NHS Refuses to Offer Surgery

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Wondering what people's thoughts are on this. My NHS healthcare trust is point blank refusing to offer me surgery for a condition that is normally fixed by surgery that almost everyone agrees that all the clinical signs are present for. They want to "do nothing". The problem is causing issues and pain and there is no way forwards from this opinion. I have reached the end point with my healthcare trust.

I have asked to be referred through patient choices for a second opinion but the issue is now causing so much pain and physical damage that I'll probably end up paying for surgery privately because its taken so long to get to this stage. Around £6k. I can afford it, but obviously I'd rather not take 6k out of my savings for something that just about anyone else would get surgery for. I should also point out that I'm not a smoker and not overweight, and even my GP surgery can't understand it. But no-one is doing anything about it. My GP is quite frustrated but can't really do anything. I had a private consultation and the surgeon said that the surgery in my case has a 99% success rate and he can't understand why I wasn't offered it by the NHS. It affects my mobility and therefore my ability to work. Yes, I will complain to the Ombudsman but realistically it will be many months before they even look at my case, never mind do anything about it.

What on earth do you do in practical terms if your NHS healthcare trust simply refuses to operate? I do think its probably a bit sexist as it appears that statistically men are more likely to get this (non-sex related) surgery than women in my trust and some of the written responses I have had display quite a bias and stereotypical thinking about women and at a couple of points, delve into the realms of fiction in inventing reasons for the issue (it occurred due to a an accident, they wrongly claim its because I'm peri-menopausal and I should just accept fractures and complications arising from them).

Honestly unless you have experienced long term serious pain and been refused any talk help, you can't possibly understand. It costs the NHS fortune to try to control my condition with biologics drugs and it seems to have slowed down the remaining disease but it doesn't reverse it. Why are they paying all this money (3-4K a Month apparently) but leaving me in this pain and unable to walk. Honestly, some days I've even looked into Dignitas so please don't tell me that paying for a a private surgery abroad is madness. What's mad is leaving actual real life Humans in so much pain that it would be unethical to do it too a dog.

You have your facts wrong. Please don't make things up. I was given no reason for the surgery not being offered, I was simply told that "doing nothing" was the "way forward".

I then made an official complaint. Part of the complaint response, rather than addressing the question as to why I was not being offered surgery, consisted of 7 paragraphs of what I can only describe as waffle and having a go at me for using a technical term for the condition which the writer felt was incorrect.

I believe that part of the complaint response was written by a physio as it and other responses bear his rather characteristic, superfluous style, and I'm unsure whether any of the complaint was responded to by the surgeon. I know of the reputation of the particular physio involved and this would appear to be an accurate conclusion to draw.

As I have already explained, my GP has stated that my own healthcare trust has to give permission for a second opinion, and this will all likely take many months.

I hope none of this ever happens to you. You have very little idea how little you will be offered when your quality of life is at stake and how difficult it is to get anyone to treat you seriously, even when you are articulate as I am. I hate to think of the people who have been fobbed off and told theres nothing to do when this is a perfectly standard day case surgery offered as routine nearly everywhere else.

This is removal of an osteochondrial body in an easily accessible location which is currently causing damage to the joint due to abrasion. Its day case arthroscopy and I have always made it clear that being told to stop weight bearing on the affected limb (I'm in my forties!) is completely unacceptable. I've basically been told that I should just expect to suffer fractures because I have (a very small amount of quite normal osteoarthritis) for my age and to go away and be a good little unquestioning woman.

Its not acceptable not to do this particular surgery, its not a joint replacement, and all the clinical signs are met. I wouldn't actually let my own healthcare trust operate on me now anyway as I have lost faith in them and they have been awful so far - failing to diagnose a fracture for 5 months because of refusing me an MRI scan even though I was non weight bearing, failing to check that the fracture had healed, etc. The private second opinion I obtained was that there was a 99% success rate. That is from a far more renowned, more senior surgeon who is also a professor of medicine, than the one at my trust.

Ironically, as one poster pointed out, this surgery is frequently carried out on dogs and other animals because to leave the bone/cartilage chip in situ is too high risk for damaging the joint.

