Knee replacements are back. After a pause for Covid, we’re delighted to be able to start working through the backlog – but there remain tough choices and challenges ahead, says Dave Duffy.
Let’s start with the positives. Knee replacements and other elective procedures are back at Harrogate District Hospital and across the NHS. Getting here has taken an enormous collective effort. But thanks to the latest lockdown, the astonishing progress with the vaccination programme, the efficiency of the service and the appetite of the general public to get vaccinated, everything is now heading in the right direction.
Infection rates are down. Cases dropped and have levelled off at relatively low levels. Hospital admissions due to Covid continue to fall. So, thankfully, do deaths. That means the NHS is no longer in the position of having to pull doctors, nurses and other theatre staff from their ‘regular’ roles into intensive care. That was why, for the past year, we’ve had to operate at reduced capacity. But now we are able to get our staff back and pick up where we left off.
Everyone involved in dealing with the crisis over the past year and in rolling out the vaccination programme needs to be congratulated.
Elective surgery post-pandemic
So we’re opening up, but waiting lists are large and we need to work through them in a fair and structured way. Recently, my colleague Nick London spoke of the relatively positive picture in Harrogate and Yorkshire regarding waiting lists. He was right to do so but, whilst our waiting lists are better than many, there’s no question that those lists will take some time to work through.
So if you’re waiting for a knee replacement right now, what happens next?
Following NHS guidelines, we are categorising patients for surgery according to priority. Broadly speaking, all patients (not just those awaiting orthopaedic surgery) are being categorised as P1 – P4.
P1 is an urgent case, where delay will clearly affect the outcome.
P2 cases need to be completed in less than 4 weeks.
P3 are cases that must be completed within 3 months and P4 are 3 months and over.
Generally speaking, knee replacements and other orthopaedic surgeries are being classified as P3 and P4. That’s because, whilst osteoarthritis may dramatically affect your quality of life, a delay to your knee operation won’t usually affect the chances of a successful outcome. That’s clearly not the case with heart surgery or many cancer treatments.
The case for higher priority
Of course, there is a counter argument to this, and it’s one that the British Orthopaedic Association, the British Association for Surgery of the Knee and other professional bodies have been making recently.
Whilst in most cases – although not all – a delay to your knee surgery will not affect the outcome of that surgery, it could profoundly affect your life. Consider younger patients unable to work because of their condition. Or the potential mental, physical and societal knock-on effects of being effectively housebound because of your osteoarthritis.
We are seeing a growing debate about the categorisations, but every decision will have a knock on effect and potential unintended consequences. There really are no easy answers but we shall continue to fight for our patients.
The next phase
After a brutal 12 months for the NHS, the legacy of the pandemic means that whilst the challenges will shift, there’ll will be no let-up for staff. Once again we will be asking them to work above and beyond to help clear backlogs. And we’ll be asking that of a workforce that is exhausted and has lots of leave to use up because they couldn’t take much of it during the pandemic.
We can also expect some levelling up of waiting lists around the country, so having relatively low waiting lists locally may mean we are required to take patients from elsewhere to avoid a postcode lottery for knee replacements.
This will not be resolved quickly. But it will be resolved. And it remains the case that, if you are suffering knee pain and believe you will need surgical treatment, the sooner you get on the waiting list the better. Talk to your GP now.
Private appointments weekly at The Duchy Hospital Harrogate & Nuffield Hospital Leeds
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