/ Waiting For a Hip Replacement

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mypyrex - on 17 Sep 2017
My brother, who is 75, has been in excruciating pain for two years awaiting a hip replacement. He is forever being fobbed off with excuses about waiting lists, cutbacks and so on and so forth.

Unlike me and others(including other family members) he will not "kick up a fuss" in an effort to get things done but, being a bit scared of bureaucrats and the like, would rather put up with the pain.

I would very much like to start kicking a few a***s ( without him knowing). I've told him that if he sits back and does nothing he is going to finish up needing two hip replacements.

Any suggestions regarding tactics???
marsbar - on 17 Sep 2017
In reply to mypyrex:
Pals is the best place to start.

You may need to write a letter and get him to sign it giving permission for health professionals to discuss his medical stuff with you.
Example here.
http://www.pembrokesurgery.com/website/K81100/files/consent%20to%20share%20information%20with%20a%20...

Good luck.
Post edited at 19:01
mik82 - on 17 Sep 2017
In reply to mypyrex:
The "without him knowing" part means you probably can't do anything. If you wrote a letter of complaint, they'd need his consent in order to reply to you.

marsbar above is correct regarding a 3rd party discussing someone's medical issues.
Post edited at 19:13
Dave the Rave on 17 Sep 2017
In reply to mypyrex:

Vote labour?
mypyrex - on 17 Sep 2017
In reply to Dave the Rave:

Given that my brother lives in Wales he is already at the mercy of a Labour controlled health service.
The New NickB - on 17 Sep 2017
In reply to mypyrex:

Welsh Assembly only gets to rearrange the deck chairs, Westminster is busy blaming the iceberg on Europe / Immigrants / Jeremy Corbyn!
Timmd on 17 Sep 2017
In reply to mypyrex:
He's lucky have a brother like you, could you try and convince him that the bureaucrats won't give him a second thought (in the way he fears) about him having kicked up a fuss?

Perhaps talk along the lines of him being just another patient to process, and that nothing bad will happen to him if he does do?
Post edited at 00:05
Big Ger - on 18 Sep 2017
In reply to The New NickB:

> Welsh Assembly only gets to rearrange the deck chairs,

Nonsense.

This is what they have to say;

"The Welsh Government sets out the strategic framework and formulates the health and social care policy which is to be implemented by NHS Wales and its partners when planning and delivering services for the people of Wales."


Andy Hardy on 18 Sep 2017
In reply to Big Ger:

Who controls the amount of money the Welsh government receive?
Big Ger - on 18 Sep 2017
In reply to Andy Hardy:
It's decided by the Barnett formula, has been for some time.

https://ichef.bbci.co.uk/news/624/media/images/78136000/gif/_78136679_scotland_public_spending_20140...

Why should that affect the way the money is spent?

All four countries in the UK have followed a similar upward trend since 2003/04, although historically, England has spent the least and Scotland the most per head. While public spending is allocated using the Barnett Formula, spending on health is a devolved issue and so the devolved nations can choose how much of their public spending to allocate to health.

In 2013/14, Scotland spent £2,187 and Northern Ireland spent £2,158 (2015/16 prices). The sharpest decrease since 2009 was in Wales, which has dropped to a similar level to England. Wales spent £2,026 per head in real terms in 2013/14, compared to £2,028 in England (2015/16 prices).

Post edited at 07:52
ill_bill - on 18 Sep 2017
In reply to mypyrex:

It is UK wide problem sadly. Orthopeadics has been especially troublesome for over 15 years at least.
you need to persuade him to talk with his GP, emphasising the increasing level of pain and immobility.

The NHS in UK needs more resources & more Drs & nurses.

But is a Government of any colour going to improve the working conditions in the NHS to encourage more staff to stay on and not retire early and more staff to join?

A recent survey showed that many of us (a majority!) would pay more tax if it went to improve out health and Social care.
Bellie on 18 Sep 2017
In reply to Big Ger:



> Why should that affect the way the money is spent?


because sadly, when there are limited funds, choices are being made, and in reality the older folk, like the OP's brother gets short thrift.



Rob Exile Ward on 18 Sep 2017
In reply to Big Ger:

Don't you EVER work?

Just askin'
Deadeye - on 18 Sep 2017
In reply to mypyrex:

Sigh.

