Key NHS operations 'being rationed'

Surgeons performing an operation Dr Foster has been looking at what the NHS has been spending its money on

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The NHS in England appears to be rationing access to vital non-emergency hospital care, a review suggests.

The analysis by the Dr Foster research group looked at three key procedures - knee, hip and cataract operations.

For much of the past decade, patient numbers have been rising as would be expected with an ageing population.

But since 2010, the numbers have levelled off - with just one in eight areas now doing more hips and knees and one in five seeing rises in cataracts.

It comes amid mounting pressures on the health service.

The challenges facing A&E units have been well documented, but reports have also been emerging that non-emergency care is being squeezed too.

'Highly effective'

These findings - to be published on Monday in Dr Foster's annual hospital guide - provide perhaps the most comprehensive picture yet of what is happening.

The health care analysts looked at the number of operations being carried out for the three types of procedures - among the most life-enhancing done by the NHS - for the past decade.


It found virtually no change in the overall numbers over the past two years with the total numbers hovering around the 475,000 mark each year.

Hip replacements were the only treatment out of the three that were still going up - although the rate of increase has slowed.

Meanwhile, the number of cataract operations is at its lowest level for five years and 2012-13 saw the first fall in knee replacements for a decade.

What has been happening

  • Cataracts - From 2002-03 to 2009-10 the numbers increased from 266,000 a year to a peak of just over 332,500, but since then they have fallen to under 322,000 - the lowest level for five years.
  • Knee replacements - The past year saw the first fall in numbers for a decade - albeit a small one - after the yearly total fell by 550 to just over 81,500 in 2012-13.
  • Hip replacements - The yearly total has continued to go up, but at a much slower rate of 2% a year on average since 2008. There were 71,000 operations carried out last year.

The review also provided details of what local areas were up to by looking at the individual figures for the 200-plus clinical commissioning groups which are now in charge of local health budgets.

'Very concerning'

The data showed that just 27 (13%) areas saw a significant rise in knee replacements over the past two years, 27 (13%) a rise for hip replacements and 40 (19%) a rise for cataracts.

Roger Taylor, co-founder of Dr Foster, said the findings suggested the squeeze on spending was having an impact on these "highly effective" treatments.

"There has been a sharp slow-down in activity. We are seeing some operations fall when normally we see them increasing by 4%, 5% or 6% a year."

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Map showing the change in the number of cataract, hip and knee procedure between 2010 and 2012

Postcode search: Find out how your area is doing

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The review will also highlight other areas of concern.

Dr Foster analysed data on what it called "ineffective operations".

These include procedures such as tonsillectomies and knee washouts where the benefits are marginal.

While overall the numbers being done had fallen by 8% in the past five years there are still 124 areas where their use has increased since 2010-11.

Mr Taylor added: "Money is being wasted on care that is of no benefit."

Colin Howie, vice president of the British Orthopaedic Association, said the findings were "very concerning".

"By trying to save money in the short term, it will cost the NHS and society in the long term. These are highly effective operations because they restore mobility and reduce disability.

"What is more, the research shows it is the most vulnerable in society - the elderly and poor - who are most likely to miss out."

A spokesman for NHS England said: "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."


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  • rate this

    Comment number 100.

    This was already forecast as NHS privatisation really bites. Expect to see the trend extend to other areas within the NHS. Guess what? If you want it quickly, you pay for it. It's a deliberate govt.. policy.

  • rate this

    Comment number 99.

    49:Direct treatment of diabetes:9.8 billion
    Treatment of diabetes complications: 7.7 billion (kidney failure,blindness & amputation) Include extra heart disease, fat cancers etc & the 7.7 billion rises to 11 billion.
    Direct treatment of obesity alone: 5.1 billion (fat operations, fat pills)
    Diabesity total: 25 billion
    Total NHS cost 108 billion

  • rate this

    Comment number 98.

    58 cityboycityboy
    French system has spare capacity, business pay towards health care as well as individuals. Compulsory insurance without cherry picking (something UK insurers won't do) is another way BUT we need to increase low incomes to give them the spare money to buy insurance. Which those at the top won't do.

  • rate this

    Comment number 97.

    Ban parasite health tourists to reduce the waiting lists for a start.

    It's a national scandal that somebody who has paid NOTHING into the pot can get expensive medical treatment in the UK.

