Patients are forced ‘to beg’ for hip and knee surgery

Health bosses admit more operations being denied on the NHS because ‘the money has run out’

HIP and knee patients are increasingly being denied operations on the NHS, figures reveal, as health bosses admit “the money has run out”.

A study in the British Medical Journal has found the number of procedures being refused by local NHS chiefs went up by 45per cent last year.

The restrictions have been criticised by the medical community, with the Royal College of Surgeons saying patients have been left to “beg” for treatment or pay for it themselves.

Under NHS rules, doctors must make so-called “exceptional funding requests” from local commissioners when they refer patients for hip or knee surgery.

Freedom of Information requests show that last year, at least 1,188 funding requests for knee procedures and 487 hip surgery requests were denied.

The funding request system was originally introduced to limit access to costly non-essential procedures, such as cosmetic surgery, but cash-strapped commissioners are now applying them more widely to preserve budgets.

The new study shows that while some local areas are rejecting about 18per cent of hip and knee requests, others reject nearly all.

Ian Eardley, senior vice-president 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.”

He added: “The use of funding requests means patients will spend more time in pain with potential deterioration of their condition, thereby generating further costs for a system already under acute financial strain.”

Local NHS leaders have said that the winter crisis and long-running financial pressures had contributed to the rise in patients being refused knee and hip surgery in the past year.

Meanwhile, doctors complain that applying for exceptional funding causes stress for them and their patients, while restricting operations affects surgical training.

Julie Wood, chief executive of NHS Clinical Commissioners, the organisation for local health bodies, said: “The money has, in effect, run out, and Clinical Commissioning Groups (CCGS) have got to find ways of delivering greater efficiencies. CCGS might, for example, decide that they need to commission a lower amount or apply different thresholds.”

“We have to be very honest and upfront. It needs to be a conversation with the public about what the NHS should be providing.”

The analysis was based on data from 167 of England’s 195 CCGS.

“In certain areas of the country there has been a complete moratorium on hip and knee surgery for several months,” said Ananda Nanu, president of the British Orthopaedic Association.

The BMJ study comes a day after a survey by the Royal College of Surgeons found that most local health chiefs were refusing to pay for hernia operations until patients were suffering such pain that they could not work.

The cost of a private knee replacement in the UK is around £11,000.