Implications of the implants scandal

“Oi!! Puffles! What are you doing blogging about jubblies?”

Actually, it’s a lot more serious, and covers a far wider range of issues than the plight of a few glamour models. It was Fleet Street Fox who first alerted me to the wider issues in her blogpost of 4 January 2012.

“The root problem is whatever caused tens of thousands of women, for no medical reason at all, to feel so unhappy with their own perfectly-lovely frames that they paid four figures to be sliced and diced in order to look like someone else. You can blame the media, advertising, Hollywood, newspapers, or our pre-programmed female insecurity. It’s probably a bit of all of them, and there’s only one possible way of fixing it.”

She also covers the issue of reconstructive surgery for those people who for example have suffered from cancer. The implants scandal isn’t just about those having surgery for cosmetic reasons.

I don’t feel qualified or knowledgeable enough to comment in further detail on how women are affected by this. The two issues that I am going to focus on are the legal protections available to patients that opt to go private only to find that private provider bails out when something goes wrong, and on the issues around how products are manufactured – and our trust in the standard that they are manufactured to.

Legal protections.

The Harley Medical Group’s announcement reported in the Evening Standard should send alarm bells ringing. Disagreement between the private healthcare trade body the IHAS and the Government has already broke out over who is liable. Just who is liable and responsible? A number of tweeple have commented that if the health risk is there, the NHS should step in and deal with that first, and deal with the costs/who should pay (i.e. taxpayer or private clinic) later. i.e. Don’t delay the treatment. Let’s not get into a debate about the deserving/undeserving when talking about people’s health. People will understandably be asking that if a private provider can respond like this a case such as this, could the same happen in other cases? With the growth of private healthcare and private providers in the UK, are some of the potential liabilities of taxpayers potentially being hidden? How do you stop private providers from trying to avoid their responsibilities because of something hidden in the small print?

The Health Secretary Andrew Lansley made a statement on this on 12 January 2012 in Parliament. With the above paragraph in mind, I’m surprised that he was not more clear on the need to put the health of all patients first, making clear that liability for the financial cost would not rest with them – rather that it would be something that would be resolved between the Department for Health and the private clinics concerned that had not offered replacement implants. Lansley stated that 40,000 people are affected. I’m surprised he did not mention the likely cost of replacement surgery for all of those people affected, separated for those who had surgery on the NHS and those who had it privately. That way, we would have some idea of the financial cost to the NHS for NHS patients as well as the financial cost to the economy. What is more difficult to measure is the further costs of those who have to take time off work for surgery, the ‘lost capacity’ of surgeon’s and healthcare capacity that would otherwise be used to treat other patients as well as the understandable anguish for those and their families who are affected.

Quality control.

Part of Andrew Lansley’s statement spoke volumes about regulation and inspection of the private sector.

“These events highlight the need to ensure the safety of people having cosmetic interventions. It is clear from the information that we have received from the industry that the safety information that it collects and provides to the regulator is of variable quality. Without good data, we have no way of knowing when problems arise.”

How long has this information been of variable quality, when did regulators first become aware of this (i.e. were they aware before) and what was done at the time? There are some industries where ‘light touch’ regulation does not work. Banking and healthcare are two of them.

As someone who has started studying engineering, I’m particularly interested in the quality control aspect – because something went wrong somewhere, and badly so. How was it that such large quantities of faulty implants could be distributed and exported all around the world before someone found out? Who was doing what random sample testing and when? Were continuous tests being carried out? If so by whom and what did these tests consist of? If the tests were taking place and did find something wrong, what was the method of raising them with the appropriate authorities? As far as the UK was concerned, who was responsible for certifying the implants as being safe and fit for purpose? Do we have a robust enough system of testing, retesting and recertification that can safeguard patients? One organisation I expect to come under scrutiny is the British Standards Institute – did the implants meet their standards? If not, whose standards did they meet and what sort of testing and assessment regime were they subject to?

In the following questions directed to Andrew Lansley, former Conservative Health Secretary and Chair of the Health Select Committee Stephen Dorrell asked:

“Does he further agree that there are some longer-term policy issues around the regulation of this industry that need to be addressed?”

In my view this is select-committee-chair-speak for saying “My select committee is going to investigate the longer term policy issues around the regulation of this industry.” Once the results of the initial inquiries initiated by Andrew Lansley have reported, I anticipate that the Health Select Committee will then look to launch its own inquiry. It would be interesting to see the likes of the Harley Medical Group defend their position under cross-examination – the results of which may highlight further issues not yet considered in the Health and Social Care Bill. (If it’s not too late by then).

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