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 140.

    The issue we have with government run services is that Labour just throw cash at a problem or even worse PFI but mismanage everything they touch and the Tories don't want any public service outside of the police, the military and the civil service old boy network and do their best to destroy every other public service. The political class have ruined this countries future.....all of them!

  • rate this

    Comment number 139.

    The problem is we've all grown so used to the great service that the NHS provides that we don't consider it a luxury anymore. If they want to cut costs, rather than raising funds charging everybody a flat rate, why not simply have a means tested rate?

  • rate this

    Comment number 138.

    So on the balance of comments here, the main threats to the NHS are:
    Fat people
    Infertile people
    Fat people
    Old people
    Disabled people
    Fat people
    ... in other words, everyone EXCEPT the Govt, their private cronies and their tactics of sabotaging the system by starving it of cash and using their media to attack it.

  • rate this

    Comment number 137.

    129. John Knee - "@117.Peter N - 'My gut reaction is to agree, however the counter argument would be that distress at - not being able to conceive,'
    Of course, there are plenty of parentless children who'd just dream of a want-to-be parent adopting them..."

    As I said, I can see both sides of the argument & anyone could adopt, not just the infertile.

    PS - (pedant alert) adoption isn't conceiving.

  • rate this

    Comment number 136.

    Be very worried - on 16th Dec. Jeremy Hunt's Bill is being considered by the Commons. If passed, he will be able to close down hospitals with minimal local consultation. Result - fewer hospitals where hip, knee & cataract ops can be performed.

  • rate this

    Comment number 135.

    Trouble is that these operations are needed primarily by the elderly, i.e. pensioners who can't afford to go private.

    Perhaps if we stopped paying our membership fee of £50 million per day to the EU so that we can sustain a negative balance of trade with other members, we might be able to sort this out - along with our other infrastructure deficiencies.

  • rate this

    Comment number 134.

    this is what happens when Tory's take charge, by stealth they are desimating the NHS.
    same as statement ---all aimed at helping the benefit grabbing, greedy immoral wealthy of this country then taking every penny he possibly can from the hard working taxpayers of this country.
    i have yet to meet a wealthy person who actually works at all

  • rate this

    Comment number 133.

    it doesn't seem to account for the possibility that they were actually being a bit too quick to do hip & knee replacements & now are taking a more cautious approach. There are guidlines for pretty much everytning in the NHS these days, a change in guidelines can be cost driven or care driven or a mixture

  • rate this

    Comment number 132.

    all joking aside I think the nhs do a great job and we are lucky to have this unique service sure it has its problems but show me an organisation that size that doesn't ,

  • rate this

    Comment number 131.

    It's no surprise. The recent reorganisation of the NHS by the LIBCONs created extra levels of bureaucracy for no real gain apart from opening up the healthcare market.

  • rate this

    Comment number 130.

    We know this already. My wife, with 2 arthritic hips first asked 18 months ago about a hip replacement. She has gone through the rigmarole of physio courses twice, which don't help. The constant pill popping to ease the pain can't be doing much good, but still no sign of a referral.

  • rate this

    Comment number 129.

    @117.Peter N
    "My gut reaction is to agree, however the counter argument would be that distress at - not being able to conceive,"

    Of course, there are plenty of parentless children who'd just dream of a want-to-be parent adopting them....

  • rate this

    Comment number 128.

    Who created the NHS = Labour
    Who opposed the creation of the NHS = Tories

    Says it all!
    The Tories have always loathed the NHS since its creation and will do anything to undermine its operations.

    The story about IDS tells you all you need to know about these poeple.

    Never trust a Tory!

  • rate this

    Comment number 127.

    It is surely inevitable that if the economy has shrunk (output is still lower than it was in 2008) then services must shrink. We have less money therefore we have less operations.

  • rate this

    Comment number 126.

    I love these HYS topics as we get to play a game of either:

    Leftie bingo. Whenever you spot Eton, posh, spiv, cronies, privilege (usually misspelled), nasty, Daily Fail etc you cross that word off your cliché board.

    Tory bingo works the same with scroungers, union scum, biased BBC, hypocrites, Guardian etc.

  • rate this

    Comment number 125.

    Interesting that the "balanced" response to this headline is in the last 2 paragraphs where probably many on HYS haven't read.

    "it should not be taken as a given that this figure should automatically increase."

    But hey, why not give a chance for a bit of anti-govt ranting?

  • rate this

    Comment number 124.

    I guess non-emergency surgery will be the first to be rationed if there is heavy demand on the NHS due to increasing population / demographics / health tourism / immigration.

    But is the root cause -
    Lack of money.
    Lack of qualified clinicians.
    Over use of procedures that have marginal benefit to already healthy people.

  • rate this

    Comment number 123.

    we pay less towards the Nhs than if webhad to buy insurance to get care. we should increase the money for rhe nhs wven if that increases taxes, to a level nearer that of insurance. we would get a better system and far better access and coverage. private health care is a rip off.

  • rate this

    Comment number 122.

    We don't have enough money for NHS services to treat our own people / UK tax payers but we have £40 bi££ion for HS2, several bi££ion for overseas aid and a few bi££ion more for Afgahnistan, a few bi££ion more for 2 aircraft carriers that will be mothballed once complete etc, etc, etc,

    Only a self-serving wealthy ruling elite can dream this nightmare up for the masses.

  • rate this

    Comment number 121.

    @107, those dying younger save the country on costs for nursing and residential care, which is much more expensive than managing an illness. We all die of something, if it is a smoker at 65 with lung cancer or a non-smoker at 95 with dementia the costs are there (and the dementia care would be a lot more).


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