NHS £20bn savings drive hits elderly hardest
Knee and hip replacement operations and cataract removals fall to lowest level for five years as patients left longer in pain.
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Patients are being denied knee replacements and cataract removals as the NHS struggles to meet its £20bn savings target, official data has revealed.
The number of those operations, as well as hip replacements, has fallen to its lowest level for five years, despite England’s elderly population – which has most need for those procedures – having risen over the same period.
Surgeons, charities and Labour claimed declining access to three of the most common surgical procedures was leaving patients in pain and discomfort and was evidence of a widening “postcode lottery” in the availability of treatment.
NHS data contained in the healthcare information firm Dr Foster’s annual Hospital Guide, published Friday, shows that 24% of England’s population, more than 12 million people, live in an area where the number of these hip, knee and eye operations fell between 2009-10 and 2012-13.
While the number of those procedures overall rose 0.1% over that time, cataract removals fell from 327,210 in 2010-11 to 321,957 last year. Similarly, the number of people receiving a new knee, because of arthritis or a break, fell slightly, from 82,122 in 2011-12 to 81,572 last year. Hip replacements have been growing at only 2% a year since 2008, compared with 6% a year between 2002 and 2008, though have fallen in some places.
“It is scandalous that some commissioners continue to restrict access to cataract surgery through the use of arbitrary thresholds, and that they do so without a robust evidence base and without being able to demonstrate that they will not harm patients,” said Steve Winyard, head of campaigns at the charity RNIB.
Denying people with sight problems corrective surgery leaves them at risk of depression, social isolation and breaking their hip, he added.
Colin Howie, vice-president of the British Orthopaedic Association, which represents orthopaedic surgeons, said NHS organisations which restricted access to hip and knee replacements were denying needy patients the chance to regain their mobility. “It’s disappointing that the health service is failing to provide treatments of proven benefit to patients that make a substantial and real improvement in their lives,” said Howie. Evidence shows such operations ultimately save the country money because they leave patients needing less pain relief, he added.
The charity Age UK said the Dr Foster figures showed that NHS organisations were guilty of “ageism” in deciding who deserved which treatments. “It is distressing that ageism remains deeply rooted in the way older people are treated by the NHS, despite being outlawed by legislation,” said Caroline Abrahams, its charity director. “Too often decisions are made on age alone with informal ‘cut-offs’ imposed on whole services … with little regard for the impact on older people.”
People denied procedures “will be condemned to live life with serious disabilities or illnesses, putting additional and unnecessary pressure on social care services and carers, that could be effectively managed or treated by access to the right care at the right time”, Abrahams added.
The cuts come as the NHS has been trying to make £20bn of “efficiency savings” by 2015 at a time of rising demand for its services. The guide shows that the service has been achieving some of that target by clamping down on procedures of “limited clinical effectiveness”, such as “knee washes”. They have fallen by 8% since 2008, while there has also been 7% fewer operations where alternative treatments may be more effective.
Some places, such as Wigan, west London and east Leicestershire, have managed the NHS’s financial squeeze well, maintaining hip, knee and eye operations while reducing operations of little value, Dr Foster said.
But it also found that the NHS is wasting money because it has failed to reduce the number of patients ending up being admitted avoidably to hospital. Despite many edicts from ministers and service bosses to do so they rose by 8% between 2009-10 and 2012-13, partly because patients were not managed properly by their GPs and community services.
NHS organisations in Croydon and West Cheshire have used their resources poorly by increasing spending on less effective treatments and avoidable emergency hospital admissions, the guide adds. Croydon clinical commissioning group (CCG) said the trends occurred under its predecessor, the local primary care trust, which it succeeded in April and it was pursuing a different approach.
Sir Bruce Keogh, NHS England’s medical director, said the service was coping well with financial pressures and that in general CCGs were spending more money on operations of proven benefit and less on others backed by little evidence.
“While the data raises important questions, we should be wary of leaping to the answers. Cataracts, knees and hip replacements are generally ‘good’ but it is still the case that they can be overused. We do a very significant number of these operations all over the country and it should not be taken as a given that this figure should automatically increase. It may reflect readjustment in line with modern clinical practice,” Keogh said.
Shadow health secretary Andy Burnham said: “It is simply wrong for thousands of older people to be denied the hip, knee and cataract operations they desperately need because of arbitrary, cost-based restrictions.” “Ministers promised to stop cost-based rationing of care in the NHS. Their failure to keep this promise has left older people facing the agonising choice of struggling on or paying to go private”, he said.
• This article was amended on 6 December 2013. An earlier version referred to NHS organisations in Croydon and East, rather than West, Cheshire.