PIP Breast Implants

Debate between Maria Caulfield and Fleur Anderson

Monday 30th January 2023 Commons Chamber

[Maria Caulfield]

I will come on to that. As I said earlier, we stopped the use of these implants immediately in 2010. As for the 47,000 women who were given PIP implants, mainly in private clinics, they are now able to come forward and have those implants removed on the NHS if their doctors agree. Many women have done that, either to avoid the risk of rupture or to prevent it from happening if they fear that it might.

The hon. Lady asked for an inquiry. As she mentioned, independent reviews have been conducted, expertly led by Lord Howe in 2012 and by Sir Bruce Keogh in 2012 and 2013. The Department has led a programme of work to ensure that the recommendations from all those reviews have been implemented, including a set of actions to prevent this from happening again. We have ensured that cosmetic surgery is effectively regulated, and that only doctors who are registered with the General Medical Council can perform surgical procedures. We have introduced a number of measures requiring all surgeons offering cosmetic procedures to follow the guidelines. The Care Quality Commission now has a duty to rate and assess the performance of providers of surgical cosmetic procedures to ensure that they meet fully the standards of safety and quality expected of them, and enforcement action is taken when they do not.

As the hon. Lady also mentioned, the Breast and Cosmetic Implant Registry was established in 2016. It collects detailed information on every implant, so that affected women can be traced and contacted in the event of a product recall or safety concern. The difficulty involved in doing that retrospectively is that many of the procedures took place in private clinics where there was no access to that information, either because it was not recorded at the time or because it was recorded but difficult to access. However, the registry covers both the NHS and the private sector, so that would not happen today, and it covers England, Scotland and Northern Ireland.

The lessons learned from the work on PIP and the recommendations made by Baroness Cumberlege in her report on medical devices have been used to drive wider-ranging improvements. NHS England now has speciality-level clinical steering boards for the top 10 medical devices implanted, which represent around 80% of the implants now used. The boards drive forward improvements for implants used in a range of medical devices, and are developing the medical device registry to ensure that the relevant patients can be traced and contacted if problems exist.

The MHRA intends to further drive forward this issue by improving the traceability of medical devices through the unique device identifier and implant cards. Again, those were not available when the incidents happened. The Medicines and Medical Devices Act 2021 introduced powers to allow the MHRA to improve transparency on medical device safety issues. As the hon. Lady indicated, we now have the plastic, reconstructive and aesthetic surgery expert advisory group, which looks for future issues around implants or other medical devices used in aesthetic surgery in a way that was not available back in 2010.

The breast cancer element is important for women to know. I take the hon. Lady's point about making that information more readily available. I also take her point about the black box labels that the FDA is using in the US, to see if we need to improve the information available for women. Any breast implant has the potential to cause a very rare form of non-Hodgkin’s lymphoma called breast implant-associated anaplastic large cell lymphoma. It is not breast cancer but a rare form of non-Hodgkin lymphoma that grows in response to the body’s reaction to a breast implant. It is not specifically related to PIP; there is a small risk from any breast implant. The MHRA has issued guidance for people with breast implants, but I take the hon. Lady’s point that women need to be informed of that small risk when deciding to go for a cosmetic procedure. We will follow up on that after this debate.

[Fleur Anderson]

I thank the Minister for her reassurance about what will happen now. I am thinking back to those women who have been affected; I take the point that it is hard to trace them. Could the Minister look at asking GPs if they know whether women have had implants, so that they can be contacted and informed about the links with the cancer, through those means if no other?

[Maria Caulfield]

Absolutely. It is important to ensure that women who have had PIP breast implants in the past are reassured and have the opportunity to come forward. As part of the women’s health strategy this year, we are developing a space on the NHS website—a go-to, informed place—specifically for women’s health. I am happy to raise this issue with officials to make sure that the information is there. PIP implants have a higher risk of rupture, but not necessarily a higher risk of the lymphoma that we have talked about. There is a small risk with any breast implant. We need to make that clear to women.

The company that produced the implants was the third biggest supplier of breast implants in the world. It went into liquidation in 2010. The founder was convicted of aggravated fraud and sentenced to four years in prison. The company had to take responsibility for its actions. I take on board the point that women who have had those implants can have them removed, but they need to know that that is available to them. I am happy to work with the hon. Lady to see whether we can improve that advice and information for women.

I reassure the House that the Government and I have patient safety and women’s health as a top priority. We will continue to keep current initiatives under review. We have put safeguards in place. I do not want to tempt fate, but we are not likely to see the same incident again, where we cannot trace women who have had the implants. We need to support those women who have been affected, and I am happy to work with the hon. Lady to make sure that that happens.

Question put and agreed to.

Breastfeeding: Government Support

Debate between Maria Caulfield and Fleur Anderson

Tuesday 8th March 2022 Westminster Hall

[The Parliamentary Under-Secretary of State for Health and Social Care (Maria Caulfield)]

It is a pleasure to serve under your chairmanship, Mr Efford.

I associate myself with comments on the importance of thinking about the mums and babies in Ukraine at this time, given how difficult it must be for all of them.

