NHS in England
PIP implants hit the headlines again this week with MPs criticising the current position adopted in England which says that women who had their implants fitted at private clinics can have them removed but not replaced on the NHS if their clinic won’t help them.
The Commons Health committee said this stance “flies in the face of common sense” and suggested that the NHS should offer women removal and replacement surgery to avoid them having to have two operations. It allowed that a charge in the region of £1500 could be made for the replacement surgery.
This has sparked a heated debate: on one hand there are obvious health and economic benefits to women only having to undergo one operation. But on the other hand, would allowing women to pay for treatment on the NHS set an unhelpful precedent? Why should the taxpayer have to pick up the bill for cosmetic procedures? And what about the ethos of the NHS – its foundational tenet which states that no one should ever have to pay for health care?
While the NHS in Scotland and Northern Ireland share the same view as English NHS Trusts, in Wales women are being offered both replacement and removal surgery. By not following suit, the NHS in England has been criticised for making a “clinically inadequate” decision.
The Government has now commissioned two reviews looking at the regulation of cosmetic procedures in the UK and also the reaction to the PIP Implant scandal. It has identified a number of “key shortcomings” that need to be addressed. One area in particular has attracted its attention: the power of the Medical and Health Products Regulatory Authority which issued an alert about PIPs in March 2010. Although the NHS was duty bound to respond to the alert by saying it would stop using the PIP implants immediately, the private clinics - where 95% of the 47,000 women in the UK who are involved in the PIP scandal had their implants fitted - were not.
The Government also recommended that proper records are kept in the future identifying what implants are given to which patients.
President of the British Association of Aesthetic Plastic Surgeons, Fazel Fatah said changing the NHS stance on removal would reassure women who are not getting any support or help from their private clinics. He previously questioned whether or not the private clinics actually have the necessary skills to deal with the sometimes complex problems that arise with removal and replacement surgery.
Health Minister Lord Howe expressed concern for those women who face the daunting prospect of having to undergo two further separate operations but was nonetheless firm in his opinion that the NHS was built on the principle that patients do not pay for treatment. He was concerned about the consequences of setting a precedent for other types of treatments and cosmetic surgeries and said it was important that private clinics met their responsibilities.
Are PIP Implants Safe?
This is the great unanswered question. There is so much conflicting information out there that it’s no wonder that women are feeling bewildered, confused and abandoned.
The Commons Health Select Committee this week highlighted the conspicuous “absence of evidence” available about the issue of safety with relation to PIP implants.
In January a group of experts lead by Sir Bruce Keogh found that there was no higher cancer risk from PIP implants than from any other type of implant. But it noted that there was not enough evidence to say with certainty whether the rupture rate amongst PIPs was comparatively higher. They were also unable to say whether PIP implants were harder to remove safely after a rupture.
Meanwhile the French Authorities said that the rupture rate was indeed higher and identified risks to the surrounding tissue. They therefore recommended the routine removal of PIP implants, whereas British Authorities did not.
The advice to women in the UK remains the same – routine removal of PIP implants is not necessary. According to the findings of toxicological tests carried out on the implant filler material there is nothing to indicate we should be more concerned about PIPs than other types of breast implant.
But given the scarcity of evidence and the seeming reluctance of authorities to divulge information this is unlikely to give affected women peace of mind. The Health Committee has also criticised the way in which the MHRA handled the situation between March 2010 and December 2011.
In March 2010 the implants were banned. On 31 March 2010 the MHRA issued a press notice to this effect which largely went unnoticed by the media. In September 2010 the MRHA released “encouraging results” of the UK testing on PIPS which showed no clear cancer risk or chemical toxicity.
The Commons Health Committee now says that a high-profile response would have been more appropriate and that the action taken by the MHRA at the time was “inadequate”. Not only did private clinics have a duty to contact all their patients directly but the MHRA and the Department of Health should have done more to raise public awareness. It wasn’t until December 2011 when the French Authorities recommended routine removal that there was a media explosion in the UK.
The Health Committee went on to say that the refusal of the NHS in England to allow women to pay for new implants during removal surgery was stopping some women from taking action. By being obstructive they are therefore jeopardising the health of countless women.
According to Department of Health figures, in excess of 5000 private PIP patients have been referred to the NHS for a consultation with a specialist after failing to make headway with their individual clinics, and more than 3000 have been scanned by the NHS. It is believed that 1 in 5 women who go through NHS channels decide to have them removed but there are no figures available on the number of women who seek private replacement or, more worryingly, the number of women who do nothing at all.
Where does that leave women with their legal claim?
Even if the NHS do offer free replacement and removal the women affected have still had to undergo an unnecessary procedure and should still be entitled to claim compensation. We are pursuing 100’s of claims against clinics and some of the clinics have agreed to join the Group Litigation Order which is good news. However, a number of clinics have gone into administration and their insurers are refusing to co-operate. They are looking for legal loopholes to avoid paying out. They are saying that they will not cover product liability or they are using the excuse that since they were not notified of the claim at the time, they do not have to pay out. This issue is likely to be the subject of ongoing litigation for some years. This is not helping to reassure these women who have been badly let down by their clinics. If the NHS step in and provide replacement implants this will go some way to reassure those women who have no means to pay for further surgery and this is very welcome news. You should still be entitled to compensation and we can advise you on the clinics that are dealing with the legal claims and those who are not.
Should you wish to seek legal advice on a no obligation basis call us on freephone 0808 1391593.