I suspect its a funding issue and the trust would rather concentrate on using their budget to bump up their joint replacement statistics, which they boast about on their webpage. Those of course have awful clinical findings for return to activity, because they wait until people's joints are so damaged and muscle weakness has progressed to such a degree that its well nigh impossible for a full recovery.

So, no, I am not going to be a good little woman and hobble about on a walking stick for an easily resolved issue, and then be all grateful for the eventual joint replacement surgery that will come once I've lost all ability to walk properly. I'd rather preserve my joints and I don't trust my NHS trust at all - they settle out of court all the time and their follow up for infections following joint replacement surgery is horrifying to read.

My orthopaedic surgeon told me that 90% of the time, patients who have arthroscopy on the knee end up needing at least a partial replacement soon afterwards anyway, and consequently he believes that in most cases they're a waste of time and .

He opts to go straight to partial replacement instead, which seemed reasonable to me, although I would have much preferred arthroscopy. I went ahead with the replacement.

Maybe your surgeon has a similar view, that it only provides a short-term fix.

An all in price for an arthroscopy in an excellent hospital in and around London is £3k this includes anesthetist consultant hospital fees and operation. It’s obviously a fair amount of money but seems reasonable to me to get it done

Its true that arthroscopy used to be overused, however this is specifically to remove a body in the knee which is causing issue, not just a general "washout" or unnecessary arthroscopy. My knee is developing a medial lateral tilt as a result of being unable to weight bear on the anterior. That will damage the patellar femoral joint which in itself will lead to a knee replacement being required. There was no arthritis in that joint until this occurred and I think it can still be saved. This is not a "short term fix".

And to be frank, I'm not having my knee butchered for a knee replacement by my NHS trust once they've managed to cripple me in a few years time. It is far far better to preserve existing joint health.

Where? Can you pm me some names? Thats much cheaper than I've been quoted so far.

I was going to say shop around.
I recently went private for an operation and did decide to pay out to have it done locally. It was clear though from a bit of googling that I was going to be charged the most expensive rate out here in the (relative) sticks. I was lucky enough to have savings to cover it and it worked better for the family logistics of course but at one point when availability was still an issue I considered going to London.

Surely it depends what the arthroscopy is for? Arthroscopy is just a technique (keyhole surgery on a joint).

OP I hope you find a solution, even if it means going private. I moved abroad long ago and as a happy coincidence I have had the orthopaedic and other surgery that I needed. I am currently waiting for the right moment (for me) to have a total ankle replacement. My road to that surgery started with a cartilage tear and I know how painful it is to be walking round with foreign bodies in a weigh-bearing joint.

Sadly this is the state of the NHS. I am NHS nurse and see patients who have waited so long for surgery that they have deteriorated so much the surgery becomes an emergency this means the surgery is often more difficult and the recover is prolonged and not as successful, this often means these patients then need follow up or rehab/respite which they likely would not have needed. This costs more money in the long run.

The trust I work in is renowned for a certain speciality which is quick turnaround and highly lucrative, strange how these patients are admitted every week, this is not life threatening or prolonging by the way.

I have nearly had enough of how the surgical lists are put together. Another speciality on my ward is colorectal procedures, patients with IBD awaiting life changing procedures continuously cancelled, until they are so unwell they come in, in obstruction/dehydrated with kidney injury needing open surgery and sometimes stoma formation.
These are often, not always young people who need to work/support young families. This is not the NHS I can in good conscience work much longer. It is so broken it really upsets me.

I wish I had advice for you, I am scared for the future and the need to access healthcare.

Does anybody know how to actually get a second opinion in England?

The letter I received from the consultant refusing to do any surgery stated that I was entitled to a second opinion and to consult my GP if I wished to arrange that.

I've now contacted my GP 3 times and each time they politely say that it is the Health Board who is responsible for arranging second opinions and that they "can't refer outwith their area".

So I phoned the musculo-skeletal service at my trust, and they said it has to be the GP that does it.

I actually feel like I'm harassing my GP now because I've sent 2 e-consults in the last week politely asking for a second opinion and been told he can't do it. I think if I keep trying they might ask me to stop because I'm being vexatious or something.

I honestly do not know how a system of healthcare can be so designed so as to be unhelpful to patients.

They can refer out of their area I would choose who you want to see and go from there.

