Cosmetic Surgery

Debate between Anne Milton and David Tredinnick

Thursday 5th July 2012 Westminster Hall

[The Parliamentary Under-Secretary of State for Health (Anne Milton)]

Sadly, as I only have about five minutes left, I will not be able to answer all the issues that the shadow Minister, the hon. Member for Hackney North and Stoke Newington (Ms Abbott), raised.

[David Tredinnick]

On a point of order, Mr Rosindell. My understanding is that the debate can continue at the discretion of the Chair.

[Andrew Rosindell (in the Chair)]

Yes, indeed that is so. I intend to let the debate run on a bit longer to allow the Minister to respond and Mr Dorrell to have his two minutes towards the end.

--- Later in debate ---

[Anne Milton]

My only hesitation is that there might be constraints that I know nothing about. However, I can see no reason why not if the evidence has been assessed. The evidence will, almost by definition, be in the public domain because it will be in papers that have been peer-reviewed and probably published. There should therefore be no reason why it should not be available to all women.

My right hon. Friend raises an important point: it is not just about what one does, but about what one is seen to do. Any restriction on access to information raises suspicions in people’s minds. All those women have already had a bad experience—they had their surgery and were reassured by surgeons and staff at the organisations they went to—and already feel that they have been deceived. Therefore, it is more important than ever to make sure that they have access to the information that we have access to.

As I said, Sir Bruce’s group has published its final report, which was informed by detailed tests on the silicone used in PIP implants and by large-scale data on the rupture rate of the implants. It draws on what doctors found when they removed some implants. It was painstaking work, and three main conclusions stand out. It is important to reiterate that research—data—should always be under constant review.

First, the evidence supports the fact that impurities in silicone gel do not pose a threat to health. That fits with the conclusions of tests on the gel carried out in the UK and other countries. Secondly, there is clear evidence that the rupture rate for PIP implants is significantly greater than for other silicone gel implants on the UK market. Thirdly, although some ruptures are associated with local clinical reactions, in the great majority of cases, that was already apparent before removal of the implant. So-called silent ruptures detected by scanning, but with no outward signs or symptoms of a possible rupture, are not in general associated with significant clinical reactions when the implants are taken out. The group therefore concluded that PIP implants are clearly substandard—there is no doubt about that—but that if the implants are still whole inside the body, there is no evidence of an increased risk of clinical problems.

I stress that that is not what the Government say; it is what an expert group says. I am happy to send anybody who wants it the list of who made up that expert group. It is important and it is about confidence in what we are doing. Ministers are not scientists. It is important that we rely on and get the best possible scientific advice, and that we remain vigilant in scrutinising that advice.

[Mr Joe Benton in the Chair]

[David Tredinnick]

My hon. Friend might be about to move on to this, but did the expert group consider the points made about two operations for people having problems with implants? She will probably deal with that in a moment, but she will forgive me for nudging her.

[Anne Milton]

I need no nudging, but I take my hon. Friend’s intervention in the friendly manner in which it was intended. I will move on to that.

The group reiterated the earlier advice that women with evidence of ruptured implants should be offered removal, and women with no sign of rupture should talk to their specialists, discuss the pros and cons of removal and decide with their doctor the best way forward.

In January 2012, in line with the interim advice, we published the NHS offer: women who originally received implants from the NHS are entitled to a consultation and a scan if appropriate. Then if the woman and her doctor so decide, the NHS will offer to remove and replace the implants. From the start, we made it clear that we expected private providers to match that offer. Many have done so. In fairness and for balance, I point out that some have been very responsible. I hesitate to mention some, as the list will not be conclusive, but BMI Healthcare, Linea Cosmetic Surgery, Nuffield Health, Ramsay Health Care, Spire Healthcare, The Hospital Group and Transform have been responsible and stepped up to the plate. It would be a shame if this debate cast negative views on all those involved in the plastic surgery industry, but I will come to some of the other points raised before I finish.

Where a private provider has gone out of business or fails to meet its moral and legal obligations, the NHS will provide a consultation, a scan if appropriate and removal, but not normally replacement, of the implants. That policy remains in place today. My hon. Friend the Member for Bosworth (David Tredinnick) wanted me to go on to the question whether the policy should be varied. As has been reiterated today, the Select Committee on Health suggested that women should be able to pay a fee for new implants to be put in place by the NHS during the same operation in which the old ones are taken out. I completely understand why, and I have discussed the issue at length.

There are several points. Allowing a mixture of NHS and privately funded care within a single operation risks undermining a founding principle of the NHS that care is free. I take the point made by my hon. Friend the Member for Totnes (Dr Wollaston) about co-payments in the NHS for dentistry, glasses and so on—I could go on. I believe that Bevan resigned within two or three years of the formation of the NHS, on that very point. The issue of co-payments goes back a long time. However, I feel that this situation, although complicated, is different. If the NHS were to carry out replacement breast augmentation, it would become responsible for all the aftercare, including possible future replacements. As my hon. Friend the Member for Totnes and my right hon. Friend the Member for Charnwood mentioned, the rupture rate is significant anyway. Breast implants do not last a lifetime; it is unlikely that they will.

