PIP Breast Implants

Debate between Fleur Anderson and Sarah Champion

Monday 30th January 2023 Commons Chamber

[Fleur Anderson (Putney) (Lab)]

I know, Mr Deputy Speaker, that despite this late hour you will be very interested to hear the shocking story I am about to tell, in this first ever parliamentary debate on a health scandal that is affecting at least 47,000 women across this country in one way or another. When I told people that I had secured this debate, it seemed that most, like me, remembered stories about the breast implant scandal from quite a few years ago. Like them, I thought the issue had been dealt with, and that the women had been recalled and supported, and the breast implants removed if necessary. But no.

A few months ago, local resident Jan Spivey from Putney came to my surgery with her shocking story. She is a victim of the Poly Implant Prothèse breast implant scandal, and she has had years of illness as a result. She also leads the national PIP Action Campaign, and I will start by thanking Jan, Louise, Wendy and Diane for all the work they have done to lead the campaign. I also thank all the women who wrote to me in advance of this debate telling me their stories, the relatives of the young women who have died as a result of this scandal, and the journalists who have exposed it.

Doctors estimate that, unless action is taken, there will be a peak of implant-related cancer deaths in 2026. Thousands of women and their families have been failed, by the implant companies that knew they were dangerous; by the Medicines and Healthcare products Regulatory Agency, which should never have allowed it to happen; by the medical clinics that restructured to avoid their duty of care towards PIP patients, and got away with it; and by the Government, who failed to take action over a decade ago when all the evidence was there. This just makes me angry. This is a women’s health issue, and I do not think it would have happened if it was men who had been affected. I think action would have been taken by now, but instead women have been suffering and dying in silence.

PIP stands for Poly Implant Prothèse, which was once the third biggest supplier of breast implants in the world, making an estimated 2 million sets of implants over 20 years. Following reports of abnormally high rupture rates, it was found in 2010 that the manufacturer had been filling implants with a sub-standard silicone gel made of a cocktail of chemicals intended for mattresses and not cleared for human use. The company went into liquidation in 2010, and its founder, Jean-Claude Mas, was convicted of aggravated fraud and sentenced to four years in prison in 2013. The French Government offered to pay for the removal and replacement of all PIP implants fitted in France, and after a decade-long battle, in 2021 a French court ruled that 2,500 victims are owed compensation. At the same time, 47,000 women in the UK have had PIP implants, but they have not been contacted to be told about the risks. Some have been offered and undergone removal, but many more have not been told about the risks of other illnesses and the links to cancer. They have not had the options.

[Sarah Champion (Rotherham) (Lab)]

I am incredibly grateful to my hon. Friend for securing this debate, because I do not think the general public know of the risk. But those 47,000 women do know, so does she share my concern that the mental health toll that is putting on them is almost as bad as the health risks they have?

[Fleur Anderson]

I absolutely agree. Someone knowing that they potentially have a ticking time bomb inside their body that might be causing poison is extremely worrying and causes huge anxiety. Many women have also not been told about the impact. For example, they have not been told by their GP of the links between having that in their body, and what they are experiencing.

Victims have reported a range of mental and physical health issues, including extreme pain, inflammation, headaches, infections, anxiety, digestive issues, sight issues, severe exhaustion and low energy. Many women suffered for years before realising that their health issues were a direct result of their faulty implants. GPs often are not putting the two together, and there is not the right information for them. One woman—she is an example of the many stories I heard—told me:

“I had the PIP implants placed in January 2009. Within a very short time I suffered from shortness of breath, heart palpitations, extreme fatigue, and my joints were swelling up to name a few symptoms. I was in and out of hospital for breathing difficulties and pains in my chest. At no stage were any of my symptoms ever recognised and I was told to take painkillers or, ‘It’s just your age’. I had the implants replaced in 2013 at my expense from the same company because they would not take any responsibility.”

She still has most of the capsules from the PIP implants, and she believes that they are still affecting her today. Her health has been compromised and the hazardous chemicals that remain inside her chest have taken a toll on her quality of life.

Women said to me that they were told that their implants were water-based and absolutely safe, and then they were not being listened to about their illness. They were often misdiagnosed and in so much pain. One woman told me of her “17 years of hell”, including that she could barely walk for two years. She also had sight loss and digestive issues. She felt that she was slowly dying inside from 2004, when the implants were put in. That was until September 2021, when the capsules were removed and she had her life back.

