Three in four health trusts are denying hip and knee replacement surgery to patients not in ‘enough’ pain.

Sufferers are turned away unless they are judged to be in distress for most of the day, unable to sleep or taking painkillers non-stop.

Under the strict rationing rules, some trusts insist patients must be ‘largely incapacitated’ – in need of a walking stick, a frame or a wheelchair. In other cases the pain must be so intense it is a struggle to carry out basic activities such as washing or dressing.

Three in four NHS trusts are denying hip and knee replacement surgery to patients because they aren't in enough pain (FILE PHOTO)

Campaigners said hip and knee patients were easy targets for cost-cutting.

‘As a result of funding pressure, preconditions for surgery are becoming a common way to make savings,’ said Liz McAnulty of the Patients Association.

‘Restrictions on joint replacement surgery and obliging patients to stop smoking or lose weight before they will be operated on, are becoming ever more frequent. While these may be sensible and desirable actions for people to take, they are not medically necessary, and commissioning groups are increasingly frank that it is all about cost savings.’

An average hip replacement costs £9,000 while a knee replacement is slightly cheaper at about £6,500.

But Ian Eardley, senior vice-president of the Royal College of Surgeons, said the savings would prove illusory.

Draconian rules which could deny you an operation Wiltshire: Patients must have ‘intense’ or ‘severe’ pain, be ‘largely or wholly incapacitated’, and need a walking stick, frame or wheelchair. Otherwise, they must try six months of conservative measures before they can be considered, including wearing shock-absorbing shoes and taking painkillers. Barnsley: Must suffer pain after walking less than 20ft, standing for half an hour or in constant pain for at least 75 per cent of the day. Ashford & Thanet: Pain ‘significantly interfering’ with patient’s ‘activities of daily living and their ability to sleep’. Should have tried painkillers, walking sticks and adapting their home, by installing handrails for example, for an unspecified length of time beforehand. Scarborough & Ryedale: Patients’ pain must interfere with their ‘activities of daily living’ including washing, dressing, lifestyle and sleep. They must also be suffering from a ‘diminished quality of life’. Cambridgeshire: Pain must be ‘uncontrolled, intense and persistent’ and when walking short distances. All patients must try six months of ‘conservative management’, including avoiding heavy use of the affected joint, for at least six months. Norfolk: Must have tried conservative measures for at least six months and provide evidence of this in doctors’ letters. Birmingham & West Midlands: Pain and disability should be ‘sufficiently significant’ to interfere with daily life or ability to sleep. Vale of York: Must try ‘conservative’ measures for at least three months including muscle strengthening exercises, taking three types of painkiller and wearing insoles in their shoes. They will be referred for hip and knee replacements afterwards if pain is interfering with their daily living, including washing, dressing and sleep. Advertisement

‘We recognise the NHS is under increasing financial pressure but this does not excuse these short-sighted rationing policies,’ he said. ‘Hip surgery is one of the most cost-effective medical treatments available.

‘Restricting surgery simply delays the inevitable, simultaneously adding to the overall cost, often prolonging the use of pain relief, severely impacting patients’ quality of life and, particularly among the elderly, increasing the need for social care.’

Rejected patients can be told to try installing hand rails at home, perform stretches or buy special shoes.

They will be considered for surgery only when they have tried these measures for at least six months. However many hospitals allow patients to pay for replacements privately – jumping the waiting list.

The rationing policies have come to light following freedom of information requests by the Mail to England’s 207 health trusts, which are now known as clinical commissioning groups.

Of the 184 CCGs that responded, 73 per cent admitted imposing strict pain thresholds. Cambridgeshire and Peterborough states the pain must be so bad the patient would struggle to stand for half an hour. Wiltshire stipulates the use of a walking stick, frame or wheelchair.

Forty-one CCGs said patients must try ‘conservative’ measures for between three and six months before surgery. These include wearing shock-absorbing shoes, physiotherapy and taking a combination of paracetamol and ibuprofen.

Seventy-seven CCGs said obese patients must try to lose weight before surgery and 31 CCGs said the same of smoking.

If patients meet the criteria – and have tried cheaper treatments for six months – they may have to wait up to another year before their operation can finally take place. The Royal College of Surgeons said instead of ‘arbitrary’ rules, trusts should leave doctors to decide whether patients need surgery.

The NHS is under severe financial pressure from the ageing population, migration and the toll of lifestyle-related conditions such as obesity and diabetes. In response, NHS England – which runs the health service – has told commissioning groups to make substantial cost savings.

The restrictions for hip and knee replacements are very similar to those previously used by health trusts to deny patients cataract surgery. Trusts were told to abandon these rules by the health watchdog Nice after the Mail exposed cases where patients were being turned away unless they were nearly blind.

Michael Hill (pictured) was told to do muscle-strengthening exercises by his GP despite his knees being in so much pain that he couldn't walk

A spokesman for Cambridgeshire and Peterborough CCG said: ‘Policies are under continuous review, are based on the best possible evidence of effectiveness, and are designed to ensure we can offer the best level of treatment within our budgetary constraints.’ Wiltshire CCG did not answer a request for comment.

Hip and knee replacements are two of the commonest procedures on the NHS – with 190,000 undertaken each year. They are mostly performed on patients with osteoarthritis, a joint condition which affects a third of adults over 45. Caroline Abrahams of the charity Age UK said: ‘It is deeply concerning that older people are being made to wait for surgery that would help them live independent lives free from pain.

‘Delaying recommended treatments can cause huge physical and emotional distress, and risk letting people’s health deteriorate while they wait. We recognise that NHS budgets are under huge pressure but it is essential that older people who need operations are able to get them within a reasonable timescale.’

I finally had knee surgery... it improved my life overnight

Michael Hill was told to do muscle-strengthening exercises when he went to his GP with severe knee pain.

The retired engineer, who lives in Exmouth, had progressively lost the cartilage on the inner section of both his knees due to age. He said he was in agony and bicycled, because walking was too painful.

Mr Hill (pictured with his wife Jane) had to wait a year for his knee replacement which he said improved his life 'overnight'

He went to his GP in spring 2016 and was sent on a six-week course of knee-strengthening exercises – rather than being referred for an operation. Despite being in agony when standing or walking for short periods, he did not meet the criteria for knee replacements.

He went back to his GP a few months later and was referred to a physiotherapist who agreed his pain was affecting his quality of life.

He was told his first knee would be done at the Royal Devon and Exeter Hospital in 12 weeks but the date kept being pushed back. At one point Mr Hill rang the hospital to be told the wait had been extended to a year. After searching online, he found another NHS surgical unit in Somerset – which had much shorter waiting times.

He had his first knee replaced in April 2017 and the second in June. Mr Hill, who lives with his wife Jane, a retired nurse, said: ‘My life improved dramatically almost overnight.’

He celebrated his 70th birthday by going to Greece by train and travelling for a month in October. He said he never would have been able to do this before the surgery.