Hywel Dda University Health Board (UHB) is transforming support for patients with urinary catheters across Carmarthenshire, Ceredigion, and Pembrokeshire through its Trial Without Catheter (TWOC) Improvement Project and moving care from hospitals to the community.

A TWOC is a procedure used to determine whether a patient can urinate naturally after an Indwelling Urinary Catheter (IUC) is removed. If successful, it helps avoid long-term catheter use and its associated complications.

An IUC is a thin, flexible tube used to drain urine from the bladder when someone is unable to do so independently. While often necessary, prolonged use of indwelling catheters increases the risk of complications such as sepsis, and catheter-associated Urinary Tract Infections (UTIs), which account for approximately 75 per cent of all UTIs. Catheters can also affect daily life by limiting mobility, social interaction, and independence.

Launched in June 2024, the TWOC Improvement Project ensures that every appropriate patient receives a TWOC within 28 days of catheter insertion. Funded by Hywel Dda’s seven Primary Care Clusters, the project also appointed a dedicated triage nurse until February this year to assess referrals and ensure patients are well-prepared before attending clinic.

Community TWOC clinics have now been established across all the three Counties across Hywel Dda UHB. Led by the Health Board’s award-winning ambulatory clinic nursing teams, these clinics have reduced travel time and costs for patients, making care more accessible and convenient.

TWOCs are now being offered in more convenient, local settings, making it easier for patients to get the care they need closer to home. This change means less travel and shorter waiting times, which had been a challenge after COVID-19. The new approach also helps services work better together and improves how IUC care is managed.

Since the project’s launch, the results have been remarkable. Waiting times have dropped from 120 days to just 17. Every referred patient has received their TWOC within 28 days, and the success rate has reached 62 per cent, exceeding both national and global benchmarks.

The project has also delivered significant financial benefits, saving over £98,000 annually in catheter-related costs, with projected savings nearing £500,000 over three years. Additionally, it has freed up capacity in Secondary Care, allowing urology teams to focus on urgent bladder cancer referrals and restore pre-COVID-19 service levels.

The clinics have received outstanding feedback from patients and families, with 100 per cent of respondents reporting satisfaction with privacy, dignity, and overall consultation experience. One family member shared: “The staff had lovely patience with my relative, which made the whole process go very smoothly.”

Another added: “The staff were fantastic with my aunt, her dignity was respected at all times, and the way the staff involved her was much appreciated. I felt they went over and above to make her feel included.”

The project supports the Welsh Government’s vision for healthcare, which emphasises care closer to home, prevention, and reducing health inequalities. By integrating Primary, Community, and Secondary Care, the TWOC model ensures patients receive the right care, in the right place, at the right time.