NHS Funding for Orthopaedic Surgery

The NHS does a great job providing top quality medical care for millions of UK residents. It’s widely regarded as a shining example of a public health care system done right but it’s not without its problems. Perhaps the most notable of these is the extensive queues you’ll need to endure to A) get your surgery approved for reimbursement and B) actually have the surgery itself. And in spite of all the recent talk about reforming the NHS waiting list process waiting times for orthopaedic surgery are only expected to get longer in the next 2 years. As is the process of applying for NHS funding. That’s because the number of patients in the queue is expected to balloon from the current 370,000 to more than 800,000.

A Better Way

For the next year-plus the UK will remain a member of the European Union. This is important because it means the UK must still abide by the EU directive which stipulates any UK resident in need of medical care has the right to seek treatment in any European Economic Area (EEA) country and – more importantly – be fully reimbursed by NHS for operation costs. The possibility of having a knee or hip replacement abroad is not something that occurs to everyone, but perhaps it should; for a few very good reasons:

• It will cost you less out of pocket to have the surgery in a place like Riga.
• Even if you are ultimately approved for surgery in the UK you could still wind up waiting more than a year for your surgery date due to the incredible backlog of patients. In Riga you can have your surgery within weeks of your first consultation.
• The quality of the surgical teams in Riga as well as the quality of the facilities are every bit the equal of the best NHS hospital for hip replacement, knee replacement or ACL surgery.
• The experienced team at Orthopaedic Riga will help guide you through the Byzantine process of securing reimbursement from NHS.

Any one of those benefits would be enough to justify having your orthopaedic surgery abroad. When you add them all together however the question changes from “Should I have my orthopaedic surgery abroad?” to “Why shouldn’t I have my orthopaedic surgery abroad?” About the only reason most people can come up with is that they’re intimidated by the reimbursement process. And that’s understandable. The following is an abbreviated version of that application and reimbursement process just to give you some idea what we are talking about and why you need Orthopaedic Riga on your side to help.

Applying for NHS Funding for Orthopaedic Surgery Abroad

In order to be eligible for reimbursement of your hip or knee replacement surgery abroad you will need to obtain prior approval from NHS. As such the first thing you will need to do is fill out an NHS application form (available for download from the NHS website). Make sure the form you download and complete is the latest form as older forms may not be accepted. On the application you will need to describe at length details of the procedure and who is to perform it including the date of the surgery, the dates you anticipate being admitted and discharged along with anticipated costs. Documentation relevant to the procedure that may be in a different language will need to be accompanied by accurate professional translations.

Eligibility

NHS funding for hip replacement and other orthopaedic procedures is possible under the EU Directive though they will need to make sure your case meets all of the relevant eligibility requirements. Those are:

• You are a UK resident or legally living in the UK and entitled to treatment on the NHS
• The treatment is the same or equivalent to what you would receive on the NHS
• The provider of your surgery is based in an EEA country
• The surgery is considered medically necessary
• You provide a letter from an EEA clinician either in the UK or abroad as proof that you have had a proper clinical assessment

Since, as we stated above, orthopaedic surgery abroad requires prior authorisation from NHS it is possible that your application may be refused if:

• The risk to the patient in travelling to the proposed location is deemed unacceptably high
• There is some form or risk the public may be exposed to a safety hazard as a result of your procedure. (Zero chance of this)
• The healthcare provider is one with questionable standards when it comes to patient care and safety (Not an issue with Orthopaedic Riga)
• The NHS believe they can provide the surgery themselves in a “medically justifiable” period of time (possible)

Important: Because orthopaedic surgery requires prior NHS approval if you are to be reimbursed the letter from the EEA clinician must state in clear medical terms why you need to have the surgery as well as the clinicians assessment for what constitutes a “medically justifiable” time frame for having the surgery. Again, Orthopaedic Riga will help you with this aspect of the application process in order to ensure it goes smoothly.

Many patients make the mistake of trying to fill out the entire application themselves and then are surprised when they are rejected. There is no need for this to happen to you. When you contact Orthopaedic Riga about having your surgery with us talk to the patient coordinator about getting help filling out and filing the application. She will be happy to take you through the entire process.

Keep in mind too that if the NHS pre-approves your orthopaedic surgery abroad, whether in Riga or anywhere else, they do not assume liability for the procedure.

Are These Programs Available to Everyone?

