Hello, I'm Greg Jenna and good news, Your Dead to Me is back for a new series. Here we go. Yes, we'll explore Emperor Nero's notorious reign with Professor Marybeard and Patton Oswald. I would not want my daughter having the remote control, not alone an empire. We'll dissect the decadent life of Philippe Duke-Dor-Leon with Tom Allen. I've often tried to pretend I'm an aristocrat and being very quickly knocked down. And there'll be so much more with comedians like Olga Koch, Mike Mosniak and Rihalina. I'm excited. You're dead to me, the comedy podcast that takes history seriously. Listen first on BBC Sounds. This is the BBC. Hello, thank you for listening to this edition of Inside Health.

I hope you enjoy it.

Coming up today, carpal tunnel syndrome, hernias and varicous veins,

and why you might now struggle to get any of them treated on the NHS.

And the difficulty is not limited to these common complaints.

Clinical commissioning groups in the Midlands have been in the headlines this week

after raising the bar for eligibility for hip and knee replacements.

If you live in Worcestershire, your arthritis now needs to be severe enough

to cause pain that interferes with daily life and keeps you awake at night.

If it's not, then the local CCGs won't pay for the surgery.

A move they believe will lead to 350 fewer operations, saving them around £20 million a year

to spend on other therapies they deem higher priority. Prioritisation is otherwise known as rationing

and there's a burgeoning number of interventions on the not normally funded list produced by CCGs to show what they're not prepared to pay for unless there are exceptional circumstances.

Clinicians with patients they regard as special cases with things like hernias have to seek approval using an individual funding request or IFR,

which is appraised by a panel to check the patient meets the necessary criteria.

Jonathan Earnshaw is a consultant surgeon at Cheltenham General Hospital.

Groyne hernia is very common and the danger with having a groin hernia is strangulation

where a piece of bowel gets into the hernia and twists.

And in that circumstance, people need an urgent hernia repair, and sometimes even the bowel needs to be removed.

And the reason for doing routine elective hernia repair is to prevent strangulation.

The problem is it's really very tricky to assess whether an individual hernia is

likely to strangulate. And for that reason, we've ended up in the past operating on most people

...