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NHS: Joint Replacement Procedures

Volume 726: debated on Tuesday 5 April 2011


Asked By

To ask Her Majesty’s Government what is their forecast of the effect that proposed efficiency savings will have on the availability of joint replacement procedures in the National Health Service.

My Lords, decisions about whether patients receive procedures, including joint replacements, need to be taken by patients and clinicians together, based on high-quality clinical evidence.

I thank the Minister for that reply. Is she aware that in 2010 1,200 fewer knee replacements and 350 fewer hip replacements were carried out in the National Health Service, that the Patients Association has said that there is evidence that waiting lists are increasing, and that the Medical Devices Agency says that companies that produce the prostheses for joint replacements are finding that demand is declining? Is it not likely that the so-called efficiency savings within the NHS will make this deteriorating situation even worse?

I thank the noble Lord for his Question and pay tribute to his long battle for patients in the NHS. I assure him that, if it is clinically appropriate for a patient to receive a joint replacement, they should do so. As noble Lords will no doubt know from their own experience and that of their relatives, people often find that their recovery is not as uneventful as they might have wished, and for some patients the joint replacement does not work as well as it might. There are other procedures. For some patients, the best road to go down may be that of other options, which may be a factor here. However, I assure the noble Lord that, if it is clinically advised that people should have a joint replacement, that is what is supposed to happen and, if there is any evidence that that is not being carried forward, we would certainly like to know.

My Lords, joint replacement treatment of all sorts is a highly successful area of medicine but there are still failures and many joints give up. Improvements have been possible only with continued research. Can the noble Baroness tell the House how it is envisaged that such research will continue under the improved National Health Service that the Government are proposing when more and more private providers will be offering these services and there is no particular academic interest in this aspect of medicine?

I note what the noble Lord has to say. Of course, he will know that my right honourable friend in the other place, Vince Cable, has recently put a considerable amount of money into health research. Looking forward over the next few years, real-terms spending on health research will increase. The National Institute for Health Research will be co-ordinating this and it supports research in this area. As for the noble Lord’s question about new arrangements in the health service, it is of key importance that research is carried on within the NHS. The NHS has led in clinical research and we are very committed to ensuring that under the new arrangements that continues to be the case.

Is my noble friend aware that the construction and production of joints have improved enormously? In earlier days, many failed and had to be replaced a second or even a third time. Does she agree that it is a false economy to use anything but the best now? Have any records been kept of how many people on the long waiting list are waiting for a second replacement rather than a first?

I am aware of the failure rate of earlier replacements and the trauma of having to go through such a procedure again, often with all sorts of additional health complications. It is very welcome that the improvements to which the noble Baroness referred have come about. I do not have the figures here showing how many joint replacements are second replacements and I shall write to her about that.

My Lords, given the increased waiting times for elective surgery that we have heard about, can the Minister give her assessment of whether the proposed new commissioning arrangements are likely to exacerbate or increase this trend?

My information is that waiting times are stable, and that is obviously welcome. As regards commissioning in the future, it is extremely important for noble Lords to be aware—I am sure that in this Chamber people really are aware—of our ageing population and the pressures that that brings. That is why, in all our interests, we have to look at how best to deliver health in the future. Ensuring that people have access to good quality, timely care is central to that.

Given that yesterday the Health Secretary described the gap between the Committee stage and the Report stage of the health Bill as a natural break for the Government to go away and think again for a couple of months, can I urge the Government to consider following his example by having a natural break between Committee stage and Report stage of the Fixed-term Parliaments Bill?

That is somewhat wide of the scope of this Question. In relation to the natural break in the health service Bill, it does not seem to be reaching my responsibility any later than I thought it would.

My Lords, what is the procedure if a patient is turned down for a joint replacement? Whom does she or he appeal to?

That is a very interesting question and one that we hope is addressed within the new NHS Bill. It is very difficult, as the noble Baroness knows, to get a response from some of the organisations that currently exist. However, the NHS constitution is still there and patients have rights under that; they have rights to treatment and rights within a certain amount of time. Trying to secure that, as we know, has been difficult. That is one of the challenges that we have to face and we have to ensure that new arrangements build in better ways of handling this.

Is the noble Baroness aware that there are still choices in hospitals and that orthopaedic surgeons can use whichever joints they want to? She makes the point about using the best and that is something on which they have discretion. However, there is always a question about what is the best: some people use different prostheses and find that they work well, but some people have to return for a second hip replacement. Is it not right that that choice should stay with clinicians?

I hear what the noble Baroness says. Clinicians are undoubtedly likely to be and need to be in the lead on this. It is extremely important that we have transparent evidence, but we always have to bear in mind that a patient is an individual and what may look like the best route for one individual may not work out quite like that. All of us have experience of that. However, if you are basing it on the best evidence possible, I hope that the patient will be able to see the real choices and that things will work out for the best.

My Lords, I declare an interest as a recipient of two finger joints and I am waiting for another one. Can the Minister tell us what work has been done to identify the cost of failing to replace joints and allowing waiting lists to grow—as they almost inevitably will in view of the present cuts—in terms of decreased mobility and the inability of people to sustain their own independent living?

This is a key area. The noble Baroness is absolutely right. The Leeds Musculoskeletal Biomedical Research Unit is carrying out research in this area. I find that extremely reassuring because it is right that there are consequences of not undertaking these procedures in terms of pain for patients which, in turn, reduces their ability to work, to look after their families or to undertake whatever other responsibilities they may have. It is very important that that is factored in.

When efficiency savings are proposed, does the department immediately make that money available to spend or does it wait to see whether the efficiency has been achieved?

The noble Lord, as ever, asks very challenging questions. The various sections of the NHS have been set various tasks in terms of efficiency savings, but with the responsibility of reducing bureaucracy—which has grown, as noble Lords know, over the past 10 years or so—as opposed to making any reductions in clinical services.