A serious impact is the link with cancer called breast implant-associated anaplastic large cell lymphoma, which is a rare type of cancer of the immune system. Susan Grieve, a mother of two young children, was the first person in the UK to have been recorded as dying from BIA-ALCL in 2013. As of 31 December 2021, the Medicines and Healthcare products Regulatory Agency has received 81 reports of confirmed BIA-ALCL. My first ask of the Minister is to review the link with cancer and to review the NHS website guidance. A long list of peer-reviewed papers—too long to include in my speech—evidences the link with cancer in the UK and internationally. However, the NHS website mentions six times that there is no cause for concern for women with PIP implants. It does say that there is a high risk of rupturing, but it should clearly explain the link with cancer to avoid GPs and PIP victims missing that important link and making a diagnosis too late.

One such diagnosis came too late for 36-year-old Lydia Bennett, who died from BIA-ALCL in 2019. Lydia’s family were not informed that she had died from breast cancer until 2022. The MHRA set up the plastic, reconstructive and aesthetic surgery expert advisory group and, based on the group’s advice, issued several medical device alerts stating that patients undergoing breast implants for any reason should be warned about BIA-ALCL before the operation. However, that does not go far enough. By contrast, in 2021 the US Food and Drug Administration made the links clear and placed so-called “black box” labels on breast implants, warning that they have been linked to a host of chronic medical conditions including autoimmune disease, joint pain, mental confusion, muscle aches and chronic fatigue, as well as to lymphoma.

In replying to my written questions on concerns about PIP implants last November, the Minister cited two reports from the MHRA in 2010 and 2012, which seemed to be the basis for deciding that there was not a risk and putting that guidance on the website. However, so much more evidence has come to light since then. Does she have a view on the new evidence and why that has not been taken into account? Evidence buried away on the website contradicts the view that people with PIP breast implants do not need to worry. The risks are clear and well evidenced, and women should be told the truth.

My second ask is that there needs to be a register, and it needs to be used. The Government’s initial response to the scandal in 2010 was to issue a medical device alert to all UK clinicians and cosmetic surgery providers, asking them to cease use of the implants but not proactively to offer advice, removal or support for women who had had the implants. That support has fallen short ever since. The Government conducted the Howe report into PIP breast implants in 2012 as well as the Keogh review of the wider system of regulation for cosmetic interventions and whether a breast implant registry could be put in place. Both reviews promised action that has not been taken, and neither addressed the need to recall the PIP implants and let women know about the risks, let alone went into the area of compensation for the women affected.

All the women affected should be on a register and should be contacted proactively. There is no central register now. Since 2016 there has been a breast and cosmetic implant registry, which collects data for England and Scotland, but the problem is that it does not include women who had their PIP implants removed or replaced up until 2016. In the Government’s February 2014 response to the Keogh review, three recommendations were singled out for agreement, one of which was

“creating a breast implant registry to reassure women that if problems arise they can be contacted, kept informed and called in for treatment if necessary”.

Even the limited new register has not been used to proactively contact all women on the register to offer them medical check-ups, advise them of the links with cancer and other illnesses and, if suitable, offer them removal of implants.

Officially, as I think the Minister is about to tell me, anyone who has a PIP breast implant can request that it be removed, but that has not been the experience for many women with PIP implants—even those who know that their implants have ruptured. Many applications have been turned down, leaving women with a ticking time bomb in their body. They are unable to afford to get their implants removed privately, are worried that they will rupture further, and are experiencing clear side effects. Not only are they suffering through no fault of their own, but they are costing the NHS more because of the treatments that are needed.

Another shocking fact is that for those PIP victims who had their implants privately, all the major clinics that treated them have avoided paying compensation by “financially restructuring”—changing their name and reopening with another name on the same premises, with the same staff and the same medical records for the same patients. How can that be allowed? I know that many women affected by the issue will be watching or reading this debate; I urge them to contact the patient safety commissioner and tell her what they have experienced.

I know that the Minister was not in post when the scandal initially happened, but the support that victims are receiving now can be changed. I know that she is professionally experienced in the area, and I thank her for her interest so far. I fervently hope that she will take a personal interest in looking into the scandal and the reality of how women affected can be supported. I hope that justice can be done, and that the deaths from cancer that have been predicted can be prevented. I ask the Minister to follow up on this debate by meeting me and members of the PIP Action Campaign group.

