1,700 are denied hip and knee ops – even after GPs beg NHS
THE reality of NHS rationing means soaring numbers of patients are being denied hip and knee surgery – despite ‘begging’ letters from their doctors, an investigation has found.
Nearly 1,700 ‘exceptional’ requests were turned down by health trusts last year, up 45 per cent on 2016/17.
GPs and consultants are increasingly having to put in special requests for patients to undergo procedures which were once carried out as a routine.
Many trusts – Clinical Commissioning Groups – will only let patients have hip or knee surgery if patients are unable to sleep or are constantly on painkillers.
If patients don’t fulfil the criteria, their doctor must fill out a form, an exceptional or individual funding request, proving they still deserve the op.
This is then judged by a panel of healthcare workers and managers who meet once a month to decide on all cases without ever meeting patients.
Medical leaders say they are ‘appalled’ that doctors have to beg for operations on patients’ behalf which were once routinely provided by the NHS.
Freedom of Information requests by the BMJ to the 195 Clinical Commissioning Groups in England show that 1,675 of these requests were rejected in 2017/18. This was up from 1,155 in 2016/17 and some health trusts turn down more than 90 per cent of all requests.
The responses from 167 of the 195 CCGs show the number of requests being made by doctors has risen by 50 per cent in a year as the criteria has become increasingly strict. A total of 16,169 requests were put in during 2017/18, up from 10,598 requests in 2016/17.
This means an average of one in ten requests were rejected across England although there was considerable variation. Rotherham in South Yorkshire rejected all hip surgery requests last year while Doncaster CCG, also in South Yorkshire, turned down 96 per cent of knee surgery requests. Ian Eardley, of the Royal College of Surgeons, said: ‘Hip and knee surgery has long been shown to be a clinically and cost effective treatment for patients. We are therefore appalled that a number of commissioning groups are now effectively requiring thousands of patients to beg for treatment.’
Ananda Nanu, president of the British Orthopaedic Association, which represents surgeons carrying out hip and knee replacements,
Daily Mail, January 27 said: ‘My concern is that we have elderly, very vulnerable people who are being affected.’
And John Kell, head of policy at the Patients Association, said: ‘ Patients shouldn’t be forced into making a “hail Mary pass” such as trying to use a mechanism that’s really intended for something else to access relatively basic care.’
Jonathan Ashworth MP, Labour’s shadow health secretary, said that the rise in refusals ‘demonstrates the stark consequences of the Tories’ sustained underfunding of the NHS.’ The NHS is under severe financial pressure from the ageing population and the growing toll of lifestyle-related conditions such as diabetes. Local commissioning groups have to meet strict savings targets at the end of each year and as a result they ration routine operations.
Only this week separate figures revealed how half of CCGs were denying patients 45-minute hernia operations unless they were in substantial pain. And an investigation by the Mail in January revealed how three quarters of CCGs were refusing to provide hip and knee replacements to patients who didn’t meet strict criteria. Commissioning groups are also denying patients cataract ops unless patients’ sight is extremely poor. The investigation also showed that Rotherham had rejected 100 per cent of hip surgery applications, 11 out of 11 put in, and 88 per cent of knee surgery applications, which was 28 out of 32 requests. Doncaster turned down 96 per cent of knee surgery requests and 90 per cent of hip surgery requests.
Hull in East Yorkshire rejected 92 per cent of knee surgery requests and North East Essex turned down 70 per cent of hip surgery requests, the probe found. Graham Jackson, cochairman of NHS Clinical Commissioners, which represents CCGs, said surgery didn’t always work. But he acknowledged some CCGs may be overzealous in imposing criteria. He said: ‘There are cases where we have put joint replacements in people that have not improved their outcome, cost money, and created morbidity.’