    Of course the PC obsessed politicians who allow this insanity to happen all have private medical care. It's the ordinary folk who have to wait in the queue

    use your vote in May to change things

  • rate this

    Comment number 96.

    #79 Having a reality check is one thing but scare mongering is something else. These op's do take place in countries which have an insurance based system #78 has a point. #76 sorry to your plight another example of how bureaucrats can't make sensible decisions.

  • Comment number 95.

    This comment was removed because the moderators found it broke the house rules. Explain.

  • rate this

    Comment number 94.

    I will make the same comment that I do every time the BBC posts up one of these open invitations for all the usual perfect specimens to crawl out of the woodwork and attack 'the obese'. By all means ration treatment by BMI, use it as a means of bullying people into losing weight through dangerous and unhealthy methods, even ban us from the NHS altogether. Just don't expect us to go on paying NI.

  • rate this

    Comment number 93.

    With open borders, what do you expect. Vote UKIP to control immigration.

  • rate this

    Comment number 92.

    This is what happens when you over pay people. Are doctors and consultants really worth £100k - £250K a year or more.

    Come back and answer that stupid, fatuous question when you're recovering from a livesaving operation performed by an 'overpaid' doctor.

    There are some people in our society how ARE overpaid, but they aren't doctors, nurses, or medics.

  • rate this

    Comment number 91.

    I need some fairly non-essential surgery. My GP has said it's highly likely I'll get it because the NHS can only do essential surgery because of the 'political climate'. I do hope we don't have a Tory government in 2015.

  • rate this

    Comment number 90.

    No rationing if you are a sponging health tourist who shouldn't be let near a hospital in the first place.

  • rate this

    Comment number 89.

    81.Nick J
    '"since 2010, numbers have been levelling off..." Why is there an expectation that everything should increase?'

    In this case - see article - the number of people in the age ranges where these ops are needed is increasing. Unless there there is better preventive medicine the demand will be rising.

  • rate this

    Comment number 88.

    We saw what Labour did with the NHS - they killed thousands of patients through neglect like at Mid Staffs hospital"

    Two can play at this game mate!

    What about all the scandals during the 80s and 90s you seem to have forgotten to mention?

    I'll name one shall I, Hillsborough!

    By your reckoning the Tories were responsible!

    Good man!

  • rate this

    Comment number 87.

    Went to my GP with a bad knee, got referred to hospital. Was sent straight to physio with no consultation. Forced to do exercises that damaged it even more as after a year of complaining I finally got a scan and was diagnosed (by the physio, not a doctor) with arthritis. 2 years later, I can't walk far. I used to be very active. Still being denied access to a doctor, and that's how they do it.

  • rate this

    Comment number 86.

    That because in 2010 the tories told #NHS to cut back on knee & hip replacement & most ordinary people can't have a replacement till their 70+ so this map is rubbish how do I know because my doctor has told 2 or 3 times in last the year if I want replacement I have wait to I'm 70 as the rules change so if your working age & can't work because of a hip & knee problem hard luck

  • rate this

    Comment number 85.

    Step aside from the political arguments. Progress in medical technology long ago exceeded the ability of virtually all nations to fund it on demand. Unfortunately some form of 'rationing' is a necessity - I'm just pleased that in the NHS it isn't based on ability to pay (I've direct experience of the USA and wouldn't want that here!). NHS is inefficient but less so than others.

  • rate this

    Comment number 84.

    The NHS is clearly not safe in the hands of Cameron and Hunt, all that's happening is the total erosion of public confidence in the NHS (largely due to measures they implemented) as a precursor to selling it off to their mates.

    Fight Hunt and Cameron on this at every opportunity you have

  • Comment number 83.

    This comment was removed because the moderators found it broke the house rules. Explain.

  • rate this

    Comment number 82.

    This is what you get when you have an extremist right wing govt backed by the majority of the press: they can get away with letting the NHS whither and die because so many people are too stupid/too badly informed to see the reality of what is going on. E.G. many of the comments below about non-issues like so called 'health tourists' and other figments of the gutter press's imagination.

  • rate this

    Comment number 81.

    "since 2010, numbers have been levelling off..." Why is there an expectation that everything should increase?

    NHS budget was ringfenced. Same amount of money, same number of operations. Logical.


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