Some patients forced to ‘effectively beg’ for hip or knee operations

Nearly 1,700 medical requests for hip or knee surgery were turned down last year – a sharp rise from the previous year, a report suggests.

In 2017/18, 1,675 requests by doctors on behalf of patients were rejected by local health bodies, according to a news article published in the British Medical Journal (BMJ).

This includes 1,188 “exceptional funding requests” for knee surgery and 487 for hip surgery.

This is a 45% increase from 2016/17, when 1,155 requests were rejected, according to data obtained through Freedom of Information requests by the BMJ.

Such requests are made by doctors to their local clinical commissioning group (CCG) if the local health body requires specific criteria to be met before patients are referred for certain treatments or procedures.

Leading surgeons said they were “appalled” that some health bodies are “effectively requiring thousands of patients to beg for treatment”.

Traditionally such requests are made for more specialised procedures or ones that carry a high price tag.

The BMJ analysis, based on data from 167 of England’s 195 CCGs, found that the funding requests are used differently across the country – Buckinghamshire CCG had 1,298 exceptional funding requests for knee surgery last year and rejected 18%.

Meanwhile, Doncaster only received 24 requests and rejected all but one.

Commenting on the analysis, 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.

“Use of the individual funding request mechanism also seriously undermines the historic decision-making process; decisions about treatment should be made between a doctor and a patient, not by a panel that may not meet the patient.

“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.

“NHS England should issue clear guidance to commissioning groups, setting out the limited circumstances in which an IFR should be allowed.”

One GP told the BMJ that the process of applying for funding placed strain on GPs and their patients.

“It’s a source of extra work for GPs at a time when we are desperately short of clinical GP time,” she said.

Julie Wood, chief executive of NHS Clinical Commissioners – the membership organisation for local health bodies – said: “The money has in effect run out, and 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.”

Commenting on the study, shadow health secretary Jonathan Ashworth said: “The increase in patients refused knee and hip surgery demonstrates the stark consequences of the Tories’ sustained underfunding of the NHS.

“It is completely unacceptable that thousands of patients are being forced to live in distress and pain, simply because of financial shortfalls.

“Care is increasingly being determined by what is cheapest, not what is best, with growing inequalities about which services are provided in which areas.

“Forcing vulnerable patients to turn to the private sector in desperation is nothing short of scandalous.

“Ending the ongoing rationing of routine treatments must be one of the new Health Secretary’s top priorities. Failure to do so risks undermining the very principles of our National Health Service.”

Ms Wood added: “Where the evidence is clear, it should be possible to achieve consensus. But where there is disagreement, sadly we may not.”

Tracey Loftis, head of policy and public affairs at the charity Arthritis Research UK, said: “Joint replacement operations are routine but they’re life-changing, and are often a last resort for people with arthritis living in excruciating pain, unable to do fundamental things such as work or even sleep through the night.

“This Freedom of Information data suggests that thousands of people are being refused requests for this treatment despite it being highly effective. CCGs are managing tight local budgets, but it’s not acceptable to deny people treatments which reduce pain and restore independence.

“The new NHS plan must ensure that people with arthritis have timely access to joint replacement surgery and that this is financially resourced.”

A Department of Health and Social Care spokesman said: “Decisions about when or whether an operation is carried out are rightly made by doctors based on what is best for their patient.

“NHS funding has increased each and every year since 2010 with an additional £1.6bn invested this year to improve waiting times, and as part of our long term plan the health service will also receive £20.5 billion a year more than it currently does by 2023/24.

“We expect NHS England to intervene if there is any evidence of rationing care.”

An NHS England spokesman said: “The NHS is planning to fund more waiting list operations this year, including hip and knee operations, and we are encouraging hospitals to ramp up their elective operating now rather than wait until later in the year.

“That is, however, entirely compatible with GPs and patients also reaching a shared decision about how best to treat a specific condition.”

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