BOA Statement: NHS operations – waiting times to rise in trade off

Following the latest press coverage of the NHS Five Year Forward View, please see the statement below from BOA President, Ian Winson.

NHS operations – waiting times to rise in trade off

We were surprised to hear the NHS England Chief Executive suggest that hip and knee replacements might be ‘traded off’ – through more physiotherapy for orthopaedic patients, many of whom are frail and elderly – to enable improved care in other areas. While we all accept that our NHS needs pragmatic solutions to deal with the inexorable rise in demand for elective care across the system – including some reasonable adjustment to waiting times – Mr Stevens’ suggestion for balancing the books is not one that is clinically or financially sound. Financial efficiency follows effective care.

Physiotherapy and many other conservative therapies have an enormously important part to play for all patients with osteoarthritis (OA), including those on the hip and knee replacement pathways. But they should never be used as an alternative to joint replacement for those patients who need the surgery: to do so would be to compromise their recovery of function and mobility. Any prolonged delay at the end stage of OA will weaken the muscles and other soft tissues. Once that happens the consequences for the patient can be devastating and usually lifelong, with long term implications for health and social care funding.

We look forward to working with NHS England and NHS Improvement in developing and delivering the themes highlighted in the recent progress report on the Five Year Forward View. We have been strong supporters of the Getting It Right First Time programme since its inception. Our members are innovators by nature – many are leading from the front in the Sustainability and Transformation Partnerships – and passionate about the care of their patients.

As clinicians, we are doing our very utmost to deal with the enormous challenges facing health care across the UK:  we have an obligation to do this on behalf of our patients and surgeons. What we do not need are high level, ill-informed comments that are likely to encourage a further outbreak of the rationing we have been dealing with over the last few months in order to avoid undue detriment to our patients.