Surgeons say patients in some parts of England have spent months waiting in pain because of delayed operations or new restrictions on who qualifies for treatment
. In several areas routine surgery was put on hold
for months, while in many others new thresholds
for hip and knee replacements have been introduced. The moves are part of the NHS drive to find £20bn efficiency savings
by 2015. The government said performance should be measured by outcomes not numbers.
Surgeons have described the delays faced by patients as "devastating and cruel
". Peter Kay, the president of the British Orthopaedic Association (BOA), says they've become increasingly frustrated that hip and knee replacements are being targeted as a way of finding savings. GPs were told not so send as many patients to hospital, maybe to delay referrals until the end of the financial year
while perhaps introducing thresholds for surgery.
Overall, 692 surgeons in England sent the BBC information about the policy on hip and knee replacement of their local Primary Care Trust (PCT). Between them they covered the majority of PCTs in England. 106 surgeons told the BBC routine operations had been put on hold in their area. Others described new limits on when patients qualify for hip or knee replacements. 152 specialists said patients now have to be more disabled or in greater pain
, and 118 told us hip and knee surgery had been regarded as a procedure of low priority
A number of PCTs have been explicit about their decisions to put all routine operations on hold for several months up to April to help balance their budgets
by the end of the financial year. They include Warrington, Sheffield, Eastern and Coastal Kent, Bury and Warwickshire. Alex Waring, a patient in Warwickshire, was told he was being referred for an urgent knee replacement in August of last year. Now he looks at that letter with bewilderment as more than seven months later he is still waiting for surgery. Mr Waring has already had one successful knee replacement and says he is in daily pain waiting for this second operation. "It's excruciating sometimes to put it mildly. And it affects you at the times when you're not expecting it. I get off my mobile scooter and nearly fall over because my knee is gone, the pain, you've to sit there until the pain just goes away."
Putting routine operations on hold means that GPs simply stop referring their patients for surgery. So although a patient might be waiting longer, this isn't recorded in the official waiting statistics
. Another way of adding invisible waiting time
into the system is to implement stricter new criteria which have the effect of delaying the point when a patient can be referred for treatment. An investigation by the BBC also found evidence in many PCT board papers of new thresholds being added for hip and knee replacements.