The number of patients seeking hip surgery has risen significantly amid an ageing population Credit:Alamy Want the best of The Telegraph direct to your email and WhatsApp? Sign up to our free twice-daily Front Page newsletter and new audio briefings. “Arbitrary” rationing measures restricting NHS surgery to those in most pain must be lifted, health officials have ruled.NHS England has warned clinical commissioning groups (CCGs) to stop denying hip and knee operations to patients using criteria which only allow surgery to those in the worst discomfort.Health officials intervened after warnings from the Royal College of Surgeons of “alarming” restrictions on surgery, with patients told they could only have surgery on the NHS if pain left them unable to sleep or carry out daily tasks.NHS England has now issued advice that such restrictions are not allowed, with local health officials told they should follow guidance from central rationing bodies.Noting that “a number of CCGs in England are rationing large joint replacements using arbitrary cut offs” – using a system to measure pain levels – advice from regional officials warns against such actions.Local services have also been warned not to restrict surgery for smokers and obese patients – although delaying operations while giving patients help to lose weight and quit smoking is endorsed. A separate memo from NHS England urges all organisations to follow guidance from the National Institute of Health and Care Excellence (Nice), which says surgery should be considered “before there is prolonged and established functional limitation and severe pain.” The letter, from Matthew Cripps, national director for “NHS RightCare” and Peter Kay, a consultant hip and knee surgeon from the Whittington Hospital, says: “For some indicators, such as elective activity, investment cannot be interpreted as poor or good value without further investigation… There is strong evidence that hip and knee replacements are extremely cost-effective interventions when warranted by clinical need and patient preference.”The disclosures, reported in Health Service Journal, were welcomed by surgeons.Clare Marx, President of the Royal College of Surgeons, said: “It is extremely welcome news that NHS England has now intervened to discourage clinically unacceptable rationing of surgery in the NHS.”However, she urged NHS England to go further, and to instruct CCGs to lift any unfair restrictions on surgery.“The guidance in this letter is a very welcome start. However, it only criticises the rationing of hip and knee surgery. Patients are left wondering about the validity of restrictions to other types of surgery and NHS treatment,” she said. “Given this very clear intervention from NHS England we strongly encourage CCGs to reverse any existing discriminatory policies.”Three commissioning bodies in the West Midlands came under fire in January for drawing up policies to restrict hip and knee operations to those most in pain. The move followed widespread restrictions in access to treatments, drugs and IVF across the country, after the NHS recorded the worst deficit in its history.