Patients forced to beg NHS to fund cataract or hip surgery

‘Special requests’ for routine ops soar – but half are turned down

‘Reduce the number performed’ ‘Increasing financial pressures’

PATIENTS are having to plead with the NHS for hip replacements, cataract surgery and other routine treatments that were once provided without question, an investigation has found.

There has been a surge in the number of special requests made by doctors on patients’ behalf for procedures to be funded.

In total, some 73,900 requests were made in 2016/17. Out of these, half were rejected as they were not deemed cost effective or beneficial.

The total number of requests has increased by 20 per cent in the past year and by almost 50 per cent compared to four years ago. Many were for treatments that were previously routinely available on the NHS, such as hip and knee replacements, cataract surgery, and procedures to repair damaged nerves or varicose veins.

Those patients whose requests are turned down must decide whether to put up with their pain or pay up to £10,000 to go private.

The situation has come about as local health trusts, or clinical commissioning groups (CCGs), are having to ration procedures considered to be low priority to meet strict financial targets.

Managers are imposing increasingly strict eligibility guidelines to limit the number of patients referred for routine procedures.

In January, four CCGs in the West Midlands produced new rules stating that patients would be offered hip and knee surgery only if their pain was so severe they were kept awake at night. Many others will not fund cataract operations unless patients can prove they are almost blind in both eyes or their quality of life is severely affected.

Mr Stephen Cannon, vice-president of the Royal College of Surgeons, said: ‘These CCGs are unfairly and unnecessarily prolonging the time patients will spend in pain, possibly immobile and unable to carry out daily tasks or work.

‘It is assumed these policies have been put in place to reduce the number of hip and knee replacements performed, and thereby save money for these CCGs. But patients needing surgery will cost the NHS more, in physiotherapy, pain medication and other support, while they wait to find out if they can be referred.’

The investigation by the British Medical Journal used Freedom of Information laws to ask all 209 CCGs about special requests – known as individual funding requests. Responses from 169 CCGs showed that 73,927 requests were made in 2016/17, of which 48 per cent were refused.

The responses show that requests for hip and knee surgery had increased from 49 in 2013/14 to 899 in 2016/17. Cataract surgery requests had trebled in the same period from 359 to 1,034.

Aylesbury Vale CCG and the Chiltern CCG, both in Buckinghamshire, have recently issued guidelines that patients have to make a special request to have any hip or knee surgery.

Rachel Power, chief executive of the Patients Association, said: ‘Individual funding requests were never designed to be used to obtain routine treatment in this way, and these figures clearly show that funding shortfalls are harming patient care.’

Dr Richard Vautrey, acting chairman of the British Medical Association’s GP committee, said: ‘It’s completely unacceptable that local health bodies are placed in the situation of having to ration care, leading to one patient being able to access a service in their area but another patient who lives in another health area, being unable to access the same service.’

Julie Wood, chief executive of NHS Clinical Commissioners, which oversees CCGs, said: ‘Unfortunately the NHS does not have unlimited resources, and ensuring patients get high- quality care against a backdrop of spiralling demand and increasing financial pressures is one of the biggest issues CCGs face.

‘On a daily basis, commissioners are forced to make difficult decisions that balance the needs of the individual against those of the wider population.

‘As a result there are some tough choices that have to be made, which we appreciate can be difficult for some patients.’