NHS rationing: hip-replacement patients needlessly suffering in pain on operation waiting lists

There is a perverse incentive for managers to let waiting lists in Orthopaedics rise. This is rightly seen as better than letting people die on cardiac or paediatric surgery lists. It is however covert post-code rationing, and citizens are unaware of their locality service failings – until they need the most common operation with the greatest pain and lifestyle benefit. Since 1981 the Politicians have been aware that the solution lies in a series of National Cold Orthopaedic centres… (The Duthie report 1981) but have failed to act. In fact they have done the opposite. If waiting lists are very short then rationing by age and occupation is acceptable, but when they are long there is an outcry if overt rationing by age is suggested.. Hip joints are strong and outlive the Health Service and the patient.. and the wait has been getting worse over a decade without significant action.

Image result for hip pain cartoon


Steven Swinford in The Telegraph 1st January 2017 reports: NHS rationing: hip-replacement patients needlessly suffering in pain on operation waiting lists 

Hundreds of thousands of elderly people are needlessly suffering in pain while they wait for hip operations because care is being rationed by the NHS, leading doctors have warned.

The waiting list for hip, knee and other orthopaedic operations has risen by a quarter over the past eight years to more than half a million in 2016.

One in 10 people have to wait more than 18 weeks for surgery amid rising concern that NHS is deliberately delaying treatment because it is not seen as life threatening.

Those forced to wait for surgery suffer extreme pain as their bones wear away and are left increasingly immobile, often unable to climb stairs or go outside.

It comes as hospitals have been ordered not to schedule any more major non-urgent operations over the next month to avoid a meltdown.

Routine operations could be cancelled because regulators say that beds are too full and wards must make space for emergency patients coming in over the festive period.

Steve Cannon, Vice President of the Royal College of Surgeons, warned that people waiting for hip replacements are being left with little more than painkillers for comfort.

He said: “For NHS managers hip replacements and knee replacements can generally wait because they are not life threatening.  They are easy targets for rationing.

“But they are very painful, they can severely inhibit peoples lifestyles. The longer you wait the worse the hip becomes, day by day by day. The cartilage gets worn away and the bone becomes exposed. It then slowly wears away.”

He said that the operations could be life-changing.

He said: “Any doctor would like in an ideal way to do any life-improving surgery extremely quickly. When you have the skills available you want to use that to the benefit of your patients.

“It transforms lives. It makes the immobile mobile, it can give you the ability to climb stairs. It can allow you to walk very good distances if the rest of you is OK.”

According to NHS England the waiting list for non-urgent orthopaedic operations referrals- the bulk of which experts say are comprised of hip and knee operations – has risen from 376,000 in October 2008 to 505,957 this year.

More than 60,000 of them were not treated within the 18-week maximum guaranteed by the NHS constitution. The figures also suggest that there has been a huge rise in the waiting list for cataract operations, with the “opthalmology” waiting list from 242,193 in 2008 to 385,000 this year.

The figures show that a total of 3.7million people in the UK are now on the waiting list for non-urgent operations, up from 2.4million in 2008.

More than 360,000 of them have been on the waiting list for more than the minimum waiting time of 18 weeks, equivalent to one in 10.

It means that one in 14 people living in England is now on an NHS waiting list.

Dr Sarah Wollaston, the Conservative MP and chairman of the health select committee, is calling on Theresa May to increase health funding.

She said: “There has been a strong increase in demand.  The longer you live, the more likely you are to end up with joint problems. We had a 35% increase in the number of people living to 85 or older over the last decade.

“At the same time we also have an unprecedented level of financial challenge for the NHS. At a time when you have an unprecedented increase in demand you have also got an unprecedented squeeze on finances.

“Either we spend more or we will see increased waiting lists and all the markers of decline. We have some tough decisions to make. We need all parties to have a discussion about how to fund this fairly.”

Katherine Murphy, Chief Executive of The Patients Association, said: “The Patients Association is concerned about the rise of waiting times for elderly people expecting hip operations and cataracts.

“Delays in hip surgery prolongs the pain and lack of independence for elderly patients. Delaying cataracts surgery can complicate the operation and allows the condition to worsen leaving the patient increasingly unable to maintain their independence. Moreover, delays to treatment means that patient recovery times lengthen and surgery itself may be more invasive.”

A NHS England spokesman said: “Actually the number of NHS-funded hip and knee operations is rising year on year, and more patients will be offered these treatments this year than last. But with a million more over 75 year olds over the next few years, demand is of course likely to continue to rise.”

The Duthie report. Time for Trust Boards and CCGs to re-visit this excellent and altruistic work from 1981

Orthopaedic waiting lists: time for more, and equal access to, non-urgent centres

Stop publishing individual surgeons’ death rates

Life expectancy by Post-Code: Gloucester shows the future and spending is being cut. What better way to ignore the problem – by not collecting information.

Image result for hip pain cartoon

The Mail 22nd December 2016: Firefighters retrieve nothing but a hip replacement joint from the Grade II-listed cottage in the grounds of Blenheim Palace where an elderly couple …  and Number waiting for hip and knee operations soar by 25% in just three years: One in ten are facing delays of more than 18 weeks for surgery

MedGadget reports the trend in demand: Hip Replacement Implants Market 2016 Global Trends, Market Share, Industry Size, Growth, Opportunities, and Forecast to 2021

In Tyrone, Ireland they have the same problem: Over 700 waiting on hip replacement surgery

WalesOnLine: Hip replacement patients in Wales ‘waiting twice as long as English …

Tom Bodden reported 2004 in The Daily Post: Why size of waiting lists makes us weep in despair – MEDICAL staff in Wales are “weeping in despair” at the numbers of patients waiting for treatment, a doctors’ leader said yesterday.


This entry was posted in A Personal View, Commissioning, Perverse Incentives, Post Code Lottery, Rationing, Stories in the Media on by .

About Roger Burns - retired GP

I am a retired GP and medical educator. I have supported patient participation throughout my career, and my practice, St Thomas; Surgery, has had a longstanding and active Patient Participation Group (PPG). I support the idea of Community Health Councils, although I feel they should be funded at arms length from government. I have taught GP trainees for 30 years, and been a Programme Director for GP training in Pembrokeshire 20 years. I served on the Pembrokeshire LHG and LHB for a total of 10 years. I completed an MBA in 1996, and I along with most others, never had an exit interview from any job in the NHS! I completed an MBA in 1996, and was a runner up for the Adam Smith prize for economy and efficiency in government in that year. This was owing to a suggestion (St Thomas' Mutual) that practices had incentives for saving by being allowed to buy rationed out services in the following year.

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