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Eligibility for hip and knee replacement 'could become more restricted'

Published on 27 January 2017
Eligibility for hip and knee replacement 'could become more restricted'

People with joint conditions in three regions could soon find it more difficult to get access to knee and hip replacement surgery, due to planned changes in eligibility criteria.

The choice by three clinical commissioning groups (CCGs) to explore the idea has attracted criticism, as some believe this may suggest that CCGs are looking to change the scoring system used to decide which patients are suitable for these operations.

As reported by the Health Service Journal, the Redditch and Bromsgrove, South Worcestershire, and Wyre Forest CCGs - all based in the West Midlands - are planning a reduction in the Oxford hip and knee score needed to qualify for surgery from 30 to 25, meaning operations will only be available for patients whose pain and disability is severe enough to impact their daily life and sleep habits.

Additionally, only patients with a body mass index of less than 35 would be eligible for surgery unless they can demonstrate a ten per cent loss in weight, or if they are in danger of losing their independence or experiencing further joint destruction if surgery was delayed.

This would reduce eligibility for hip and knee replacement surgeries by 12 and 19 per cent respectively, leading to budget savings of around £2.1 million per year. The Daily Mail has subsequently reported that other CCGs - including the Harrogate and Rural District, the Vale of York, South Coast Kent and Shropshire CCGs - are planning similar steps.

The proposal has attracted criticism from the Royal College of Surgeons, which said the Oxford scoring system is designed to measure patient outcomes, rather than being used to limit access to care, and claimed there is "no clinical justification" for using such a system to determine who gets NHS treatment.

A spokesman from the Royal College of Surgeons said: "While the CCGs have stated they hope this policy will save them £2 million a year, it is unclear whether they have considered the costs of not treating a patient.

"This could include the cost of pain relief medication and a later operation when the patient does meet the required pain and weight thresholds. Delaying access to surgery also adversely affects a patient's quality of life and surgical outcomes, meaning the operation may not be as beneficial as if it had been carried out earlier."

Dr Liam O'Toole, chief executive officer at Arthritis Research UK, comments: "We are extremely concerned to hear about this decision. Everyone experiences pain in different ways; someone experiencing less pain might have more damage to their joint.

"Best practice guidelines from the National Institute for Health and Care Excellence (NICE) make clear that people experiencing joint pain that has a substantial impact on quality of life should be considered for referral for a joint replacement. People's access to these life-changing surgeries, which reduce pain and restore independence, should be based on their clinical need alone."

If you have been denied joint replacement surgery, you can:

  • Discuss with your consultant other treatment options, such as weight loss, physiotherapy and a pain management course or pain medication, to determine an alternative treatment plan
  • Ask for a second opinion
  • Explore what appeals process your CCG has in place
  • Visit the arthritis and daily life section of our website here, which has self-help and exercise tips designed to help you manage your pain

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