carers Count. Their open letter was sent to NHS procurement leaders.
The data identifies variation in access and a potential transfer of costs to patients. It does not show that every NHS trust has run out of products, that all capped allocations are clinically inadequate, or that the health service is entering an inevitable collapse. Those broader conclusions would require trust-level and patient-level evidence.
What the Freedom of Information Data Found
The Guardian reported that 53% of the 110 NHS trusts in the freedom of information dataset had a cap on product availability. Among the trusts with a cap, 34% limited provision to three products a day and the remaining 66% limited it to four.
The campaign compares those limits with research indicating that NHS healthcare workers expect to fit up to five pads a day for a person experiencing incontinence. “Up to five” is not a universal prescription. Product type, absorbency, the person's condition, mobility, skin health, care setting and frequency of changing can all affect an appropriate continence plan.
A fixed number can therefore create a mismatch even when products remain in stock. If a person needs more than the allowed quantity, the campaign says patients or carers may have to buy the difference using income such as a pension or Personal Independence Payment. The reporting did not provide a representative estimate of monthly household spending.
Around 14 million people in the United Kingdom experience incontinence, according to the coalition's figures. That population includes people with different causes, levels of severity and care needs. The freedom of information responses cover trust policies, not the individual experience of every person with incontinence in the country.
Why Product Choice and Quantity Matter
Continence products are part of daily care rather than a convenience purchase. An inadequate product or too few changes can contribute to leakage, sleep disruption and skin exposure to urine. Millie Baker, executive director of Bladder Health UK, also described anxiety about odor or visible leaks and the risk that people withdraw from work, relationships or social activity.
Dementia Carers Count says more than half of people with dementia develop incontinence. Its campaign page argues that access to suitable protective products can help carers keep a person comfortable and continue caring for longer. That organization is a campaign participant, so its account documents the concerns it hears from carers rather than measuring clinical outcomes across the NHS.
Royal College of Nursing deputy president Alison Leary said nurses report that rationing prevents them from providing the dignified care patients need. The concern involves staff as well as patients: a nurse or carer working with a fixed allowance may have little room to respond when a person's needs change during the day.
The freedom of information findings alone cannot determine whether patients reused disposable products, faced prolonged delivery delays or developed additional infections. Establishing those outcomes would require incident reports or clinical data rather than an inference from the existence of a cap.
The Coalition Is Asking Procurement Leaders to Change Course
Dementia Carers Count says the open letter asks NHS procurement leaders to stop limiting people with incontinence to a set number of pads per day. The campaign presents the cap as rationing because it can override individual need and require carers to purchase extra products themselves.
The Guardian reported that the government is introducing value-based procurement across the NHS. Under that approach, trusts are expected to consider products that improve quality of life rather than selecting solely on purchase price. The coalition describes the change as an opportunity to improve continence care and reduce burdens on staff and carers.
The campaign is a policy appeal, not a legal finding that the caps breach the NHS Constitution or a duty of care. It calls for procurement changes; it does not announce a legal review or a national minimum already under consideration by Parliament.
The Guardian said NHS England had been approached for comment but did not include a response. The reasons for individual trust policies therefore remain unclear. Budget pressure may be relevant, but the freedom of information figures do not establish the decision process at each trust or whether caps can be adjusted after a clinical assessment.
A National Percentage Does Not Replace Local Accountability
The clearest policy question is whether trusts are using a fixed ceiling or a needs-based pathway. A useful response would identify which organizations cap products, how exceptions work, whether patients receive the right product and absorbency, and how complaints or reassessments are handled.
Further reporting should also distinguish a procurement rule from an inventory shortage. A cap limits what a trust supplies by policy; a shortage means the required products are unavailable. The freedom of information result primarily documents the first problem, even though the practical effect for a patient can still be going without or paying privately.
The 53% figure is significant because it shows that fixed limits were not isolated to one organization. It cannot, on its own, quantify infections, hospital admissions, social isolation or mortality attributable to those policies. Measuring those outcomes would require linked clinical and patient-level evidence.
The case for reform rests on a documented problem: many trusts in the dataset used daily caps below the campaign's cited level of expected use, and some patients and carers bought additional supplies. Publishing trust-level rules, requiring individualized assessment and monitoring the effects of procurement changes would provide a testable route from campaign pressure to better care.