NHS rations knee and hip replacement operations to save money
Last updated at 8:34 AM on 28th July 2011
Hip and knee replacements, cataract surgery and removal of tonsils are among a list of ‘non-urgent’ operations being rationed by the cash strapped NHS in a bid to drive down costs by billions.
Two thirds of England’s Primary Care Trusts (PCTs) are now limiting treatments they deem to be of ‘low priority’ in efforts to save over £1million each, an investigation has revealed this week.
According to responses from 111 PCTs to a Freedom of Information Act request, the survey by health service magazine GP shows that 64 per cent of PCTs have now introduced the rationing policies and 35 per cent have expanded their lists of restricted procedures for 2011/2.
On average, PCTs expected to save £1,051,000 through restricting procedures they deemed ‘non-urgent’, of ‘limited clinical value’, ‘low priority’ or ‘cosmetic’.
Tell someone who can’t walk because of the pain that it is non-essential (Earlsview)
These include; knee and hip replacements being reserved only for patients in severe pain, cataract operations being withheld until the patients sight is substantially affected, varicose veins only being removed if there is chronic pain or bleeding, tonsils only being removed in children if they have had seven bouts of tonsillitis in the last 12 months and grommets to improve hearing for children being reserved for use in ‘exceptional’ cases.
Some PCTs have also cut funding for IVF procedures. Birmingham PCT is reducing operations in gastroenterology, gynaecology, dermatology and orthopaedics and Nottingham City has policies in place weed out procedures which are primarily cosmetic and have relatively ‘small health benefits’. Bassetlaw has placed restrictions on procedures for adults with cosmetic value only.
Of the PCTs, 55 have revealed policies that restrict GP referrals for interventions that they class as non-urgent.
A third have introduced new management schemes to filter out inappropriate referrals for low priority treatments.
In the last year 35 per cent of PCTs have added procedures to lists of treatments that they no longer fund because they deem them to be non-urgent or of limited clinical value.
Dr Chaand Nagpaul, lead negotiator for the British Medical Assocation’s (BMA) General Practitioners Committee, SAID that the government needed to decide on a consistent set of national standards of ‘low priority’ treatments to help remove postcode lotteries.
‘The problem with different low-priority thresholds is that they are often drawn up on the basis of local interpretation of evidence,’ he said. ‘Ultimately that is not fair to patients.’
He added: ‘Patients and the public recognise that with limited resources we need to make the maximum health gains and so there needs to be prioritisation. What is inequitable is that different PCTs are applying different thresholds and criteria.’
The BMA as a body has ‘growing concerns’ about the rationing decisions in the NHS.
A spokeswoman said: ‘This is something that has been an issue for a long time. Decisions like this should be made based on good clinical evidence focusing on the impact on patient care.
‘Blankets bans on procedures in different areas is unhelpful. Every patient should be treated individually on clinical grounds.
‘The patient should be the priority and decisions should be made on what is clinically best for them.
‘Rationing like this is a growing concern and we need to keep a close eye on it.’
A Department of Health spokesman said: ‘The NHS will receive £12.5billion in funding over the next four years. There is no reason why patients should not receive the care or operations that are clinically right for them.’
He added: ‘Decisions on the appropriate treatments should be made by clinicians in the local NHS in line with the best available clinical evidence. There should be blanket bans because what is suitable for one patient may not be suitable for another.’
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