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The latest newsletter from Healthwatch Enfield includes the following announcement:

Criteria for having a hip or a knee replacement on the NHS are being looked at - have your say

london choosing wisely

Healthwatch Enfield has been advised that a clinically-led programme called London Choosing Wisely is underway to develop pan-London policies for eight treatment areas, to ensure patients across London have consistent access to treatment that improves their health, based on the latest available evidence.

Two of the procedures being reviewed currently are primary hip replacement and knee replacement. As part of the review, London Choosing Wisely has entered a testing phase. During this stage of the draft policy’s development, London Choosing Wisely are keen to invite comments to ensure that the draft policy is easy to follow and use, and that patients will receive the most effective clinically appropriate treatment available to them.

Find out more information and how to submit your commentsThe deadline for responses is Monday 4th June.

If you follow the links to the draft criteria for providing these two operations on the NHS, you won't be very much wiser unless you have medical training.  As a layperson, I can only suppose that for some reason the criteria developed by NICE for application across England are now considered not to be necessarily appropriate for London (because we can withstand less pain, or more pain than people from the North of the Midlands?)

What I do know is that a similar exercise that was carried out last year in relation to Enfield patients only (the so-called Application of Evidence-Based Medicine consultation) made no bones about having as one of its objectives reducing the amount of money that our clinical commissioning group spends on a list of particular surgical procedures.  I can only assume that this new London-wide initiative is also aimed at tightening up the criteria used to assess whether the NHS should fund hip and knee operations (soon to be followed by operations for back pain, varicose veins, subacromial shoulder pain and cataract surgery - see this page).

As is now perfectly clear to everyone, including government ministers but for some reason not the prime minister, the NHS is in urgent need of more money.  The only alternatives are for the NHS to start charging patients or for it to no longer offer a comprehensive service.  I think that these "reviews" are aimed at saving money so that the NHS can survive by stopping carrying out some operations on the grounds that they are "unnecessary".

So we will end up with a less comprehensive NHS and also a "postcode lottery", where what services are provided will depend on where you live.

What will be the consequences of the NHS refusing to carry out hip and knee operations on people who are in pain?  If their pain isn't fixed by an operation, they will become less mobile, with social and economic knock-ons - for instance, grandparents might not be available to do babysitting, people with hip problems will have to give up work etc, they will become overweight, develop diabetes etc.

Some people who can afford it will opt to pay for a private operation so that they don't have to wait for the pain to be sufficiently long-lasting for the NHS to reluctantly agree to operate.  Many others won't be able to afford it.  So we get a two-tier health service, despite the fact that we have all being paying our taxes.

Now these paid-for "private operations" might be carried out in an NHS hospital - they're allowed to earn money this way and, let's face it, they are in desperate need of more money.  So the NHS gains - but we still have the situation where people who can't afford it have to wait and possibly may never get the treatment.

Which brings me to an interesting observation about the new Chase Farm hospital.

We know that the smart new hospital "will provide planned ("elective") treatments in eight operating theatres and an endoscopy Unit. There will be 50 beds - 42 in single rooms, all en-suite and all with free Internet and a 42" TV."

We've also been told that there will be "four ‘barn theatres’, specifically designed for orthopaedic work'.

What might "elective" orthopaedic surgery comprise?  Why, hip and knee operations fall squarely into this category.  And if people are going to pay to have these done privately, then en-suite single rooms with free wifi and a big screen will be just what they'll be expecting.

Draw your own conclusions!

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