Oral Answers to Questions

Debate between Anne Milton and David Tredinnick

Tuesday 22nd November 2011 Commons Chamber

[David Tredinnick (Bosworth) (Con)]

Has my right hon. Friend the Secretary of State or any of his ministerial colleagues been able to visit the People’s Republic of China to consider traditional Chinese medicine?

[Anne Milton]

I thank my hon. Friend for that question. He must be psychic, because I recently visited China, and it was fascinating to meet Ministers there. He will also be very pleased to hear, as I am sure the whole House will, that I visited a hospital and community centre that combines western medicine and traditional Chinese medicine.

Oral Answers to Questions

Debate between Anne Milton and David Tredinnick

Tuesday 25th January 2011 Commons Chamber

[David Tredinnick (Bosworth) (Con)]

Will my right hon. Friend the Secretary of State please explain why it is taking so long for him to come to the House about the regulation of herbal medicine? He has to do that before April to comply with European legislation. What is the hold-up?

[Anne Milton]

I thank my hon. Friend for his question and I know that he has a keen interest in this subject. I share his frustration that the previous Government spent a long time not doing anything about it. The Medicines and Healthcare products Regulatory Agency has identified the possibility of creating a national regulatory scheme, allowing authorised herbal practitioners to continue to commission unlicensed manufactured herbal medicines after 30 April. We are in discussions with the devolved Administrations, the Health Professions Council and the Complementary and Natural Healthcare Council about the feasibility of a statutory register. As I say, I share my hon. Friend’s frustration but we will make proposals shortly.

Oral Answers to Questions

Debate between Anne Milton and David Tredinnick

Tuesday 29th June 2010 Commons Chamber

[David Tredinnick (Bosworth) (Con)]

Would my right hon. Friend accept that there is widespread anecdotal evidence of the effectiveness of homeopathic medicines? There are 500 doctors in this country who use them, and nobody is obliged to have them if they do not want them. Will he therefore heavily discount the illiberal views of our hon. Friend the Member for Cambridge (Dr Huppert)?

[Anne Milton]

May I thank my hon. Friend for his question and pay tribute to him for his continued and persistent lobbying on this subject? I gather that he has been elected a member of the Select Committee on Health, so I welcome him to that position and I am sure that we will meet again at some point.

What is important is that decisions about treatment are made by clinicians, and they will base their decisions on the safety, efficacy, efficiency and outcomes that a particular treatment will provide.

Integrated Health Care

Debate between Anne Milton and David Tredinnick

Wednesday 2nd June 2010 Commons Chamber

[The Parliamentary Under-Secretary of State for Health (Anne Milton)]

I congratulate my hon. Friend the Member for Bosworth (David Tredinnick) on securing this Adjournment debate on complementary and alternative medicine and integrated health care—a subject that I know is close to his heart. His continued interest and continued efforts to raise the matter in this House, as well as his determination to keep the issue alive and uppermost in our minds, is legendary. He commented himself on his 20 years of campaigning on this issue. It is important to note that it is the efforts of individual Members—their continued efforts, sometimes against the odds—that keep these issues uppermost and alive in our minds.

My hon. Friend may be interested to know that although I trained as a nurse and worked in the NHS for 25 years in conventional medicine, my grandmother trained at the homeopathic hospital in London, and was herself a homeopathic nurse. Later, she became a Christian Scientist. I am therefore not without my own roots in alternative therapies. My hon. Friend may also be interested to know that my grandmother never, until her death at the age of 89, took any conventional medicine.

My hon. Friend raised the issue of homeopathic hospitals and his concern about them. I understand that there are five such hospitals in the United Kingdom, based in London, Bristol, Tunbridge Wells, Liverpool and Glasgow. However, the Tunbridge Wells homeopathic hospital stopped providing services in March 2009 owing to the primary care trust’s decision to end funding. All the hospitals have experienced a reduction in the number of referrals over the past three years, and it has been claimed that all of them are now in a precarious position as a result of such significant funding losses. That is a matter of concern, given that they have clearly offered valuable treatments to patients.

My hon. Friend said that a number of people turn to alternative therapies when they have either been failed by conventional medicine or have adverse responses to it. Although he referred to the current position, it may help if I make some more general points connected with our approach to health care.

Decisions about patient care are best made by clinicians. Local practitioners are best equipped to decide which therapies will ensure the best outcomes for individual cases, and are best placed to decide which services can cater for their areas’ health needs—in conjunction, of course, with patients themselves. The Government’s role in all that is to empower patients and professionals to take control of the funding and provision of health services in their areas, to encourage further research on new treatments and therapies, to support the local NHS by providing information on the clinical effectiveness and cost-effectiveness of various treatments, and, of course, to protect the public by ensuring that those treatments are safe. We do that through the National Institute for Health and Clinical Excellence, which is responsible for making recommendations on treatments to the NHS, and through the Medicines and Healthcare products Regulatory Agency, which is responsible for regulating the safety of medicines and treatments. The Government also encourage research on new medical treatments and technologies, primarily through the National Institute for Health Research. Research proposals are assessed in open competition, on the basis of scientific quality, and are subject to peer review.

