A record 7.3 million patients are on NHS waiting lists in England – many of them waiting for planned care such as knee and hip replacements – a fact that is now triggering a shift to privately owned providers.
As part of a new series on global health care, The National spent months speaking to doctors, hospital managers and patients from the UK and overseas, to track changes in how people are treated.
In the UK, patients are embracing private health care as the NHS creaks.
According to the National Joint Registry, private hospitals performed 119,026 joint operations – which includes a majority of hip and knee replacements – in 2022, while NHS hospitals performed 117,906 in the same year.
This represents a 171 per cent increase in hip replacements and a 150 per cent increase in knee replacements at private hospitals – the two biggest increases in private procedures – since 2019, according to the Private Healthcare Information Network.
It is a stark contrast to pre-pandemic figures, where, in 2019, NHS hospitals performed approximately 40 per cent more operations than private hospitals. The trend began in 2021 and has continued to surge in the past year.
Knee and hip replacements are considered non-urgent planned care and fall behind on NHS priorities. “It’s not life or death, it’s not cancer or emergency care,” said Winston Kim, an orthopaedic surgeon at the private Alexandra Hospital in Manchester.
But the belief that patients with joint pain can live with their ailment, is misguided, he added.
“If you speak to somebody with severe arthritis on the hip and knee, you’ll see that it takes over their lives,” Mr Kim said. “Intrusive pain affects every aspect of their lives, and disturbs their sleep.”
Such is the extent of the pain, that patients with the available funds are compelled to make the one-off payment for private surgery.
Damian Watson, 66, a retired car sales professional, had a robot assisted knee replacement in March this year at the Alexandra Hospital, which he paid for using his pension at a flat fee of £14,000 ($17,346) – discounting any additional stay in intensive care should he experience complications post surgery.
A long-time sufferer of osteoarthritis, Mr Watson opted for surgery after he found himself struggling to walk while caring for his grandchildren.
Speaking to The National seven weeks after surgery, he reported a quick recovery, and that, to date, the pain had disappeared.
Mr Watson said he did not enquire about his treatment options at his local NHS clinic after anecdotal advice he’d received from NHS staff. “I’ve got family members who are nurses at my local hospital. They told me not to waste my time,” he said.
Prices with HCA Healthcare, the group of Central London hospitals to have done the most hip and knee operations in the capital in 2022, start from £13,900 for the procedure and hospital stay, and consultant fees starting at £1,400.
Mr Kim estimated that 80 per cent of his patients, who are mostly from the north of England, were self funded.
Another driving factor is the growing use of robotic-arm-assisted surgery, which is more prevalent in private hospitals.
Mr Kim performed more than 300 robotic-arm-assisted hip and knee surgeries in 2022, the largest number for a surgeon for that year.
"The ultimate measure of success for a hip or knee replacement, is that once the patient has recovered from the operation, they forget they had that joint replaced," Mr Kim said. "One of the complications is if the surgery doesn't meet expectations: it's good, but not good enough."
Mr Kim believes that robot-assisted surgery can help mitigate this risk, due to the increased precision, particularly when it comes to partial joint replacements.
"Most surgeons prefer to do a full replacement [of the joint]. But with robotics, we know that we can precisely replace that one part of the knee. It gives the surgeon more confidence to do a more minimally invasive operation," he said.
Twenty per cent of his patients, he added, had opted for robotic-arm surgery.
There are signs that robotic-assisted surgery could help reduce pressure on the NHS.
“Robotic surgery may lead to less need for follow-up outpatient appointments and physiotherapy and fewer surgical revisions,” said Fares Haddad, consultant orthopaedic surgeon and divisional clinical director of surgery at University College London Hospitals, one of the few NHS trusts to offer robotic-arm-assisted surgery.
But the technology is a costly investment for hospitals, and its benefits have yet to be empirically proven, according to the NHS.
The Racer trials announced in 2021 and 2022 at the University of Warwick will test the effectiveness of robot-assisted hip and knee replacements against those performed by a surgeon.
“It is unclear whether more precise but expensive robotic-assisted hip-replacement surgery offers any meaningful benefit to patients or represents good value for money to the NHS,” said the NIHCR which awarded £1million in funding to the trial.
But patients with daily knee and joint paint – the majority of whom are in their 60s and 70s – are hesitant to wait for the results.
“I’m a strong supporter of the NHS, but with the waiting lists, it has gone so badly in the wrong direction and I’ve lost trust,” said Mr Watson, the patient.
“In an ideal world, that £14,000 would still be in my pension pot,” he said.