I will end with a list of nine actions that I would like the Government to take—I have quite a few more questions, but I will save them for our meeting. First, in the light of this scandal, will the Government please review and act on the Paterson inquiry and the Cumberlege review and their recommendations about patient information, complaints, recall, ongoing care and compensation? Secondly, will they please look at funding research into BIA-ALCL and creating and maintaining a national tissue bank of BIA-ALCL cases, including full genome sequencing, as recommended by the plastic, reconstructive and aesthetic surgery expert advisory group? Thirdly, will they please ask the MHRA to further investigate the evidence of the cancer link and change its guidance accordingly?

Fourthly, will the Government change the guidance on their website to give women all the information they need? Fifthly, will they change the guidance on the implants themselves so that they carry stronger warnings? Sixthly, will they set up a register for all women affected and proactively use it to offer them a full medical check-up and advice about their implants and tell them about all the risks of cancer and all other illnesses?

Seventhly, will the Government offer women removal of the implant and capsules? I know that that surgery carries risks, and that there is a balance of risk to be reached, but women need information and options. Eighthly, will the Government pursue companies for compensation for the women affected and stop the loophole that allows companies to shut down in one name without being liable and then carry on operating in the same building with the same patients? Lastly, will they hold an inquiry into how the whole scandal happened, so that the best support and treatment can be given now to women who were affected, and so that this can never happen again?

I am grateful to the Minister for the interest that she has taken in the matter. I hope that this debate will be the start of real action, taken at speed, to make up for the years of failure.

Strategy for International Development

Debate between Fleur Anderson and Sarah Champion

Wednesday 6th July 2022 Commons Chamber

[Fleur Anderson (Putney) (Lab)]

Thank you, Mr Speaker, for calling me to speak in this important debate. It is an absolute pleasure to follow the hon. Member for Tiverton and Honiton (Richard Foord). I spent many childhood summers in Cullompton, so I know what a beautiful constituency he represents. I can see already that he will be a strong advocate for his constituents, local schools—he spotted a lobbying opportunity in his maiden speech—and farmers. He displayed an internationalist outlook, which I certainly welcome, as I am sure we all do. I am delighted that he chose to speak in this debate for his maiden speech; I think that shows real acuity. What a day, here in Parliament, on which to give his maiden speech! I look forward to following him in many speeches to come.

I campaigned, along with hundreds of thousands of people across the country, for the move to 0.7%. Many are in this Chamber now, but they are also in towns, villages and cities across the country. That decision had cross-party support and was one we could all be proud of—proud to be British, and proud to achieve 0.7% of GDP on development spending. The fact that it was cut is deeply disappointing to me, to Opposition Members and to people across the country, including many of my constituents who write to me. It is very disappointing that the 0.7% target has not been reinstated in these estimates. Achieving 0.7% was the right thing to do. It was the wrong thing to do—it is a false economy—to cut it to 0.5%. That diminishes our position in the world and has damaged many successful poverty-reducing, conflict-cutting and climate change-tackling programmes. There is a £4.6 billion black hole and 1,000 programmes have been or will be cut. It would be welcome if the Minister could confirm whether that is correct.

I want to focus not only on how much and which programmes have been cut, but on how the remaining money is spent. I am concerned about the merger of the Foreign and Commonwealth Office and the Department for International Development, and the fact that so much money in this strategy will be under the remit of ambassadors. I have spoken to many ambassadors and they have not had the training to spend development funds. They have been trained to be excellent diplomats and we are really proud of them. They do a great job for us around the world, but development expertise is very, very different. Will the Minister confirm that the training programme for ambassadors has changed as a result, right from selection through to achieving their positions? It needs to change dramatically if the money is to be spent in a way that achieves our aims.

Then we come to our aims. What are the aims of the international strategy? I have serious concerns that they are not clear, that they break our promises to achieve the sustainable development goals and that they are not to cut poverty.

Anyone who has followed any of my speeches will not be surprised by the two areas on which I will focus today, but I have not plucked them out of thin air. I have worked in development around the world for 25 years. I have worked for Christian Aid, Oxfam, CAFOD—the Catholic Agency for Overseas Development—and Water Aid. I did a round of the development agencies, which meant that I had the privilege of visiting many countries and seeing programmes that are funded by the British public around the world. Two key areas that can achieve poverty eradication are: tackling conflict, focusing especially on genocide prevention; and tackling climate change, focusing especially on water sanitation and hygiene.

