Pain threshold tests to be introduced for hip operations

Some people expecting to have hip or knee replacements may find they are denied the surgery on the NHS. A new pain threshold test is being brought in by three health trusts and those who are able to sleep through the night will not be deemed urgent cases for the operations.

In a bid to save £2 million a year and cut the number of procedures performed by a fifth, only people whose daily lives and ability to sleep are affected will be referred by GPs. Three local health trusts in the West Midlands - Redditch and Bromsgrove, South Worcestershire, and Wyre Forest Clinical Commissioning Groups (CCGs) – have drawn up the proposals together.

They are not the only CCGs to be introducing such measures, with a number of others throughout England contemplating similar stances. They include Harrogate and District, Vale of York, Coastal West Sussex and Shropshire, where a scoring system will determine if a patient’s pain is severe enough for surgery to be carried out.

It is estimated by the Royal College of Surgeons that some four in ten trusts in England are turning patients down for operations due to insufficient pain and not being overweight. Approximately 100,000 people, many of them elderly, have hip or knee replacements on the NHS annually, at a cost of £5,000 each.

Most of those in need of the procedures have severe arthritis or fractured joints and as a result find basic daily tasks difficult. The Oxford Points System is the commonly used method of assessing pain and involves the doctor filling out a questionnaire on behalf of the patient.

Answers to questions including “Have you had any trouble washing yourself?”, “Are you troubled by your knee at night in bed?” and “Could you walk down a flight of stairs?” are given a score between zero and 48. Lower scores mean worse pain and mobility in patients. Other criteria, such as the way they walk into the room and how they feel is also supposed to be taken into consideration.

The three West Midlands CCGs are cutting the score for eligibility for surgery from 30 to 25 and are using it as the only measure. In documents uncovered by the Health Service Journal, the plans suggest hip operations will be cut by 12 per cent and knee procedures by 19 per cent.

NHS rationing is becoming increasingly common and could affect more patients. Hip and knee replacements are the kind of procedures that older people have, but some may have to live with their old joints if their pain is not considered severe enough to take action.