BOA statement: National Tariff for Trauma and Orthopaedics 2017-19 presents major risk to patients
The British Orthopaedic Association is deeply concerned at the funding for Trauma and Orthopaedics proposed in NHS Improvement’s latest tariff consultation for hospital health care. We call on the Government to think again. There is a major risk of there being losers here – predominantly many thousands of orthopaedic patients.
This is because the proposals represent an approximate reduction of 13.25% in the prices paid for the whole of T&O surgical care. That care includes joint replacement which is in high demand precisely because it restores mobility to osteoarthritic (OA) patients who would otherwise become disabled. It also includes spinal surgery and many other procedures which restore function.
Our volunteer surgeons have spent an enormous amount of personal time and energy in each area of our practice to modify these funding proposals and reduce the negative impact. Their advice has been disregarded.
Given that the government has repeatedly reassured the country that the financial provision for our NHS is being protected, this very real reduction in T&O funding raises two possibilities. Either that the government’s reassurance has no basis to it and there is indeed a serious financial shortfall; or that funds are being diverted away from highly effective orthopaedic interventions for other purposes.
The question is where is it being diverted to? The likelihood it is either being allocated to preventative care or into a fighting fund to bail out those hospitals which are failing most spectacularly.
If funding is being diverted to preventative care there is little if any evidence that this will benefit OA patients – and plenty of evidence that delays to surgery for OA result in worse outcomes for patients whose mobility will not be as good as it could and should have been. Indeed, the overall cost to the NHS of delayed surgery will rise due to unnecessary expenditure on preventative OA treatments and the increased complexity of the eventual intervention due to bone loss and soft tissue damage.
The cost of a total hip replacement is £7.50 a week for the 15+ years it will improve a patient’s quality of life and for over 90% of people it will be the only significant treatment they will have for that hip arthritis during the rest of their life time.
Of particular concern, the current funding proposals will disadvantage our most vulnerable joint replacement patients with multiple conditions. Hospitals will try to avoid treating those patients who require more complex care, either because their general health will mean they take longer to recover, or because their particular problems are more complex and costly. This in itself will threaten independence and ability to self-care. Patients will as a consequence require more complex home care packages – at a further cost to the taxpayer.
For all queries, please contact the BOA on 020 7405 6507 / [email protected]