Commitments have been made across the House and we have said many times in debates that we want to prevent genocide. We have stood here and said, “Never again,” and I am sure we all agree that this crime of crimes must be prevented. That has been highlighted this week by the international ministerial conference on freedom of religion or belief, which is being hosted by our Government and is happening now in London.

Religious persecution and the targeting of people because of their ethnicity go hand in hand, but to achieve the aim of “Never again” in relation to genocide, we need genocide prevention strategies across all the countries in which we work to predict when early steps towards genocide are being taken, to prevent genocide through peace building and to fund social and economic actions and targeted intervention to prevent it. There is a list of continuing genocides around the world and of areas where there are moves towards genocide. Our projects and programmes can make all the difference. They will not be glamorous or hit the headlines, but they will save lives in their millions.

The Foreign Secretary’s promise to restore the humanitarian and women and girls’ development budgets has been broken because of the aid cuts. Compared with the spend in 2020, the cuts include the Ethiopian budget by 90% and the Syrian budget by 64%. Yemen, one of the poorest countries in the world, has had a cut of 40% and Sudan has had a 74% cut. There is an unprecedented famine in the horn of Africa, yet the cuts to humanitarian budgets continue regardless.

Last year, the British Government made famine prevention their flagship humanitarian agenda when they held the G7 presidency, and the UK played a lead role in convening discussions on famine prevention in the UN Security Council. That is—or should be—a key feature of the international development strategy, but there is a perception that the UK risks being somewhat missing in action on humanitarian aid because of the cuts. For example, in 2017, when 16 million people in the horn of Africa were facing severe hunger, the UK provided £861 million as part of the global response. That helped to avert widespread famine. The work that was done then has helped to reduce the number of people who are facing famine, even now, in the next period of crisis. Despite that, however, 23 million people in 2022 are facing famine as a result of drought, conflict and covid, but the UK has provided—bear in mind that the figure was £861 million in 2017—£72 million to support people in Ethiopia, Kenya, Somalia and South Sudan. This is the worst famine in that area in 40 years, yet we have dramatically cut our support. That is not what the British people want from the aid budget.

[Sarah Champion]

My hon. Friend makes a powerful point and she knows at first hand the importance of our contribution to the international and aid sector, particularly on famine prevention. My Committee has just published its report on food security, and there is so much more that the Government could do to take a strategic leadership view. However, the countries that my hon. Friend mentioned, where famine is running wild, seem to be completely off the Government’s radar and hidden. One can only assume that unless we raise the profile of those countries, this will just keep going.

[Fleur Anderson]

I thank my hon. Friend for raising that issue. This debate has been really important in enabling us to talk about the issues, because these cuts seem to be happening quietly and in secret. If British people knew about the cuts to famine prevention and the other things going on, they would not be happy. These are not our values; these are not British values.

The House will hear no argument from me against championing women and girls, which is in the development strategy, but the budgets for women and girls are being cut and are not being prioritised. The Government are not putting their money where their mouth is. CARE International estimates that £1.9 billion was cut from women and girls projects in 2021. I would welcome any assurance from the Minister that that is not correct and that the budgets for women and girls are being protected. I would like to hear that in her response.

The international development strategy should have poverty reduction as a target, but it does not. Instead, it talks about people being “more prosperous”. It could be said that that is just semantics—putting a positive spin on poverty by talking about prosperity instead. However, I am very concerned, as other hon. Members clearly are, that it shows a move away from poverty reduction, tackling inequality, support for the most marginalised and inclusive growth, with a focus instead on macroeconomic prosperity and the hope that it will trickle down. We know that that will not work and that it risks fuelling inequality and instability. It is a move away from achieving the sustainable development goals on the interconnected issues of poverty, inequality, climate change, inclusive societies, access to health and education, and water and sanitation.

Water and sanitation is all but missing from the international development strategy. WASH—water, sanitation and hygiene—is the foundation on which any development strategy should be based. There is a lot of talk in the strategy about trade, but trade cannot increase if farmers cannot water their livestock or crops. Farmers just cannot achieve very much with no water: they face ill health and poor hygiene, or have to fetch water instead of farming and being a trading actor. It is truly frightening that the Government have cut funding for WASH by two thirds between 2018 and 2021.

Water Aid is one of the most popular and well-supported aid agencies in this country. I am not just saying that because I used to work for it; I chose to work for it because I know the importance of water and sanitation. Its popularity demonstrates how obvious it is to British people and to anyone who has travelled to any of the countries we are talking about that without clean water, sanitation and hygiene, we just cannot get the other benefits to progress for girls, for trade, for autonomy and for villages and towns. WASH is a no-regrets solution: it is really good value for money, and it fast-forwards progress in gender equality, global health, climate change and so many other areas.

