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Postcode rationing for 'routine' patient procedures

Patients needing hip replacements or cataract removal are facing long delays while doctors battle a new wave of NHS rationing, an investigation suggests.

Patients needing hip replacements or cataract removal are facing long delays while doctors battle a new wave of NHS rationing, an investigation suggests


Hip replacements and help in coping with mental health issues are also behind an extra
layer of red rape. Picture: Alamy

Freedom of Information data obtained by the British Medical Journal (BMJ) shows a rise in the number of special requests for funding now being lodged for procedures that were once considered routine.

Cataract removal, hip replacements, knee surgery, procedures for carpal tunnel syndrome and help for mental health problems are among those treatments now needing to go through an extra layer of NHS red tape.

Overall, the number of exceptional funding requests made by GPs in England to clinical commissioning groups (CCGs) rose to 73,900 last year, a 47% increase from 2013/14, when they made 50,200.

Annual rise

In just the past 12 months alone, there has been a 20% rise, from 60,400, the BMJ data from 169 CCGs showed.

Just over half (52%) the requests made in 2016/17 were approved by CCGs, although some patients are then waiting months to start their treatment.

Most of the funding requests are for cosmetic procedures, such as removing skin tags and varicose veins, or for IVF, which the National Institute for Health and Care Excellence (Nice) says should be routinely funded but is not.

Between 2013/14 and 2016/17, the number of requests for hip and knee surgery rose from 49 to 899.

According to the BMJ, Aylesbury Vale and Chiltern CCGs in Buckinghamshire recently issued guidance stating that all referrals for hip and knee surgery should go through a funding request process.

Prolonging pain

Stephen Cannon, vice president of the Royal College of Surgeons, condemned the restrictions on hip and knee surgery saying CCGs doing this were 'unfairly and unnecessarily prolonging the time patients will spend in pain, possibly immobile and unable to carry out daily tasks or to work.'

Tracey Loftis, head of policy and public affairs at Arthritis Research UK, said: 'We are disappointed to learn about the increase in the number of special requests for funding for hip and knee surgeries, which are routine operations.

'Joint replacement surgery is effective at reducing pain and restoring independence.

'Access to this surgery is the difference between people going to work, walking to the shops on their own or even being able to sleep through the night.'

Julie Wood, chief executive of NHS Clinical Commissioners, the organisation that represents CCGs, said: 'Unfortunately the NHS does not have unlimited resources, and ensuring that patients get high-quality care against a backdrop of spiralling demand and increasing financial pressures is one of the biggest issues CCGs face.'


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