Care England Briefing to Members on the UKHSA Report “Understanding the burden of UTI hospitalisations in England”

Summary 

The UK Health Security Agency (UKHSA) has published its analysis of urinary tract infection (UTI) hospital admissions in England for the financial year 2023–24. The findings highlight a significant and increasing demand for acute services, with marked implications for community and residential care providers. 

There were 189,756 admissions with a primary diagnosis of UTI during 2023–24, representing a 9 % increase on the previous year. These admissions accounted for approximately 1.2 million bed-days and are estimated to have cost the NHS over £604 million. The majority of cases occurred in older adults, particularly those aged 70 and above, with women under 50 also showing a higher incidence. 

This data reinforces the need for enhanced prevention, early detection, and effective management of UTIs within care settings to reduce avoidable hospitalisation, improve resident wellbeing, and support antimicrobial stewardship. 

 

Key Findings: 

Admission Volumes and Trends 

• 189,756 admissions in 2023–24 with a primary diagnosis of UTI. 
• 9 % year-on-year increase from 2022–23, though numbers remain below pre-pandemic levels. 
• Average length of stay: 6.4 days, with 34 % discharged within 24 hours. 

Demographic Distribution 

• Older adults (70+) accounted for more than half of admissions. 
• 90+ age group experienced the highest admission rate: 3,367 per 100,000 population. 
• Women represented 61.8 % of admissions overall; in under50s, females accounted for over 90 % of cases. 
• In the 70–79 age group, admission rates for men and women were more evenly distributed. 

Seasonality 

• Admissions were lowest between February and April. 
• Peaks occurred between May and October, suggesting a possible association with warmer weather, dehydration, and related risk factors. 

Clinical and Resource Impact 

• UTIs remain one of the most common causes of antibiotic prescriptions in primary care. 
• UTIs are frequently associated with E. coli bloodstream infections (approximately 51 % of cases). 
• Increasing incidence of antimicrobial resistance (AMR) in UTI pathogens complicates treatment and increases hospital stays. 

 

Implications for Care Providers 

Prevention within Care Settings 

• Hydration management: Structured hydration programmes, particularly during warmer months, to mitigate dehydration-related risk. 
• Toileting and hygiene: Scheduled toileting support and improved personal hygiene practices to prevent bacterial growth and transmission. 
• Prompt recognition: Staff training to recognise early symptoms (increased confusion, changes in continence, or behaviour) for timely intervention. 

Reducing Hospital Admissions 

• Early intervention pathways: Use of local community nursing services, urgent community response teams, or rapid access GP services to treat uncomplicated UTIs within the care environment. 
• Virtual ward support: Participation in local NHS virtual ward schemes to allow hospital-level monitoring in care homes where appropriate. 
• Infection prevention controls: Regular review of catheter use, ensuring removal as soon as clinically appropriate. 

Antimicrobial Stewardship 

• Collaborate with GPs and pharmacists to ensure appropriate antibiotic prescribing. 
• Monitor for recurrent infections, which may indicate the need for specialist assessment. 
• Ensure accurate documentation of suspected or confirmed UTIs to support care continuity. 

Seasonal Preparedness 

• Enhanced hydration and monitoring protocols should be in place from late spring through autumn. 
• Staff awareness campaigns can align with national NHS/UKHSA seasonal messaging. 

 

Strategic Recommendations for Care Providers 

1. Implement structured UTI prevention programmes incorporating hydration, toileting, and hygiene best practice. 
2. Establish clear escalation protocols with community health partners to support early treatment and reduce hospital transfers. 
3. Participate in local AMR initiatives to promote appropriate prescribing and reduce antibiotic resistance risks. 
4. Enhance staff training to improve early recognition, accurate reporting, and infection control measures. 
5. Monitor seasonal risk patterns and prepare targeted interventions during high-incidence periods.

 

Conclusion 

UTIs represent a persistent and preventable cause of hospital admission among older adults in England, with a considerable financial and operational impact on the health and care system. Care providers play a critical role in early prevention, timely identification, and community-based management of UTIs, thereby reducing hospital admissions, supporting antimicrobial stewardship, and improving resident outcomes.