Cosmetic Surgery

David Tredinnick Excerpts

Thursday 5th July 2012 Westminster Hall

[David Tredinnick (Bosworth) (Con)]

Thank you, Mr Rosindell, for giving me the opportunity to speak in this debate.

It is a pleasure to follow my hon. Friend the Member for Totnes (Dr Wollaston) and my right hon. Friend the Member for Charnwood (Mr Dorrell), who is not only the Chair of the Health Committee but who was, of course, Secretary of State for Health in the Major Government. I think I can say modestly that I have been in Parliament long enough to remember him as an Under-Secretary in the Department of Health—at that time, of course, he was the MP for Loughborough—although I have not been in Parliament as long as he has.

I do not wish to repeat the remarks that were made earlier by my right hon. Friend and my hon. Friend, other than to say that we are basically dealing with a French company—Poly Implant Prothèse, or PIP— that produced a defective product. It then used false documentation—my recollection is that it did so by registering in Germany; I think that came up in the Health Committee. The company was also using non-compliant silicone. My right hon. Friend also said that there was a period—between March 2010 and July 2011—when there was a lack of action. The Health Committee was certainly concerned about why my hon. Friend the Minister and our right hon. Friend the Secretary of State for Health did not look at the issue earlier.

My right hon. Friend the Member for Charnwood has already given us the background, so I do not want to go into it further, but there are two types of issue to consider: first, the PIP implants, which are the defective products; and secondly, the wider issues.

Both my right hon. Friend the Member for Charnwood and my hon. Friend the Member for Totnes have mentioned the lack of a register, which is a fundamental problem. Without a register, we do not know the size of the problem. I have no doubt that my hon. Friend the Minister will refer to that issue in her response.

The second issue that really exercised me when the Select Committee was considering this topic was what I noted down as “the double jeopardy rule”—it is not quite a double jeopardy rule, but a woman will potentially need two operations if they have this problem. The NHS is looking to offer more patient choice and greater flexibility, and dealing with this issue is a good opportunity to provide greater flexibility. It makes absolutely no sense to have a surgeon remove an implant and then to have another surgeon at another time replace it with something else. First, I think it is clinically unwise; I do not know if my hon. Friend the Member for Totnes wants to comment on that. Secondly, it is certainly bad value. Thirdly, it means that the patient will have a much higher level of stress. I would have thought that statistically the probability of complications must be greater if a patient has two operations rather than one.

The third issue that I want to raise is advertising. The advertising for these products appears to be misleading, to say the least. We have heard that there is a failure to mention the inevitable requirement for removal of the implants. It is not only the surgeons or the promoters of the operation who should make patients aware of that requirement, but the advertising, which should carry a warning at the bottom.

The next point about advertising of these products is that I think a lot of it is targeted at less well-off people—a market in which people might not necessarily apply their minds as extensively as people in some other socio-economic groups might do to the consequences of these implants. A culture, or belief, has grown up around implants that they will enhance careers and make a person more attractive, which may not necessarily be the case.

Taking things a stage further, when teenagers are encouraged to have implants there is an absolute duty of care on those who promote them to explain to those concerned that although they may not be very full in the front at that age, if they have children they will naturally expand and have no need for implants. Furthermore, if they reach that point of having children, they may not want the implants that they received earlier. We need to think particularly about the market involving younger people.

My right hon. Friend the Member for Charnwood and the Committee agreed to the web forum on patient experiences, which was a very good exercise. Select Committees should consider using such an approach regularly in the future. We had responses from 194 women, and there were 279 posts. That widened the base of the pyramid of knowledge that the Committee had to reflect on, provided a greater degree of certainty about where things are going, and gave us understanding.

My hon. Friend the Member for Totnes touched on the long-term consequences of ruptures and the fact that that issue has not been fully recognised in the responses so far. Last week we had a presentation in private by distinguished academics from the university of Leeds. One point that came up was that if the silicone leaks, it can find its way into glands and lymph nodes. I cannot believe that that is a desirable impact for any patient. It defies logic to suggest that if there is a foreign body in a part of someone’s body there will be no complications or implications; and if there are none now, where will we be 30 or 40 years down the road? As a Member who has represented a constituency with a declining coal mining industry, I deal even now—30, 40 or 50 years down the road—with cases of emphysema and other mining-related diseases. What will happen after that length of time with the issue we are discussing now? We simply do not know. We cannot tell.

Dr Hardy and Professor Holliday at Leeds made two recommendations, which I am not going to claim as my own, and which merit serious consideration. The first is that all advertising should carry the risk rate. I am thinking both of advertisements and the agents’ recommendations to the client. There should be an absolute requirement to explain complications, and the fact that implants will have to be replaced at some time. The failure to tell patients that implants must, whether faulty or not, be replaced at some point, came through on many occasions in evidence.

The second point was also an excellent one: the contract that the patient forms should be not with the agency, which could fold, but with the surgeon, who is covered by a form of insurance, and tightly regulated. Any issue in the future would be with the surgeon himself. That would give us a much greater degree of accountability and make the regulation much more simple.

--- Later in debate ---

[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.