NOW YOU’VE GOT TO BE IN AGONY TO HAVE HIP OP
Most NHS trusts now imposing cruel new pain tests in row over ‘rationing’
THREE in four health trusts are denying hip and knee replacement surgery to patients not in ‘enough’ pain.
Sufferers are turned away unless they are judged to be in distress for most of the day, unable to sleep or taking painkillers non-stop.
Under the strict rationing rules, some trusts insist patients must be ‘largely incapacitated’ – in need of a walking stick, a frame or a wheelchair. In other cases the pain must be so intense it is a struggle to carry out basic activities such as washing or dressing.
Campaigners said hip and knee patients were easy targets for cost-cutting.
‘As a result of funding pressure, preconditions for surgery are becoming a common way to make savings,’ said Liz McAnulty of the Patients Association.
‘Restrictions on joint replacement surgery and obliging patients to stop smoking or lose weight before they will be operated on, are becoming ever more frequent. While these may be sensible and desirable actions for people to take, they are not medically necessary, and commissioning groups are increasingly frank that it is all about cost savings.’
An average hip replacement costs £9,000 while a knee replacement is slightly cheaper at about £6,500.
But Ian Eardley, senior vice-president of the Royal College of Surgeons, said the savings would prove illusory.
‘We recognise the NHS is under increasing financial pressure but this does not
excuse these short-sighted rationing policies,’ he said. ‘Hip surgery is one of the most cost-effective medical treatments available.
‘Restricting surgery simply delays the inevitable, simultaneously adding to the overall cost, often prolonging the use of pain relief, severely impacting patients’ quality of life and, particularly among the elderly, increasing the need for social care.’
Rejected patients can be told to try installing hand rails at home, perform stretches or buy special shoes.
They will be considered for surgery only when they have tried these measures for at least six months. However many hospitals allow patients to pay for replacements privately – jumping the waiting list.
The rationing policies have come to light following freedom of information requests by the Mail to England’s 207 health trusts, which are now known as clinical commissioning groups.
Of the 184 CCGs that responded, 73 per cent admitted imposing strict pain thresholds. Cambridgeshire and Peterborough states the pain must be so bad the patient would struggle to stand for half an hour. Wiltshire stipulates the use of a walking stick, frame or wheelchair.
Forty- one CCGs said patients must try ‘conservative’ measures for between three and six months before surgery. These include wearing shock-absorbing shoes,
‘It simply delays the inevitable’
physiotherapy and taking a combination of paracetamol and ibuprofen.
Seventy-seven CCGs said obese patients must try to lose weight before surgery and 31 CCGs said the same of smoking.
If patients meet the criteria – and have tried cheaper treatments for six months – they may have to wait up to another year on a before their operation can finally take place. The Royal College of Surgeons said instead of ‘arbitrary’ rules, trusts should leave doctors to decide whether patients need surgery.
The NHS is under severe financial pressure from the ageing population, migration and the toll of lifestyle-related conditions such as obesity and diabetes. In response, NHS England – which runs the health service – has told commissioning groups to make substantial cost savings.
The restrictions for hip and knee replacements are very similar to those previously used by health trusts to deny patients cataract surgery. Trusts were told to abandon these rules by the health watchdog Nice after the Mail exposed cases where patients were being turned away unless they were nearly blind.
A spokesman for Cambridgeshire and Peterborough CCG said: ‘Policies are under continuous review, are based on the best possible evidence of effectiveness, and are designed to ensure we can offer the best level of treatment within our budgetary constraints.’ Wiltshire CCG did not answer a request for comment.
Hip and knee replacements are two of the commonest procedures on the NHS – with 190,000 undertaken each year. They are mostly performed on patients with osteoarthritis, a joint condition which affects a third of adults over 45. Caroline Abrahams of the charity Age UK said: ‘It is deeply concerning that older people are being made to wait for surgery that would help them live independent lives free from pain.
‘Delaying recommended treatments can cause huge physical and emotional distress, and risk letting people’s health deteriorate while they wait. We recognise that NHS budgets are under huge pressure but it is essential that older people who need operations are able to get them within a reasonable timescale.’
Have you been denied a hip or knee replacement? Please email operations@dailymail.co.uk