Patients will be refused hip and knee replacements unless they are in so much pain that they cannot sleep or go about their daily lives, under the latest NHS rationing plans.
Health chiefs in the West Midlands are using a scoring system designed to assess patients’ illness to reduce hip operations by 12 per cent and knee replacements by 19 per cent. The move is intended to save £2.1 million a year.
Very obese patients would be refused surgery unless they could show that they had lost 10 per cent of their body weight or were in danger of losing their independence, the Health Service Journal revealed.
The Royal College of Surgeons (RCS) said yesterday that the “alarming” cost-cutting plans would inflict needless suffering on patients. It said that thousands of people were falling victim to arbitrary denial of treatment.
About 160,000 hip and knee replacements a year are carried out by the NHS in England and Wales and the figure is rising by about 8 per cent annually as the population ages. The prostheses replace joints worn by age or damaged by conditions such as arthritis.
Most patients are elderly but the number of replacements provided in people aged under 60 has increased by 76 per cent to 18,000 during the past decade. Better surgical results and more durable implants mean that joints can be replaced in younger people without the need for operations to be redone after 15 years. Doctors also say that younger patients are less willing to wait for surgery than in the past.
Stephen Cannon, vice-president of the RCS, said that the decision to restrict access to NHS care, based on arbitrary pain and disability thresholds, was alarming.
“It is another example of how the huge financial strains the NHS is under are directly affecting patients. It is right to look at alternatives to surgery but this decision should be based on surgical assessment, not financial pressures.”
He added that the savings estimate “overlooks the longer-term impact on patients of delayed treatment, prolonged pain and potentially higher costs of treatment. For example, patients affected by these changes may require additional pain relief medication and may still require surgery further down the line.”
Redditch and Bromsgrove, South Worcestershire, and Wyre Forest, the three local health groups implementing the plans, hope to avoid 350 operations a year. Paul Green, from Saga, said: “To suggest that it is acceptable for people to have to wait until they are unable to sleep before they are eligible for an operation is an outrage. How would these people feel if that was their mother or father or grandparent?”
Three years ago the RCS found that 44 per cent of local clinical commissioning groups required patients to be in various degrees of pain before surgery, against advice from the National Institute for Health and Care Excellence.
NHS Redditch and Bromsgrove Clinical Commissioning Group said: “The Oxford scoring system is a guidance for clinicians and they recognise that many patients will benefit from physiotherapy and weight loss before considering surgery. If a patient feels that they require this surgery but do not meet these criteria, there is a clear appeals system via individual funding requests.”