As stated above anyone who is a UK citizen or legally living in the UK and eligible for NHS treatment is eligible to apply to have their orthopaedic surgery abroad paid for by NHS. If NHS determines the trip abroad is too great a risk to your health they may refuse reimbursement. Or, if they deem the surgery medically unnecessary, they may also rejected your reimbursement application. If rejected however, you retain the right to appeal the NHS decision and we can help you with the appeal process as well.

ACL, Hip and Knee Replacement on NHS Abroad

NHS will refund the cost of any of the following orthopaedic procedures up to what it would cost to have the procedure done by the NHS.

• Knee Replacement
• Hip Replacement
• Meniscus Tear
• Spine Surgery
• Hip Arthroscopy
• Shoulder Arthroscopy
• Spinal Disc Herniation
• Shoulder Replacement

Should You Simply Go Ahead and Have Your Surgery Abroad?

It is not possible to receive reimbursement for orthopaedic surgery performed abroad if you did not receive prior approval for the procedure. The only exceptions might be if your surgery was of the emergency type, necessitated by an accident you experienced while abroad. Otherwise, if you go ahead with knee replacement or any other type of orthopaedic surgery abroad without prior approval from the NHS you will need to shoulder the cost yourself.

A wiser course of action is to go ahead and apply for reimbursement since it only takes about 3 weeks to hear back from NHS as to whether or not they’ll cover the cost. If they say they will then you can go ahead and book the procedure at Orthopaedic Riga the same day applying for your refund when you return.

If, for whatever reason, you are not willing or able to wait the 3 weeks to hear from NHS it’s not necessarily the end of the world because the cost of having your knee replacement, hip replacement or ACL reconstruction at Orthopaedic Riga is just a fraction of what it would be in the UK. So it may be that you are able to shoulder the cost yourself without it causing you financial distress. Which brings us to our cost comparison chart.

Cost of Having Various Orthopaedic Surgeries in Europe

Below are comparison charts showing the cost of knee replacement, hip replacement and ACL surgery in various European cities compared to the cost of these procedures at Orthopaedic Riga.

Average cost of hip replacement throughout Europe including the cost of a hip replacement operation with NHS, London (that’s single, not double hip replacement with NHS).

Average cost of knee replacement throughout Europe including NHS Knee Replacement Cost.

Average cost of ACL reconstruction throughout Europe including the cost of ACL surgery with NHS London.

Why are Costs So Much Lower in Latvia?The above prices represent the average cost of the different procedures in a particular city compared to the cost of the same procedure at Orthopaedic Riga in the Latvian Capital. The exact cost at a specific hospital or clinic may vary from the average price shown above. Things like NHS ACL rehab however are not covered by the above charts.

Cities like Riga are not burdened with the outrageous property valuations and high taxes that are the order of the day in places like London and which increase knee replacement cost for NHS patients. This means owning and operating a clinic costs far less in Riga than it does in cities like London or Paris. As the cost of operating the clinic is lower (as is the basic cost of living) all other costs associated with the orthopaedic surgery are similarly lower. But this is not to imply that the quality is lower. On the contrary. The facility at Orthopaedic Riga is state of the art and compares favourably with any you will find in the UK or other western European nations. In addition, the surgical staff at Orthopaedic Riga are some of the most experienced and qualified you will find anywhere.

Who is a Good Candidate for Knee Replacement?

Never mind the staggering NHS knee replacement waiting time, before you even consider whether you should travel abroad to undergo knee replacement surgery or start worrying about NHS knee replacement cost you need to determine if knee replacement is the right option for you. This type of procedure is not like having a face lift or tummy tuck. It is a major procedure that will completely replace one of the most important joints in your entire body. Yes, it will likely improve your quality of life in many and various ways. However, if you don’t actually need to undergo the procedure then you are replacing original equipment that doesn’t need to be replaced and this can open you up to a slew of negative long term side effects. So what are the criteria for determining if a person should undergo knee replacement?

• Your age – If you are less than 55 years of age most surgeons will want to know if you have exhausted all other options before deciding to have knee replacement. For those between 55 and 70 with severe knee problems surgery is more likely to be recommended.
• Your degree of immobility and pain – If you experience more or less constant and severe pain in the knee joint the surgeon may decide that knee replacement is the right option. Likewise if movement is severely impaired and the knee is not responding to more conservative treatments knee replacement may be indicated.
• Damage to the knee – If the amount of damage to the knee is extensive there may be no choice but to proceed with knee replacement surgery.

Recovering from Total Knee Replacement

The recovery process following total knee replacement will require patience and determination and will typically take several months before it is considered complete.

