'Pain tests' being used to screen hip and knee patients by one in 10 health bosses

Henry Bodkin
NICE says surgery should take place before pain interferes with daily life - www.Alamy.com

Bogus "pain tests" are being used to ration hip and knee surgery for eligible patients in one in ten local health areas, it has emerged.

New data reveals patients with “crumbling” joints are increasingly having to prove they are suffering severe discomfort before being referred for treatment, despite official guidelines requiring action to be taken to prevent pain interfering with everyday life.

Doctors leaders last night denounced the practice, but warned patients to expect ever more “arbitrary restrictions” on referrals from cash-strapped local commissioners in future.

Any decision based on pain and disability of a severe nature is clearly wrong

Clare Marx, President, Royal College of Surgeons

Analysis of regional affiliations of GP practices, known as clinical commissioning groups, found 24 out of 209 had adopted pain scoring criteria to limit access to surgery.

Of nineteen CCGs which have adopted the Oxford Hip Score and the Oxford Knee Score, 16 insist that patients reach a pain score of “severe” before being referred to treatment.

A further five groups in the East of England were found to be using the “New Zealand” pain scoring system, but the National Institute for Health and Care Excellence, which sets eligibility guidelines, says there is “no evidence” to support the use of either.

Overall, 84 CCGs demand that patients demonstrate either “severe” or “moderate to severe” pain before undergoing surgery, whether or not by use of a scoring system, according to analysis by the UK Orthopaedics Industry Group shared with the Health Service Journal.

Clare Marx, President of the Royal College of Surgeons, said people with osteoarthritis can quickly lose mobility, balance and confidence if not treated promptly.

The pain criteria is being applied to knee and hip problems Credit: Alamy

“Nobody should be left to get to this stage of pain,” she said.

“These conditions don’t go away, and by delaying treatment CCGs are just kicking the can down the road.”

“You might then have a crumbling hip that is more complicated to replace, and patients will take longer getting back on their feet.

"They may also need social care.”

Board papers by CCG in the West Midlands reveals it could save more than £2 million a year imposing a severe pain requirement on hip and knee operations.

But Miss Marx said such tactics risked costing the Health Service more in subsequent years.

She warned, however: “This is going to become more common - people are going to see more and more arbitrary restrictions on having surgery.”

Vale of York CCG is one of the groups requiring a patient to demonstrate severe symptoms before being referred for surgery, however a spokesman said the scoring tools are used in conjunction with other clinical information.

Meanwhile Oldham CCG, which also demands patients demonstrate severe pain, said it would “update” its policy in line with NICE guidance, describing use of the Oxford score as a “decision aid”.

Last month the RCS revealed concerns that local commissioners were unofficially rationing bariatric surgery, such as the introduction of gastric bands, by imposing spurious criteria such as extremely high body-mass index to qualify for surgery.

Yesterday’s data came amid warnings that the number of patients waiting longer than the official NHS target of 18 weeks for routine surgery is set to double over the next three years.

The Chief Executive of NHS England, Simon Stevens, has admitted waiting times will grow as hospital bosses prioritise A&E and cancer services amid tighter financial circumstances.

NHS Providers, which represents the hospital sector, last night condemned the approach of local health bosses and said CCGs must act within national guidelines.

“What we now need is a national debate about how much of our country’s national wealth we want to devote to care,” said Saffron Cordery, director of policy and strategy at the organisation.

“If treatment has to be restricted, the choices required should be managed on an NHS-wide basis, rather than piecemeal.”