The Parliamentary Under-Secretary of State for Health (Ben Gummer)
I thank the hon. Member for North Durham (Mr Jones)for securing this debate on what is clearly an extremely distressing case for his constituent and an unfortunate one more generally. I want to pick up on the specific issues he raised to do with his constituent’s case before talking about the generality of the regulation of cosmetic surgery.
The hon. Gentleman pointed out the failure of his constituent’s doctor to have insurance and he will be pleased to know that, as of July 2014, new legislation required all surgeons providing cosmetic interventions to provide insurance and proper cover. A failure to do so would render them liable to undergo the fitness to practise tests conducted by the GMC. Those doctors operating outside the UK but in the EU who would have a temporary ability to operate in this country under the directive on mutual recognition of professional qualifications would still, under GMC regulations, be required to provide evidence of insurance cover. That legislation was brought into effect in August, which was clearly too late in the case of his constituent.
Mr Kevan Jones
Will the Minister look specifically into the case of Dr Paganelli, as I understand that he is still practising in this country?
Ben Gummer
I will certainly look into that case, as it does not sound right. I cannot trespass on the realms of the GMC, but I will inquire into the specific case outlined by the hon. Gentleman.
The hon. Gentleman makes a valid point about the cost to the NHS and this is not the only area in which we have considered and continue to consider cost recovery for the NHS. It can be difficult as sometimes the cost of legal action outweighs the cost of recovery and it is not something that the service is used to doing. I am keen to explore it further, but in the context of the action we are taking, which I shall come on to, I hope that the hon. Gentleman will understand the need to take this bit by bit so that we get the process right. In principle, I certainly agree that if organisations cause a cost to fall on the NHS, as in this case, there is a good argument for seeing whether that cost can be recovered.
That takes me on to another part of the hon. Gentleman’s speech that was particularly striking, about the celebrity endorsements in this case. It is not for me to make policy announcements in an Adjournment debate, nor would I want to in the case of celebrity endorsements, but I agree with the hon. Gentleman that people should think carefully about how they endorse cosmetic surgery. It is a serious intervention and if anyone seeks to glamorise something to which careful thought should be given, people and the organisations using those endorsements should treat them with extreme care.
I would point the organisation that the hon. Gentleman is dealing with and everyone else towards the code of conduct in advertising, the Committee of Advertising Practice and the Broadcast Committee of Advertising Practice, which drew up guidance in October 2013, especially on protecting children and young people. I think it would be appropriate to make sure the organisation of which he speaks is complying with the spirit as well as the letter of that guidance, and if not I will certainly help him to ask whether anything more can be done on that.
The hon. Gentleman raises the issue of counselling. Any reputable organisation should seek to ensure that people undertake procedures only when they need to do so and have been properly counselled on the consequences of their actions so that they can make an informed decision. The Government believe that that should happen in every case for cosmetic surgery. There should be an informed decision, taken with serious thought.
Finally, on the issues to do with The Hospital Group the hon. Gentleman raised, I cannot speak without further advice, but there clearly seem to be questions about trading standards, which he raised. I hope that I and my officials will be able to meet him to look carefully at this case, to make sure if The Hospital Group is misrepresenting its position apropos its surgeons and those it seeks to represent, it is not besmirching an industry which more widely does take its duties and the way it represents itself seriously.
Jim Shannon
The hon. Member for North Durham (Mr Jones) has raised a topical issue of which we are all aware. Many people have had botched operations. Has the Minister’s Department been able to quantify how many? Optimax was one of the groups involved with a lot of the operations for laser surgery. People thought that was safe, but it was obviously not safe for all. Has the Department been able to quantify the numbers and therefore take action?
Ben Gummer
I am afraid I do not have an answer to the hon. Gentleman’s question, but I will make sure we write to him if such figures exist, although I suspect they may not. Let me inquire, and then I shall reply to his question.
Let me turn to the broader policy issues to which the hon. Member for North Durham referred. He referred to Sir Bruce Keogh’s review. It began in January 2012 after the PIP breast implant scandal. It covered the rapidly growing non-surgical cosmetic market. He published that review in 2013 and it highlighted the rapid growth of cosmetic interventions, and suggested safeguards among 40 recommendations to protect patients. The aim of those was to improve how surgical and non-surgical interventions were done, to set standards for training practitioners and surgeons and for how supervision from regulated healthcare professionals can support self-regulation of the industry, and to improve the quality of the information clients have to ensure they are able to make informed decisions about their treatment. The Government published their response in 2014.