The first hurdle is GP support. If the GP feels it is inappropriate or inadvisable, they will not refer, and there may be many reasons for this - other conditions making surgery inadvisable being very common.

I don't know in Wales, but I expect it's similar to England, in which case hip replacements are what's known as "threshold dependent procedures" - the thresholds being set with recognition of several factors including the fact that it's a major operation with significant impact (and some risk), and with somewhat variable outcomes, as well as the issue of cost. The description of the threshold will be on your local health authority website. If you fall outside this your GP can put in a recommendation to a panel that reviews and decides funding for exceptions.

Once you've got a referral, the orthopedic surgeon may also decide that surgery is not the appropriate intervention, again for a variety of reasons to do with how well they feel the patient will do under surgery and the risks vs potential gains. The problem with hips and knees is that whilst some do very well, about 20% get worse and 40% stay about the same - so it's not a slam dunk win. Also, at 75 issues of a prolonged general anaesthetic may not be trivial, especially if the patient is over or under weight.

Finally, assuming your brother is of sound mind and can make his own decisions, maybe you should let him? The NHS and PALS should take zero notice of your views unless you have health power of attorney (actually they should rightly and properly refuse to discuss his care with you).
mik82 - on 18 Sep 2017
In reply to mypyrex:

If he's in Wales, then it doesn't have PALS but the local CHC instead.

Presumably he's already been referred and seen an orthopaedic surgeon, if he's on a waiting list for a hip replacement. In this case, going to see his GP may not help much. Getting the GP to write "expedite" letters to try and speed things along rarely has any effect, as huge number of people on the waiting lists are in similar positions.

If he's not seen a surgeon yet, then paying for an initial appointment privately is an option. The surgeon may then add him to his NHS waiting list directly, and it avoids the initial wait to be seen. However, often the only way to get anything done quickly is to pay for the whole thing privately.
Bob Kemp - on 18 Sep 2017
In reply to Deadeye:

You're right in pointing out these issues, but as the OP asked about tactics I think we can be a bit more constructive. As you say, the GP's role is crucial. My understanding is that a patient is entitled to bring a companion to a consultation - this should certainly apply in the case of an elderly patient. That means that there's someone there to ask the questions that maybe wouldn't get asked, like those about any risk factors. It also means that the exact nature of the difficulties involved can be pinned down - it's very easy as a patient not to properly explain these, and someone there to jog the memory would be helpful.

In that case, it's important to emphasise the factors that GPs pay attention to. In the case of hips, things that matter, amongst others, are pain, disability, inability to live a normal life, and lack of sleep. So maybe discuss with your brother these issues, and ensure that they are raised.

One last thing - if he's been in excruciating pain for two years, what's his pain management programme like? He (and you) could usefully pursue this with the GP.
Deadeye - on 18 Sep 2017
In reply to Bob Kemp:
> You're right in pointing out these issues, but as the OP asked about tactics I think we can be a bit more constructive.

I think I've given him the pointers for how to navigate the process? Look up the criteria, get GP onside, understand the decision making process.

But it's his brother that needs to do those things. yes, brother can invite support at a consultation, but he may not want it...
Post edited at 10:53
Bob Kemp - on 18 Sep 2017
In reply to Deadeye:

> I think I've given him the pointers for how to navigate the process?

Yes, you outlined the key areas but I thought it was worth being a bit more direct - can't do any harm. And knowing exactly what GPs are interested when making decisions in always helps in my experience. In particular I've found that they will always take your problems seriously if you emphasise effects on sleep.
Trangia on 18 Sep 2017
In reply to Dave the Rave:

> Vote labour?

And how do you do that when there is no impending election in view?

Not much help to the OP's brother who needs attention now.....
oldie - on 18 Sep 2017
In reply to mypyrex:

More minor op but I have just had bunion/double toe realignment surgery about 10 weeks after seeing consultant.
This and similar "non-essential" treatments had to be OK'd by the CCG and I had to fill in a questionnaire (effects on my everyday life etc) with the consultant, which was part of the process together with GP and consultant recommendations. The consultant pointedly said that my answers were very important.
I saw my mother answering a questionnaire for council support with an official and her nursing home supervisor (bias as the home gets less money if the council pays) in which made it appear she could feed herself etc (she was actually totally immobile and couldn't even press a TV remote button). I think your brother and many old people are likely to give answers which underestimate pain and the effect on their life, and will be encouraged to do so if the consultant is under pressure to save money. In this type of situation a way round would be for you to accompany your brother and prompt him to give the correct answers, it sounds as if there is no need for exaggerations.
Lots of useful info in the earlier posts.














































































Dave the Rave on 18 Sep 2017
In reply to Trangia:

> And how do you do that when there is no impending election in view?