Are they classing it as plastic surgery?

How did you get on in. MRI with a metal plate?

Hope you get it sorted.

It’s always been the GP who has referred me out of area for a second opinion.

OP for the love of all that is holy please just pay off you can. You will end up making yourself ill with the stress of trying to fight the system when the system is clearly not going to engage.

I had private ankle surgery last week in the centre of London. I stayed overnight as I was a complex patient, and had athriscopy, bone renouvellement, ligament resection with an internal brace. The whole lot, including 2 pre op consultations and an MRI will cost under £7k. Luckily I could see what would happen to the NHS so took private health insurance out at the start of Covid.

I only saw the consultant (leader in his field) 2 months ago and held out til May for my op, it coukd have been quicker. What astonishes me the most is how efficient it all is and hopefully how by not waiting for things to be really bad I will not only recover better but will have cost both my employer and the NHS far less money than if I was stuck on NHS timescales. And my mental health is not suffering.

TL;DR morally NHS should treat you, practically for your health and sanity just pay, you can afford it

This will just waist everyone's time as almost certainly just ask you to see your GP to refer you to the relevant surgeon. I think you'd be within your right to ask your GP to refer you to a surgeon from a different hospital though or ask for a different surgeon at the same hospital to review your case. There's every chance they might decide surgery isn't in your interest though. Good luck xx

*going to ED will waste time I mean

It's hard to say without knowing what's going on exactly but all I'll say is that surgeons love to cut people open 🤣 If they're refusing then they aren't doing so for fun. It's almost certainly because a) They think surgery is too risky for some reason or b) They think there's a good chance you won't get the desired outcome from surgery. Private surgeons will still follow these principles but let's just say they're probably going to be a bit happier wasting your own money than the NHS's money.... It's worth really pinning down your surgeon as to why they won't do surgery and what they think the chances of success will be and making a fully informed decision before you spend your own money. X

For the love of god, this is not plastic or vanity surgery. It is to remove a fragment causing irritation in a joint which is such standard surgery virtually everywhere else in the country that the consultant I saw privately for a second opinion was astonished it hadn't been done because in my case it would have a 99% chance of fixing the problem in my case and preserving the health of the joint.

I'm clearly in one of the worst, if not the worst, healthcare trusts for this in the country. Might explain why in my local town you see so many people literally hobbling about crippled.

I can see why the NHS gets away so easily with fobbing people off though!

Have they written your GP a letter explicitly stating this? If not they need to. I think your GP/surgical department would have a hard time justifying not at least getting you reviewed by a different surgeon if this is the case and yes I'd keep at them until you get this.

OP. You have said numerous times that you don't trust the NHS so just go to Turkey and get it done.

Going on and on about it but saying you don't trust the NHS is just a waste of time.

You don't trust the NHS, you are in constant pain,you can afford the surgery. Just do it.

Yes, they have! They sent me a copy of the letter that they sent to the GP and it quite clearly states all that I have said above. The letter back from the NHS consultant also advises me to contact me for a second opinion outwith the area.

I'm beginning to wonder if there is some kind of cultural thing going on in my healthcare trust area.

Currently waiting for a callback from a GP. I might as well ask whey they are not referring for a second opinion before parting with thousands.

Sorry to hear your having so many problems accessing healthcare atm, but surely you can ask GP for more clarity.
Also, I'm confused, what did you mean by "cultural thing going on"? I'm aware of and have evidenced adverse ageism in the NHS.

I think I'm at risk at boring everyone to death with the ins and outs of this thread now, but I did speak to a GP today and they cannot refer me for a second opinion in my particular health trust. It has to go through the trust's specific team set up for this speciality. It also seems to be set up for fobbing people off and doing what they want...

The GP also read through some of my notes and I think theres some confusion between my right and left knees. They seem to list some issues which I suffered years ago in my left knee and all of what they said and indeed the refusal of surgery makes perfect sense if applied to my left knee (which is thankfully a-symptomatic now anyway but doesn't look it on scans) but not to my right knee...

Have you clarified the garbled notes confusion?

That would make sense.

Are you in generally good health otherwise OP? Not very overweight or with other underlying conditions that would make surgery be considered too risky by some experts?