By the time of the publication the Government had already started work on a number of the recommendations. To address the issue of proper training for cosmetic practitioners, the Royal College of Surgeons set up an inter- specialty committee with representation from the relevant specialty associations and professional organisations including plastic surgery, ear nose and throat, oral and maxillofacial surgery, breast surgery, urology, the Royal College of Obstetricians and Gynaecologists, the Royal College of Ophthalmologists, the General Medical Council and the Care Quality Commission. The committee also includes patient and provider representation, and representatives from the devolved Administrations are invited as observers.
The committee established three sub-groups which are taking forward the work to implement the recommendations. They cover standards for training and certification, clinical quality and outcomes, and patient information. The committee is also in the process of developing an overarching framework for certification to improve the safety and delivery of cosmetic surgery. Individuals performing cosmetic surgery will be expected to practise within their field of specialty training. The framework for certification takes into account equivalence for non-UK-based surgeons.
Holly Lynch (Halifax) (Lab)
I thank the Minister for giving way, and I thank my hon. Friend the Member for North Durham (Mr Jones) for bringing this important debate to the Chamber. PIP has been mentioned, along with the regulations that are in place in this country. I want to ask how we need to work with our European neighbours to ensure that we get the regulation right. We have heard about doctors coming from Italy to practise in this country, for example, and we know how PIP, which started in France, has impacted on patients in the UK. What work is the Minister doing to ensure that we co-operate across Europe to close any loopholes in this area?
Ben Gummer
The hon. Lady has touched on a complicated and diverse subject. I will happily talk to her when we have more time about what the Department is doing and what we are doing within the European Union to ensure the transferability of qualifications. A considerable amount of work is being done, and the GMC has tightened up a whole number of areas to ensure that we allow only the highest quality of practice in this country, while allowing people to travel through the European Union to practise using their qualifications.
I want to turn now to training for non-surgical interventions. We asked Health Education England to develop a new qualification framework for providers of non-surgical cosmetic interventions, and for those required to be responsible prescribers, that could apply to all practitioners regardless of previous training and professional background. Health Education England has now completed its review of the qualification requirements and will publish its recommendations shortly.
The issue of breast implants initiated the review by Sir Bruce Keogh. The review placed particular importance on systems that can precisely identify the complete cohort of patients in which a specific implant has been used. It recognised that being able to monitor the device implementation and performance for clinical outcomes and tracing of patients at risk of device failure was an important safety issue. There has been a range of responses, involving the Medicines and Healthcare Products Regulatory Agency, the Health and Social Care Information Centre, the Committee of Advertising Practice and the Broadcast Committee of Advertising Practice, and a whole series of recommendations has been enacted following the review.
Turning to legislation, we know that there are examples of high-quality surgical and non-surgical intervention, as I am sure the hon. Member for North Durham would agree, and it is those standards that we must make universal. I am aware of the arguments in favour of legislation as a way of reaching those standards—for example, through the statutory regulation of the non-surgical sector or new powers for the GMC. However, it does not follow that we must depend on legislation alone to meet the fundamental objectives of the Keogh review. Much has been achieved already and there is much more to do.
I know that the hon. Gentleman understands the pressure of competing priorities on parliamentary time. The calendar for legislation is full at the moment, as he knows, but we now have an opportunity to review and monitor the impact of non-legislative action before confirming whether new legislation would add significant value to safeguards for people choosing cosmetic procedures. We will continue to be advised on that by Sir Bruce and others as the safeguarding framework continues to develop. I can give the hon. Gentleman a personal assurance that I will ensure that the review of the non-legislative remedies is thorough, and that if it is found wanting, we will immediately look again at the subject with a view to taking further action.
We are grateful for the support of the Royal College of Surgeons and its partners and for the extremely thorough work that they have done so far. We are also grateful to the General Medical Council and the Care Quality Commission. In the light of the continuing work that I have outlined, I hope that the hon. Gentleman will agree that we are in a far better position now than we were before Sir Bruce’s review to help to protect the public and ensure proper training and oversight of non-surgical as well as surgical cosmetic interventions.
On the specific questions that the hon. Gentleman raised about his constituent, I commit to returning to him with an answer on the doctor he mentioned and the insurance that he will be required to have. I will also give him a specific answer on the cost to the NHS and any work that we might do on cost recovery, and on the specific guidance on the advertising of surgical procedures. I hope also to be able to get to the bottom of the nature of the sales techniques and the claims made by the hospital that he has mentioned, to ensure that it is practising in accordance with the standards that would be expected of a decent, reasonable organisation doing what it purports to do. I thank the hon. Gentleman very much for bringing this case to the Government’s attention.