Individual budgets for people with incontinence: results from a 'shopping' experiment within the British National Health Service

Background and context: most people with urinary incontinence are given limited choice when provided with absorbent products through the British National Health Service (NHS), even though the available range is large.Objective: to investigate users’ preferences for four disposable designs (inserts, all-in-ones, belted/T-shaped and pull-ups) and towelling washable/reusable products, day and night.Design: shopping experiment.Setting and participants: community-dwelling women and men in England with moderate-to-heavy urinary incontinence recruited to a larger trial.Intervention: participants tested each design and selected products they would prefer with a range of different budgets.Main outcome measures: design preferences (rankings); ‘purchasing’ decisions from designated budgets.Results: eighty-five participants (49 men) tested products, 75 completed the shopping experiment. Inserts, most frequently supplied by the NHS, were ranked second to pull-ups by women and lowest by men. When faced with budget constraints, up to 40% of participants opted to ‘mix-and-match’ designs. Over 15 different combinations of products were selected by participants in the shopping experiment. Most (91%) stated a willingness to ‘top-up’ assigned budgets from income to secure preferred designs.Discussion: participants displayed diverse preferences. Enabling user choice of absorbent product design through individual budgets could improve satisfaction of consumers and efficiency of allocation of limited NHS resources.Conclusion: recent policy for the NHS seeks to provide consumers with more control in their care. Extension of the concept of individual budgets to continence supplies could be feasible and beneficial for patients and provide better value-for-money within the NHS. Further research is warranted