Some NHS hospitals are misusing pain scoring tools to restrict joint surgery access

People in England may be missing out on hip and knee surgery because of the way pain scoring tools are being used.

Data from the UK Orthopaedics Industry Group suggests that at least 10% of clinical commissioning groups (CCGs) across England are using unproven scoring tools to restrict access to orthopaedic surgery.

Pain scoring tools such as the Oxford hip and knee scoring system and the New Zealand scoring system are used by healthcare professionals to assess the degree of pain experienced by people with conditions such as arthritis. These tools are not endorsed by the UK’s National Institute for Health and Care Excellence (NICE) for use in identifying who is eligible for surgery.

Data was collected from 140 of the 209 English CCGs:

• 19 CCGs are limiting surgery based on a patient’s Oxford hip and knee score;
• 5 CCGs are limiting surgery based on the New Zealand scoring system;
• 84 CCGs require a person to be in severe or moderate to severe pain before they can access hip or knee surgery; some specifically state that only those whose pain is serious enough to interfere with daily activities or sleep can be considered.

NICE guidelines state that discussions about surgery should happen before the pain becomes severe enough to impact on daily activities.

Tracey Loftis from Arthritis Research UK, comments:

“Nobody should need to wait until they are in severe discomfort with their hip or knee pain before being referred for treatment. Clinical commissioning groups must not use pain scoring tools as a basis of identifying people eligible for joint replacement.

“There are 8.75 million people in the UK who live with the daily pain caused by osteoarthritis, which can affect their ability to carry out everyday activities such as climbing the stairs, walking and sleeping.

“Joint replacement surgeries are highly successful and can be life-changing, reducing pain and giving people back their independence. We believe that the ability to live pain-free is someone’s right, and receiving the appropriate treatment should be based on clinical need, individually assessed by a surgeon.”

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