NHS warns over knee and hip op ‘rationing’

A WARNING has been issued by NHS England to some clinical commissioning groups over the rationing of hip and knee surgery, it has been revealed.

The (HSJ) reports that an email was sent from an NHS England official to clinical commissioning groups last month.

The intervention comes after a number of CCGs looked to ration hip and knee replacement surgery in a bid to cut costs – including three in the West Midlands.

Redditch and Bromsgrove, South Worcestershire, and Wyre Forest CCGs said they intended to slash the number of people who qualify for hip replacements by 12 per cent and introduce a 19 per cent cut over who is eligible for knee replacements.

This would include only treating “severe to the upper end of moderate” cases, and people who are obese with a body mass index of 35 or over needing to lose 10 per cent of their weight unless their problems were very severe.

Board documents said a “patient’s pain and disability should be sufficiently severe that it interferes with the patient’s daily life and/or ability to sleep”.

But the NHS England warning states the body is aware a “number of CCGs in England are rationing large joint replacements using arbitrary cut-offs from the Oxford scoring system”.

“In addition some CCGs are restricting surgery for smokers and obese people as opposed to a period of slimming support and smoking cessation support for surgery,” the email adds.

Royal College of Surgeons president Clare Marx welcomed NHS England’s warning to CCGs to “discourage clinically unacceptable rationing of surgery in the NHS”.

“There have been growing examples of commissioning groups ignoring Nice guidance and imposing arbitrary pain, weight, or smoking thresholds to defer or prevent patients from receiving timely surgery as a way of saving money,” she said.

“In particular, NHS England has reminded CCGs that patient-specific factors such as smoking or obesity should not be barriers to referral for hip and knee replacement surgery.”

She said making it a condition for a patient to quit smoking or lose weight before gaining access to treatment is “unjust”.

Ms Marx said the guidance in is a “very welcome start” but only criticises the “rationing of hip and knee surgery”. “Patients are left wondering about the validity of restrictions to other types of surgery and NHS treatment,” she added.