Is NHS Rationing Access To Significant Hospital Care?

6 December 2013

Is NHS Rationing Access To Significant Hospital Care?

The Dr Foster research group has undertaken an analysis of key emergency operation procedures in its annual hospital guide, opining that there findings seem to suggest a disproportionate relationship between service provision in three key surgery areas-knee, hip and cataract operations.

This rationing effect has arguably come about as patient numbers have risen in proportion to a rising ageing population. Whilst this seemed to be the case for most of the past decade, since 2010 the analysis found there was no longer a direct proportion between surgeries and patient levels with just one in eight areas now doing more hips and knees and one in five seeing rises in cataracts related surgery.

Despite an increase the ageing population-and so patients-the disproportionate result and subsequent rationing of services may well have come about due to extra pressure on the health service in the form of challenges to both A&E units and non-emergency care.

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

It found that there had hardly been a change in the overall numbers over the past two years. Hip replacements were the only treatment out of the three that were still rising, with the number of cataract operations being at its lowest level for five years and 2012-13 saw the first fall in knee replacements for a decade.

The review also went deeper by understanding spending levels for the clinical commissioning groups in local areas in charge of local health budgets, with their findings suggesting that a squeeze in spending was directly impacting these treatments.

The data illustrated a slowdown in the overall treatment in these three areas, showing 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 "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."

The review will also highlight other areas of concern, and what Dr Foster has said are ‘ineffective operations’ such as tonsillectomies and knee washouts where the benefits are smaller.

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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