I congratulate the hon. Member for Glasgow Central (Alison Thewliss) on calling for and securing this debate, particularly today, which is International Women’s Day. We often talk about many issues affecting mums, but very rarely do we talk about breastfeeding, so it is really important to have this debate. Ensuring that every baby gets the best start in life is really important. As we have heard, positive experiences during this period will have a significant impact on a child’s health and wellbeing, and will inform the course of the rest of their life. Although the hon. Member for Aberdeen North (Kirsty Blackman) did not get the chance to speak for long, I sense her passion on this subject and she made her points very well.

Breastfeeding provides significant health benefits for both mother and baby. It has been shown to reduce the prevalence of common diseases in babies, such as respiratory infections and gastroenteritis and the risk of maternal breast cancer, as well as offering protection against childhood and maternal obesity. Breastfeeding also promotes emotional attachment and parental wellbeing. However, as the hon. Member for Glasgow Central said, we need to be mindful of the women for whom it does not work. We must ensure that they get the support and reassurance they need. As the hon. Member for Bristol South (Karin Smyth) said, it can be a very difficult experience for some.

I want to reassure colleagues that the Government are taking this matter extremely seriously. We want to promote breastfeeding as much as possible. The latest available data from the infant feeding survey, which we discussed, shows that only 1% of mothers in England are still exclusively breastfeeding at six months. More than 80% of mothers who stopped breastfeeding in the first two weeks reported that they would have liked to have carried on for longer and that perhaps, with support, they could have done. Common reasons for stopping include a lack of access to support services, as we have heard today, both in the community and at work, while misinformation, inconsistent advice, negative experiences and sometimes even cultural barriers can also deter women.

There are significant disparities in breastfeeding rates across England and the UK. We heard today about some excellent experiences in Scotland and Northern Ireland. The prevalence of breastfeeding is particularly low among young mothers, those who left education before the age of 18, and those from lower socioeconomic backgrounds. That contributes to a cycle of deprivation and further widens disparities. I agree with the hon. Member for Glasgow Central: it is so important that we teach young girls about breastfeeding in schools, so they learn early on about its importance and what to expect when their time comes.

In light of that, I want to reassure colleagues that the Government are taking action to support breastfeeding and to make that support accessible to everyone who needs it. First, we have the healthy child programme, a national evidence-based programme of interventions to support parenting and healthy choices. It outlines all services that children and families need to receive if they are to achieve optimum health and wellbeing, including breastfeeding and infant support.

Secondly, we have the maternity transformation programme, which seeks to achieve the visions set out by Better Births. National guidelines have been published for midwifery and health visiting services to support breastfeeding. I want to take this opportunity to thank all midwives, health visitors, support workers and those offering peer support. I met March with Midwives just before this debate and I recognise the pressures those workers are under. Sometimes things such as breastfeeding support are reduced or taken away when there is pressure on the service overall. I recognise that, and I am very happy to work with the service to try to improve that.

Thirdly, we have the 2019 NHS long-term plan, which recognises the importance of improving breastfeeding support and sets out a commitment to ensuring that all maternity services have an accredited, evidence-based infant feeding programme by 2024. However, we need the staff and the resources to make that happen. I have heard that loud and clear. We also encourage parents to access support through the Better Health Start for Life campaign, which provides advice and information on breastfeeding.

However, for me the most exciting development is the Government’s vision for the best start for life programme. It is only in England, but I am very happy to work with colleagues in the devolved nations to share best practice. The programme will roll out support to the areas of the country that absolutely need the most help. I thank my right hon. Friend the Member for South Northamptonshire (Dame Andrea Leadsom) for her inspirational work in this field.

The early years healthy development review has taken the Government’s commitment to improving breastfeeding rates and improving the support to be included as part of the universal offer for all parents and carers, which will include practical support with breastfeeding, early diagnosis of issues such as tongue-tie and help with formula feeding, which is more appropriate in some cases. The review heard repeatedly from parents about the positive impact breastfeeding can have on their confidence and self-esteem, as well as the value of breastfeeding support groups and peer networks.

In the spending review, the Chancellor announced a £300 million investment to transform family hubs and improve Start for Life services with £50 million for breastfeeding support services. Funding will be made available initially to 75 upper-tier local authorities where we feel the most disparities exist. We will be announcing very soon where those 75 authorities will be and where we can support breastfeeding in those communities. Those local authorities will be able to invest in increasing the range of breastfeeding advice, specialist and peer support, and out-of-hours support that is available in person, on the phone and digitally, creating breastfeeding-friendly environments that will help mothers meet their breastfeeding goals.

[Fleur Anderson]

I know that time is pressing; I thank the Minister for giving way. Has the Minister done any assessment of how many clinics there were pre-covid? That number of 75 local authorities is great, but what about everywhere else? Has there been an assessment of initial services, what has been cut and what has been reinstated?

[Maria Caulfield]

I do not have that information, but I was interested to hear about the experience in Putney. I will take that away because I spoke to midwives who were redirected during covid, but I am not aware of which services have and have not restarted. I am keen to look at that, so I will follow that up. I am happy to conclude, Mr Efford, if that would be helpful.