Patients will have to wait up to a year for hip and knee replacements as the NHS imposes strict infection controls, doctors’ leaders warn.
Hospitals are facing a huge backlog of routine operations but are running at only about half their usual capacity due to the coronavirus crisis.
Non-emergency surgery cases were paused for three months in mid-March, and have only just resumed.
Doctors are also concerned that some patients on the waiting list are being prescribed highly addictive opioid painkillers.
NHS waiting times are expected to increase substantially over the coming months because hospitals must enforce stricter infection control measures.
This means only a limited number of patients can attend clinics or stay overnight on wards and theatres must be more thoroughly cleaned between procedures, meaning fewer operations can take place.
Professor Philip Turner, the immediate past president of the British Orthopaedic Association, said hospitals were ‘re-prioritising’ patients awaiting operations, including hip and knee replacements, to identify which cases were the most urgent.
He said: ‘It may seem unfair to those who have been on the list the longest and who thought they were just about to come in.
‘I’ve been talking to some who received their admission letters – they’ve now been told ‘no’. But they may not be the ones who require treatment the most urgently.’
Professor Turner said that ‘sadly’, many would be waiting longer than six months, adding: ‘I think it could be up to a year.’
He predicted it could take two years before normal service was resumed. It came as:
The latest NHS figures show the numbers of patients waiting a year or more for operations or other procedures has increased by ten-fold compared to 2019.
A total of 11,042 people had been waiting at least 52 weeks as of April, up from 1,047 in April last year.
Professor Derek Alderson, president of the Royal College of Surgeons, said the increasingly long waits were a ’cause of great concern’, adding ‘a substantial number of patients in these categories are people waiting for orthopaedic joint replacements’.
Nigel Edwards, chief executive of the Nuffield Trust think-tank said: ‘The reality is some people may end up waiting a very long time. All the orthopaedic surgeons in an area will need to look at their waiting lists and say, look, if we can do a thousand cases and we’ve got 2,000 people, who do we do?’
Under the NHS constitution, patients shouldn’t wait longer than 18 weeks for routine procedures.
The situation is being made worse because GPs slashed their referrals during the coronavirus outbreak, meaning many patients aren’t even making it on to the waiting list.
Figures from the British Orthopaedic Association show the number of patients referred for orthopaedic procedures in April was down by 80 per cent – 33,966 referrals compared to 176,033 in April 2019.
Professor Turner said: ‘To get back to anything like the throughput we normally would, we’re probably looking at two years.’
He added that he was ‘very concerned’ that patients were being put on opioid painkillers by their GPs because they were in such agony.
‘We have concerns about the sorts of analgesia (painkilling medication) they may be receiving. The other big controversy is about the use of opiates for analgesia.
‘We’re very concerned and there’s some evidence when we do see patients that they have been given very strong analgesics by GPs because they don’t have much alternative if they’re not going to have surgery for a while. We’re concerned about how to wean patients off the opiates once they get the surgery.’
The Mail has been campaigning for greater recognition of the prescription drugs addiction crisis, including opioids.
Professor Turner added: ‘If patients have to wait longer they’ll obviously be in more pain, their joints actually get stiffer, the deformity increases (for arthritis), there’s a risk that the complexity of the surgery required – particularly in knee replacements – may increase or it may be more difficult to do.’
An NHS spokesman said: ‘Now that the NHS has managed the first wave of coronavirus, there is an important job to do to help people whose planned care, such as knee and hip surgery, was postponed to protect their own safety.
‘That’s exactly what local health services are doing, while also remaining ready for any future increase in Covid cases.’
The NHS will not be able to return to normal for as long as four years due to the treatment backlog caused by the coronavirus crisis, hospital bosses warned.
Some hospitals will only be able to provide 40 per cent of the care they delivered before the crisis began due to their drive to remain infection-free.
The waiting list for operations could rise from 4.2 million people to 10 million by the end of this year, experts believe.
Hospitals are closing beds and surgeons are carrying out fewer procedures because they need to wear protective clothing, The Observer reported.
Group chief executive of Warwick hospital, George Eliot hospital in Nuneaton and County hospital in Hereford Glen Burley said: ‘It could be four years before waiting times get back to pre-Covid levels. We could see that. It’s certainly years, not months.’
Many normal services were reduced so that hospitals could focus on tackling coronavirus.
They are now under pressure from ministers and health charities to resume care for patients with conditions such as cancer and obesity.
Chief executive of the NHS Confederation, which represents health service trusts, Niall Dickson told The Observer: ‘With social distancing and the need for personal protective equipment it is simply not possible in many services to deliver as much care as would have been possible in the past.
‘Some services will not manage much more than 40% productivity.’
Tumours have spread when surgery was postponed and also have gone undetected.
2.1 million patients are awaiting crucial screening for breast, cervical and bowel cancer, Cancer Research UK said at the end of May.
Another 290,000 have missed out on urgent referrals to confirm or rule out tumours.
And at least 21,600 patients have had surgery, chemotherapy or radiotherapy postponed in the past nine weeks.
Hospital bosses said they are doing everything they can to restore services before the extra pressure of next winter.
A potential second wave of coronavirus could force care to be suspended again, so hospital bosses plan to increase the number of beds and treat as many patients as they can.
Some hospital trusts have split their hospitals, using one to treat emergency cases and coronavirus patients, with another for planned procedures.
On Friday surgeons called for same-day coronavirus testing so hospitals could start clearing the backlog of NHS operations.
One in three surgeons said they can’t restart routine ops, such as hip and knee replacements – despite pressure to resume normal services.
More than half of people waiting for tests in England had been waiting for six weeks or more by April.
In February just 2.8 per cent of people booked in for tests had to wait for six weeks, but this had soared to 55 per cent by April because of the pandemic.