Our reaction to press coverage on charges for joint replacements

Two set of crutches resting agaisnt a wall in someones home.

Our concern about Trusts’ plans to charge patients for hip and knee replacements

Versus Arthritis was deeply concerned by press coverage highlighting charges published by an NHS Hospital Trust for procedures including hip and knee replacements. These charges would apply to patients who do not meet criteria set by the local Clinical Commissioning Group (CCG).

For knee replacement surgery, this would mean that patients who have a Body Mass Index (BMI) score of more than 40 and do not meet the additional criteria (‘moderate joint pain AND moderate to severe functional limitations that has a substantial impact on quality of life despite the use of non-surgical treatments … AND radiological (x-ray) features of severe disease’) would not be treated on the NHS free of charge. Instead, the Trust published a list of proposed charges.

On 20th June, the Trust announced that they would be pausing the ‘MyChoice’ service charging for hip and knee replacements and other operations.

Versus Arthritis welcomes this decision but it is unacceptable to deny access to joint replacement surgery on the basis of someone’s weight or BMI. In addition, implying that patients should bear the cost of surgery has the potential to cause confusion and may deter people from seeking surgery that they are freely entitled to.

Your rights

Evidence shows that hip and knee replacements are both clinically and cost-effective treatments. Under the NHS Constitution, patients have the right to access hip and knee replacements, within 18 weeks following GP referral for treatment. If it is not possible to deliver surgery in this time period, the NHS also has a responsibility to take all reasonable steps to find a suitable alternative provider.

Restricting access to surgery on the basis of BMI contravenes guidance on osteoarthritis which states that ‘patient-specific factors’ including being over-weight should not be a barrier to referral or access to surgery. Sadly, data collected by the Royal College of Surgeons and the Association of British HealthTech Industries (ABHI) shows that such policies are becoming increasingly common. A Freedom of Information (FOI) request from the ABHI in 2017 showed that 47% of CCGs had a BMI threshold in place.

These restrictions have a detrimental impact on the quality of life of people with arthritis waiting for hip and knee replacements.

Wider changes to your rights

This news comes at a time when NHS-England is reviewing patients’ rights to access treatment, including waiting times. Versus Arthritis is working to try and ensure people with arthritis can access joint replacement surgery in a timely manner.

Only last week, the Public Accounts Committee of MPs acknowledged Versus Arthritis’ concerns that longer waiting times for hip and knee replacements can result in worse outcomes for patients. Evidence has shown that the longer that patients wait for hip and knee replacements beyond 18 weeks, the impact of surgery to improve their function diminishes.

We need your help

Versus Arthritis will continue to work to ensure that all patients with arthritis who need to access hip and knee replacement surgery are not subject to the arbitrary restrictions.

If you have experienced delays in getting a hip or knee replacement, let us know your story by getting in touch with our Campaigns team: campaigns@versusarthritis.org