BMI Rules May Deny NHS Joint Surgeries, Arthritis UK Warns
BMI Rules May Deny NHS Joint Surgeries, Arthritis UK Warns
Arthritis UK warns BMI-linked policies across NHS boards may ration hip and knee replacements, risking longer waits and more pain.
Nearly one in five NHS organisations are rationing joint replacement surgeries based on weight, a new report claims. Arthritis UK reveals that 31 of 42 NHS integrated care boards currently run policies tying body mass index to hip and knee replacements. Eight ICBs, about 19%, are effectively rationing procedures by setting BMI thresholds for referral. A further 23 boards have policies that encourage or mandate weight loss before eligibility. Only 11 boards do not alter access based on BMI, the charity says.
ICBs justify these policies by citing risk, but research shows BMI related risk largely appears only for very high BMI. The charity argues these policies have been used to exclude patients with BMI well below extreme thresholds, such as BMI 35. This means thousands of people with arthritis could suffer longer pain and reduced mobility while waiting for care.
The policies come amid ongoing NHS waiting lists and budget pressures. NICE guidelines advise against using BMI to exclude patients from referral to surgery. Deborah Alsina, chief executive of Arthritis UK, says that this practice is unfair and flies in the face of all guidelines and evidence. She notes that people waiting for joint replacement often have arthritis and have spent months or years in decline as their joint pain worsens, delaying surgery can hurt outcomes and quality of life.
Some board leaders argue BMI policies help reduce surgical risk and control costs, but patient groups warn the approach creates a postcode lottery of care across the country. They urge a review of policies and a move toward consistent, guidelines based decision making that prioritises need and potential benefit rather than weight alone.