Let us take gender equality as an example. The focus of the development strategy is quite rightly on women and girls, but without access to WASH, millions of women and girls will miss out on school or the chance to work and will be at greater risk of poor health, violence and abuse. Every day, approximately 800 million women and girls are on their period, yet one third do not have access to clean water, female-friendly and decent toilets, hygiene facilities and sanitary materials to manage menstruation with dignity. I have met many, many girls who miss a week of school a month, and many teachers who despair. They want to do their best, but they cannot.

Women are responsible for about 60% of household water collection needs globally. Achieving universal basic water services would free up more than 77 million working days for women each year between 2021 and 2040. The gains could be huge, so I ask the Minister: what proportion of the reinstated ODA budget for women and girls will go to programmes addressing period poverty and shame? Given its importance to the education, economic empowerment and safety of women and girls globally, will the Minister restore the UK’s ODA funding for WASH?

Global health and WASH are inseparable too. The World Health Organisation estimates that one newborn baby dies every minute from infections related to a lack of clean water and hygiene. This is such a basic problem, so heartbreaking and so easily solved. More than half the healthcare centres in the world’s 46 least developed countries lack clean water or decent toilets, which is causing preventable deaths and accelerating the spread of antimicrobial resistance as health workers are forced to use antibiotics in lieu of good hygiene. If any of our local hospitals had no running water, they would close—they would not be open—but that is the situation of half the healthcare facilities in the world’s poorest countries. The Lancet estimates that 1.27 million people died of drug-resistant infections in 2019 alone, a number that will just continue to increase as antimicrobial resistance develops, and that will affect us in this country as well: we are interconnected.

The FCDO’s own analysis in December 2021 rightly recognised the importance of WASH in maternal and child health, pandemic preparedness, and building climate-resilient health systems. However, the FCDO is not putting its money where its mouth is. The financing gap preventing universal access to WASH in healthcare facilities is just $601 million annually to 2030. That is small change for all the G7 nations, working together, and the UK should be leading the way in advocating its provision. I therefore want to hear from the Minister what the Government are doing to increase access to WASH in healthcare facilities in the world’s least developed countries, and whether she agrees that it must be better financed.

I also have a little shopping list of aid programmes which I know are changing, but about which I should like some further information. These are just examples of the problems that will come as a result of the disintegration—the Government seem to be disintegrating around us as we speak, but there is also this disintegration —of what used to be the DFID budget.

The right hon. Member for Sutton Coldfield (Mr Mitchell) raised an important issue: why are we still funding China to such a great extent, and what are those funds for? As for Sudan, has the peace programme been entirely cut? We built up that programme over many years, and we have been funding it for so long; are there any plans to reinstate it?

In Lebanon, the UK Government had been funding a very successful landmine programme to clear cluster munitions for many years. The Lebanese Government were given a five-year extension allowing them to clear their munitions by 2026, they said they were on track for 2025—and then what happened? We cut the programme. They were so close to achieving landmine eradication. They had come so far, and we had worked so well with them, and the Lebanese military, to achieve that. Farmers could have their land back, they could grow and they could trade, but they cannot achieve any of those goals in the international development strategy without that programme, so why did we cut it?

The next item on my little shopping list is the BBC World Service, the jewel in our crown. We have built up, over so many years, a trusted service. I saw its impact in Kenya, where I was living, during the post-election violence. It was the only source of information then. It is so well trusted across the world. It is a source of huge soft power for us, and I hope to hear from the Minister that it will not be subject to any of the cuts.

The final item is climate finance. On 20 June, the Secretary of State for Business, Energy and Industrial Strategy said that the BEIS was surrendering climate finance underspend to the Ukraine aid budget. Climate finance underspend is climate finance which has been budgeted for, for which there are plans, which has not been spent yet, but which will be spent on very important climate projects. I do not begrudge any aid going to Ukraine, but I do want to know where the money is coming from. If we are just robbing Peter to pay Paul, what is the point of this strategy? It is not very strategic at all.

A development strategy that does not prioritise poverty reduction, conflict and genocide prevention, and WASH is not one that the British people would want to support. It breaks our promises to the world’s most vulnerable people, and it further weakens our standing on the world stage.