Community-based Trial Without Catheter clinics helping patients across Hywel Dda
30 July 2025
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% 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, an 86% improvement. Every referred patient has received their TWOC within 28 days, and the success rate has reached 62%, 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.
Emma Cottrell, Clinical Lead Nurse for Ambulatory Clinics at Hywel Dda UHB, reflected on the project’s success: “The Trial Without Catheter Improvement Project has redefined how we deliver timely, effective care for patients with indwelling catheters.”
“Clinical and non-clinical stakeholders came together with a shared vision to co-design and implement a transformative, nurse-led, community-based model across Hywel Dda, turning ambition into action and reshaping the TWOC pathway at scale.
“As a result, we significantly reduced TWOC waiting times, improved patient outcomes, and alleviated pressure on secondary care.”
The clinics have received outstanding feedback from patients and families, with 100% 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.”
Responding to this feedback, Emma continued: “This success is a direct result of the dedication and professionalism of our ambulatory clinic staff, whose compassionate care has been consistently praised by patients.
“I’m also incredibly grateful to the Primary Care Clusters for funding the triage nurse post for one year. This role has been pivotal in ensuring patients are appropriately assessed and optimised before attending clinic. This project is a powerful example of collaborative, value-based healthcare in action.”
The project supports the Welsh Government’s vision for healthcare, which emphasises care closer to home, prevention, and reducing health inequalities. It aligns with national priorities around value-based healthcare, which focuses on improving outcomes while making the best use of resources. By integrating Primary, Community, and Secondary Care, the TWOC model ensures patients receive the right care, in the right place, at the right time.
Jill Paterson, Director of Primary Care, Community and Long-Term Care at Hywel Dda UHB, praised the initiative: “The TWOC Improvement Project has transformed the patient experience across our communities. Patients are now receiving timely, dignified care in locally, supported by a skilled and compassionate nursing workforce.
“This multi-professional, integrated approach is a great example of how innovation in community care can deliver real, measurable benefits for patients and the wider health system. It reflects our commitment to person-centred care and demonstrates the value of services that bring care closer to home.
“By investing in community-led solutions, Hywel Dda is improving lives, reducing pressure on hospitals, and delivering care that truly meets the needs of its population.”
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