Sorry, should have voted labour.

> Not much help to the OP's brother who needs attention now.....

There's plenty more folk like this, but, given the torys past history people should know better than to vote for them if they give a shit about others health.
Unfortunately, a lot don't.
And the thing is, it's generally the folk with most affluence and who vote Tory who expect the most from a service that they are helping to destroy. Obviously I don't know how the OP or his brother vote, it's just a general rant.
Kicking ass won't get you anywhere. A waiting list is a waiting list with plenty of equally or more so deserving cases on it.
If you need to jump it then you will need £12k or so to go private.
profitofdoom on 21:35 Mon
In reply to Bellie:

> sadly, when there are limited funds, choices are being made, and in reality the older folk, like the OP's brother gets short thrift.

To Bellie - but is that really true about 'older folk'? It may be true or may have been true in the past. Or it may just be people's perception. I wonder do you have any evidence that it is true. Thank you.

To mypyrex I sympathize with your brother I really do. But you have not explained why he should jump the queue. I guess I would want it for my relatives but am not sure of a reason apart from that
Big Ger - on 03:06 Tue
In reply to Bellie:

> because sadly, when there are limited funds, choices are being made, and in reality the older folk, like the OP's brother gets short thrift.

When you say "limited funds", did you miss out that Wales gets more funding than England?
Big Ger - on 03:08 Tue
In reply to Dave the Rave:

> Sorry, should have voted labour.

> There's plenty more folk like this, but, given the torys past history people should know better than to vote for them if they give a shit about others health.

> Unfortunately, a lot don't.

> And the thing is, it's generally the folk with most affluence and who vote Tory who expect the most from a service that they are helping to destroy.



Did you miss out that he lives in Wales where Labour run the health service?

Maybe his mistake was voting Labour as he was under the presumption they were competent in some way.

mypyrex - on 07:39 Tue
In reply to profitofdoom:


> To mypyrex I sympathize with your brother I really do. But you have not explained why he should jump the queue. I guess I would want it for my relatives but am not sure of a reason apart from that
Not a matter of queue jumping but one of being able to resume a good quality of active life which he previously enjoyed, not to mention that the longer it's left the more expensive it will become for the Labour controlled Welsh NHS when they have to replace the other hip.
profitofdoom on 09:04 Tue
In reply to mypyrex:

> Not a matter of queue jumping but one of being able to resume a good quality of active life which he previously enjoyed, not to mention that the longer it's left the more expensive it will become for the Labour controlled Welsh NHS when they have to replace the other hip.

OK and I understand. I hope your brother gets treated really soon
Bellie on 09:27 Tue
In reply to profitofdoom:

Hi, yes I'm experiencing it at the moment with a relative.

I understand the reasoning behind these things but it still rankles.
Bellie on 09:31 Tue
In reply to Big Ger:

I'm not sure what that has to do with it. I'm not taking a (political) dig at funding levels, just speaking of the practicalities of managing a limited budget amongst a population with varying amounts of need.



Big Ger - on 09:46 Tue
In reply to Bellie:

> I'm not sure what that has to do with it. I'm not taking a (political) dig at funding levels, just speaking of the practicalities of managing a limited budget amongst a population with varying amounts of need.

But that's the task they are, ermmmm... ....tasked with...

If they are getting less good outcomes, from greater funding than other areas, then they are not competent
Becky E - on 18:21 Tue
In reply to mypyrex:

Who is doing the fobbing off? The GP? The surgeon?

Like others have suggested, I recommend that you go along with your brother to his next appointment with the GP and/or surgeon and make sure that they're fully aware of the impact it's having on him. If he doesn't have an appointment, then insist that he makes one and takes you with him.

There's virtually nothing you can do in the way of arse-kicking without his consent/involvement.
profitofdoom on 19:34 Tue
In reply to Bellie:

> Hi, yes I'm experiencing it at the moment with a relative.

> I understand the reasoning behind these things but it still rankles.

Thank you for your reply. And I am sorry to hear about your relative having to wait.

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