My hon. Friend raised the issues of choice and cost-effectiveness. He observed that complementary and alternative medicines were often very cost-effective, and that the methods of treatment often involved limited invasiveness. It may be useful to deal with those two issues together, as they go to the heart of my hon. Friend’s concern: the fact that PCTs are not commissioning or fully using complementary and alternative medicines.

As I stated earlier, we believe that local practitioners are best placed to make decisions about individual care, and that GPs are often most in touch with the health needs of their local populations. That is why it is so important that this Government will seek to give GPs more power to commission services, and patients more power to choose health care providers. By bringing together groups of general practitioners and giving them direct control over the health budgets of their patients, we will push the decision-making process closer to patients—closer to the heart of the problem. GPs will have the power to choose how to spend resources in order to achieve the best health outcomes, and we will ensure that PCT boards include directly elected individuals who can speak for patients at board level so that local people have a voice when decisions are made about local health provision.

Giving GPs more responsibility and more control over how NHS resources are used in their areas, and giving patients the power to choose any provider that meets NHS standards, will result in a health service that is not only more flexible, which is what my hon. Friend wants, but more responsive to patient need. As he will be aware, the decision to commit NHS resources cannot be taken lightly, especially during a period when the NHS as a whole must find considerable efficiency savings. Commissioners must be sure they are funding treatments that will result in the best health outcomes. That is what we all want. They must be sure of the safety, clinical and cost effectiveness, and availability and evidence in support of any therapy, and they must be sure that there are suitable practitioners in their area to deliver it.

The issue of regulation was raised, and it is a thorny one. When I was a shadow Health Minister, I met on numerous occasions psychologists, psychotherapists and counsellors who were very concerned about the regulation of their professions. Across the professions allied to health care, there are those who are keen on regulation and those who feel regulation would be wrong and would be unable to deal with the intricacies of their work. There is no doubt that vulnerable people are often preyed upon by unskilled and unscrupulous practitioners, and I think that professions wanting to achieve the highest standards will welcome proper regulation. The issue for Government is always whether statutory regulation is the most appropriate way of dealing with that risk, or if a lighter-touch approach would be more appropriate. That is why, as I understand it, last year the Department of Health, along with devolved Departments, consulted on the regulation of practitioners of acupuncture, herbal medicine and traditional Chinese medicine. As my hon. Friend will be aware, the consultation closed in November, and more than 6,000 responses were received. The high response rate is a testament to the strength of feeling about public access to complementary and alternative medicines; I am sure I am not alone in having received a huge number of letters on the subject.

The consultation examined in detail the options for regulation, including alternatives to statutory regulation. Once the Government have considered the consultation responses, we will make clear the next steps in the regulatory process. In acknowledgment of my hon. Friend’s keen interest in the matter, I am very happy to keep in touch with him about it. In the meantime, the Complementary and Natural Healthcare Council provides for voluntary registration for practitioners from nine complementary therapy disciplines. I appreciate that my hon. Friend feels that that is not sufficient, but that is in place for the moment while we consider the consultation that has taken place and make a decision on what the next steps should be.

I note my hon. Friend’s comments on the Lords Science and Technology Committee report on homeopathy, and I am aware that it caused quite a lot of concern. It was published on 22 February, and we are still considering it and will formally respond in due course. He raised considerable concerns about the report, and highlighted the low cost of many alternative therapies and the important contributions they make. He also made reference to experiences from around the world—he mentioned Australia in particular, and also the USA—and he made an important point about the open-mindedness of some countries to alternative therapies.

In considering outcomes, patient-reported outcome measures must be an important factor. As my hon. Friend rightly said—and as I mentioned—individuals’ own experiences are very important, and if we want to achieve the best outcomes, one step we must take is to ask the patient whether they actually got better.

In conclusion, I wish to thank my hon. Friend for his contribution to the debate and to suggest that perhaps the picture is not as bleak as he fears—I noted a certain weariness in his voice; he feels that he has raised this issue on so many occasions and it has fallen on deaf ears.

[David Tredinnick]

As I have been in this position before, I was nervous that the Minister might sit down before I had the chance to make a final intervention. I wish to make one plea to her. I listened carefully to what she said in the past five minutes and I wish to suggest to her that it would be enormously helpful if the Department were to issue a circular to primary care trusts saying that it is not against these therapies and it is up to doctors to decide whether or not they can be used, that it has no bias against them and that it is leaving it to the clinicians to decide whether or not they wish referrals to be made to PCTs and on to hospitals. A great fog surrounds this issue. Nothing may come out of tonight’s debate apart from the fact that we have discussed the matter, but it would be very helpful if she could consider issuing a direction saying, “It’s over to you. We are not objecting to this.”

[Anne Milton]

I thank my hon. Friend for that intervention. As the new Minister in this post, I am hesitant to commit to things that I feel might be above my pay grade.