• In general however, given that there were no complications during or after the procedure, the patient will begin moving the knee joint shortly after surgery to keep things loose and prevent clotting and swelling.
• Most patients will be able to stand and possibly walk with assistance a day or two after surgery.
• Over the course of the following month walking (with assistance) will become more common and the physical therapist will gradually ramp up the intensity of your exercise regime to begin rebuilding strength in the joint.

Who is a Good Candidate for Hip Replacement?

Total hip replacement with NHS or any other entity is in some ways even more intensive, invasive and disruptive to one’s routine than knee replacement surgery. Still there are circumstances when replacing the hip joint is the best option. But what are the NHS criteria for hip replacement? First, you and your doctor will want to be certain that you have explored all other possible options and that none of them have provided the relief you want and need. These other options may include targeted exercises, medications, walking aids and more. Even if your doctor determines you should undergo hip replacement you will still want to get a second opinion before deciding to have the surgery. Simply because once the joint is replaced there is no going back to your natural skeletal structure. The following are the typical NHS guidelines for hip replacement:

• The damage to your hip joint is caused by a medical condition such as rheumatoid arthritis, osteoarthritis, bone tumours or something else.
• The hip joint has been badly damaged, perhaps fractured during the course of an accident.
• All other non-surgical remedies have been exhausted.
• Lesser NHS hip replacement options like partial hip replacement with NHS either failed or would likely fail to provide adequate relief.

Patients with chronic neurological disorders such as Parkinson’s disease are not considered good candidates for hip replacement surgery. Nor is anyone with a condition that results in muscle weakness.

Recovery from Total Hip Replacement Surgery

The recovery process for total hip replacement surgery is a lengthy one but if you are scrupulous about following the advice of your surgeon and physical therapist NHS hip replacement statistics show you stand an excellent chance of making a full recovery and regaining normal function of the hip joint.

• Immediately after surgery you will have a positioning splint placed between your legs to keep them apart and prevent damage while you sleep.
• You will likely spend 3 or 4 days in the clinic recovering from the procedure before flying home.
• Your movements will be severely restricted in the days after returning home with a focus on promoting mobility in the joint being of paramount concern.
• Within a few weeks you will begin to engage in more rigorous total hip replacement exercises. NHS recovery guidelines will be adhered to by your physical therapist.
• Over the course of the following months you will gradually increase your level of exercise and activity while being careful not to push things too far.
• Full recovery is typically achieved after 5 or 6 months.

Your level of commitment to the recovery process will be the single biggest factor in determining the success or failure of your hip replacement aftercare. NHS statistics back this up.

ACL Reconstruction and NHS Waiting Time

If you’ve suffered an ACL injury NHS may pay for you to have ACL surgery. NHS will likely pre-approve ACL reconstruction but NHS ACL surgery waiting time can run into many months so it’s just not realistic for you to be hobbled for so long or wear an ACL knee brace. NHS will pay for your reconstructive surgery abroad provided your doctor can demonstrate that having the ACL repaired now is medically necessary.

About Riga

The Baltic States spent the better part of the 20th century behind the iron curtain with the rest of Eastern Europe and in that time managed to pretty effectively slip from the public consciousness. Since their re-emergence some 25+ years ago however, they have slowly but surely reclaimed their position as important cultural and economic hubs and become major tourist destinations as well as an important destination for high-quality, affordable surgery of many types.

Today Riga is the centre of a vibrant metropolitan area with more than 1 million residents. Each year more than 2.5 million people visit Riga and that number has been steadily inching up over the past 10 years with visitors arriving by land, sea and air. The port plays host to all of the major cruise lines including Royal Caribbean, P&O, Cunard, Costa Cruises, Princess and about a dozen more. While Riga’s international airport is one of the busiest in northern Europe handling in excess of 5 million passengers annually: more than Belfast, Belgrade or Liverpool.

The city centre with its native Jugendstil and Art Nouveau architectural marvels has been designated a UNESCO World Heritage Site and that is only a small part of the cultural treasures to be found here. World class art galleries and historical landmarks are another major draw and of course the local cuisine is not to be missed (try the Bacon Rolls).

European Capital of Culture

The reasons for traveling abroad for your orthopaedic surgery are plentiful and the reasons to choose Orthopaedic Riga as your destination for knee replacement, hip replacement or ACL reconstruction surgery are equally numerous and compelling. Having your knee replacement surgery on the NHS in Riga doesn’t have to be a jungle of paperwork. Not when you have the experienced team at Orthopaedic Riga helping you with the process of applying for NHS funding. Give our UK patient coordinator a call today and set yourself on the road to recovery, instead of the road to the NHS queue.