From April, 10% fewer NHS hip, knee and eye operations for patients in West Yorkshire and Harrogate

A West Yorkshire and Harrogate NHS Commissioners’ Committee – which only exists because of legislation cooked up without any Parliamentary scrutiny or vote (known as a Statutory Instrument)  – has decided to restrict patients’ access to orthopoedic and opthalmic elective surgery, as well as to so-called Procedures of Limited Clinical Value, starting in April.

This is to cut £50m from the area’s NHS spending by 2020.

The Elective Care Standardisation report discussed by the Committee last November said that elective orthopoedics cost the West Yorkshire and Harrogate Sustainability and Transformation Partnership around £100m/year.

The NHS commissioners aims to slash the £50m by:

  • paying for fewer operations,
  • paying for shorter hospital stays,
  • not paying for outpatients followup (with a few exceptions) and
  • paying for an “industrial scale” patients’ behaviour change programme

Fewer operations

The NHS commissioners intend to cut elective orthopoedic and eye surgery costs by:

“reducing demand and meeting demand more appropriately”.

This means providing less hip, knee and eye surgery, and some other elective care.

The Elective Care Report says that changing the clinical threshold for referring and treating patients for elective orthopoedic and eye surgery and “procedures of limited clinical value” could potentially cut such operations by 10%.

Changing the clinical threshold means measuring the economic value of the treatment, using a benchmarking procedure known as “Right Care.” [Link to more info will be available soon].

Shorter inpatient stays

They also plan to cut the length of orthopoedic and eye surgery inpatient stay across West Yorkshire and Harrogate, so it matches the current length in the West Yorks area that has the shortest inpatient stay. Cutting patients’ time in hospital is seen as:

“a significant opportunity for efficiency and productivity gains.”

In other words cutting costs and making everyone- including patients – work harder.

Outpatients follow up – a thing of the past for most patients

Post-op outpatients’ follow up appointments will “no longer be the norm” – but

“ will be preserved for those whose clinical needs rely on the technology or skills of the secondary/tertiary care environment.”

For all other patients, it sounds as if GPs will be responsible for post-op follow up, based on electronic data shared between them and hospital consultants.

That’s all well and good, but where are GPs going to get the time? They’re already keeling over like ninepins.

‘Industrial scale’ ‘proactive’ behaviour change programme

A scheme called ‘supporting healthier choices’ will also help to “manage demand” – in other words, cut the number of patients’ accessing planned orthopoedic and eye surgery.

This scheme is an “industrial scale” “proactive” behaviour change programme:

“encouraging and supporting healthy lifestyles and behaviour change for health improvement ”

It is basically a development of the contentious ‘health optimisation’ schemes in Kirklees and Harrogate, that refused surgery for between six and twelve months to patients who are obese, smokers or who drink too much, until they stopped smoking or reduced their Body Mass Index to an acceptable level.

This scheme led Dewsbury MP Paula Sherriff to protest in the House of Commons that it was

“nothing more than a thinly veiled attempt at rationing healthcare for those in need.”

Opposition from hospital clinicians and others to the Kirklees ‘Health Optimisation’ rule has recently led Kirklees NHS Commissioners to scrap it.  A question at the most recent N Kirklees CCG Governing Body meeting revealed that it did not generate any recorded financial  savings.

If it nonetheless the “proactive” “Supporting Healthier Choices” scheme goes ahead across West Yorkshire and Harrogate, it seems likely to provide a privatisation bonanaza for the health coaches who will provide it.

Matt Walsh, the Calderdale Clinical Commissioning Group Chief Officer, is also the STP CEO for restrictions to elective care (aka elective care and standardisation of policies programme). In his STP blog post he says the programme is taking lessons from the Academic Health Science Network in behaviour change and

“how to support people to change their own minds. The advertising industry does this every minute of every day…”

Does anyone else find that vaguely sinister?

It is also neoliberal absurdity. If loads of us are killing ourselves through consuming toxic products – cigarettes, alcohol, junk food, cars, for example  – the solution starts with some combination of regulation, legislation and taxation to keep those products off the market or price them so that they’re not dirt cheap;   as well as measures to reduce poverty, precarity, insecurity and inequality – that all drive people to smoke, drink too much and eat junk.

The solution is NOT to use scarce NHS money to pay counter-advertisers to get us to resist the blandishments of the corporate stealth killers. Although all this behaviour change nonsense will probably be paid for by private finance using “innovative” financial instruments like social impact bonds.

Redisorganising eye surgery

NHS England says that opthamology in the WYH STP area is “challenged”. It is second only to orthopoedics in the numbers of people waiting for assessment or treatment.

Although on average across WY&H the percentage of patients treated within 18 weeks of referral is better than the national average, in some parts of WYH it is much better and in others considerably worse.

In our neck of the woods (Calderdale, Kirklees, Wakefield) it seems that cuts to hospital funding meant that waiting lists for cataracts etc built up. Commissioners then spent NHS money on paying the private eye hospital SpaMedica  in Wakefield to do a load of the eye ops that used to be done by Pinderfields and Calderdale and Huddersfield hospitals – so that local NHS hospitals are now underutilised and finding it hard to train up new eye surgeons.

Far from being an answer to capacity problems within the NHS, sending large numbers of eye patients to a private hospital or independent sector treatment centre – call it what you will – can be a major barrier to the provision of high quality comprehensive ophthalmic services.

Such private centres select clinically uncomplicated patients to operate on, as these are more profitable. This leaves the more complex patients with co-existing eye disease, and those patients who require general anaesthesia or are otherwise physically unwell or immobile, to have their surgery in NHS units (probably about 20% of cataract cases). The higher costs of treating these patients are left to the NHS Trust, which has lost a lot of income – and the ability to use this to support emergency eye services and the treatment of less common, but often more serious eye disease, which are not adequately paid for by the tariff system of payments.

A recently retired Community Matron said,

This makes my blood boil. Restricting orthopaedic and cataract surgery is a ploy to encourage patients to go private.

For those who can’t, usually the elderly, they could be at risk of falls and hospital admissions because of reduced mobility/sight.


As for the reduction in follow up appointments: GP’s are already overworked and do not have the skills to advise patients in specialist eye ops.

Also, restricting orthopaedic surgery referrals will increase pharmacy costs as patients will require to remain on long term analgesia!!!

This is all part of a move to cut £1bn from NHS and social care spending in West Yorkshire and Harrogate by 2020. This is to be carried out through the so-called Sustainability and Transformation Partnership which has been planning  West Yorkshire and Harrogate’s NHS and social care services for the last year.

Following directions from the government quango NHS England, the Sustainability and Transformation Partnership plans to soon become an Accountable Care System. This is a way of providing NHS and social care services that  is based on the USA’s Medicare/Medicaid business model. This provides limited state-funded health insurance, for people who are too poor or old to pay for private health insurance.


One comment

  1. We knew rationing was coming and here it is. It will only get worse. We no longer have a comprehensive health service. Disgraceful neglect of our health needs by our government.


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