This very welcome news was predictably reported in the media in negative terms as a “cost cutting” exercise, rather than one aimed at reducing waste and improving overall standards of care. The list included procedures such as injections for back pain, surgery to help snorers and tonsillectomies. Perhaps of greater interest for our industry was that the NHS has finally blown the whistle on knee arthroscopies: for year there has been a consensus across the medical literature that such operations are routinely being carried out on patients for whom weight loss, exercise or just the passing of time would produce better outcomes in reducing pain and improving mobility. One trial based in Norway, whose results have been available for nearly a decade, famously divided patients with similar symptoms in to two groups, one who were actually treated, the other who only received “sham” surgery. By the end of the trial period the outcomes of the two groups were identical. You may well wonder why it has taken NHS bosses so long to accept the obvious, and take action on what are in effect scams by opportunistic doctors. The rather shaming answer appears be that the not entirely stable UK government, already on its knees from internal divisions over “Brexit” has cottoned on to the need to limit the electoral damage of years of reductions in NHS spending. Ministers have promised a real terms boost of over 3%, or an extra £20 billion a year: our Treasury has retaliated with demands for cuts in waste – we are witnessing the opening skirmishes.
Rather nearer home, our iFHP Export Panel on Clinical Effectiveness has three times tried to come up with a position paper on hips and knees, specifically mindful of the level of arthroscopies still allowed by iFHP members. The first time, some key Panel members (mainly medics) seemed to become increasingly nervous as to whether such a paper was actually needed. The second and third times, the orthopaedic surgeons who had initially agreed to assist in writing the paper, having consulted colleagues, had second thoughts! But perhaps we can at least hope that all this will help embolden those payers, whether public or private, who have up till now taken a less robust view on reimbursement of ineffective treatment.