My GP made a request for my open hip surgery through the NHS choose
and book system (C&B) and it was rejected. I don’t know why. The NHS state the following
about Choose & Book:
- “You can choose any hospital in England funded by the NHS (this includes NHS hospitals and some independent hospitals).
Although my surgeon of choice
was located at a private hospital, he has done hundreds of similar surgeries
through the C&B system on patients coming to him from as far a field as Scotland.
I will not go into the very dull details of
how stressful the next few weeks were as I tried to get the bottom of this,
suffice to say the C&B system obviously has some very complicated internal
rules and pathways that means it does not work as straightforwardly as they like
to make us the patient think.
The final outcome was that my request
had been forwarded to “funding panel” of my local Care Commissioning Group (Formally know as Primary Care Trust) - This panel did not meet until just before
Christmas ( it was now late September). They would review my case and decide whether
or not to release funding for me to have the surgery in Truro. I would not get an answer
until after Christmas, and the answer might still be no. In which case I would have
to make an appeal, filling lengthy forms and about why I felt I needed the
surgery etc.
It was pretty much like having the wind knocked straight out of you. I will admit to putting the phone down and crying - a lot. All these years trying to find out was wrong and how it could be fixed, and now we knew, they didn’t want to fix me. I was gutted to say the least.
I spent until mid October
trying find out more out about how the C&B system worked, trying to see if this
was just some sort of computer error but I got nowhere. I could not face the
thought of struggling in pain through the coming winter. I was getting worse. I was beginning to feel
like if I did not get fixed soon, I would either have to modify my work severely –
this would mean dropping some long standing clients (I am a self employed pet
carer) or even give up work completely. They were both very real yet concerning
options. The winter would be the best time for me to get this surgery as it is
my quietest time of year. If I could spend December, January & February
rehabbing, I would be all set for the rest of the year work wise. If I were to go through the funding panel malarkey, it could be at least 6 months until I get surgery - and that was if they said yes. If they said no, it could easily drag out to another year with an appeal. To have
surgery in the spring would cause huge damage to my business, which I spent years building up.
After a lot of discussion, tears and general
stress over the situation, we decided to self fund this surgery. I booked the surgery
with Mr F for December 2nd 2013.
I did feel like I was letting
the NHS get away with not helping me. Perhaps the most annoying thing about
it all, is that by having hip preservation surgery now, it means I should avoid needing a Total Hip
Replacement in the future, so I am saving the NHS money again there
Now I don’t want to sound ungrateful for the NHS. The staff on the coal face of it are amazing people, and heaven only knows how much my friends & family have benefited greatly from their care over the years, and will continue to do so. We really are very fortunate to have “Free” health care here in UK. But when a family like us think of the £1000’s of pounds of taxes we have contributed to the NHS over the years, and also to think of some of the things they do pay for, it really hurts that they are unwilling to help me
If you would like to know about a bit more about the government Quango that is the NHS and its beloved Choose and Book system, click here:
http://www.chooseandbook.nhs.uk/
If would like to read the very dull, but nonetheless informative polices on hip impingement surgery that the NHS and NICE (National Institute for Clinical Excellence) use to base their decisions for funding upon, then, have a look here:
Open Surgical Debridement:
http://www.nice.org.uk/nicemedia/live/11181/55772/55772.pdf
Arthroscopic Surgery
http://www.nice.org.uk/nicemedia/live/11328/56417/56417.pdf
This is a table showing the surgeries and treatments that are not normally funded by my CCG. (Hip impingement is on page 5):
http://www.bristolccg.nhs.uk/media/14014/new%20branding%20-%20updated%20INNF%20LIST%20For%20Referrers.pdf
There was a policy relating to the above regarding the criteria that needed to be met for the surgery to be funded. The policy does not seem to be available at the moment
Other dull yet helpful pages:
A report of funding requests and results 2012/2013:
http://www.bristolccg.nhs.uk/media/18253/17%20-%2012-13%20Individual%20Funding%20Request%20Report%20240413%20-%20for%20information.pdf
Choose and Book Care Path Ways: http://www.chooseandbook.nhs.uk/staff/communications/fact/carepathways.pdf
Article discussing on restriction on certain treatments offered by CCG's. Hip impingement is listed as being one most serious treatments (i.e for one that causes serious pain) to be restricted by 18 CCG's :
No doubt I shall have more to report on this delightful subject as I will have apply for funding for other hip to be done in the future!
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