In theory, the PIP scandal was just about one factory in France producing substandard breast implants. In practice, it proved to be a watershed moment for the entire UK cosmetic surgery industry, opening it up to a wave of investigations and reviews and exposing its gravest flaws.
Undoubtedly one of the industry’s greatest weaknesses was an almost complete absence of meaningful data collection. Or as Sir Bruce Keogh put in his 2012 Review of the Regulation of the Cosmetic Interventions, there were sector-wide ‘woeful lapses in record keeping’.
So poor was this record keeping that, in some cases, the review panel found that many of the cosmetic surgery providers were unable to furnish details of patients who had been fitted with PIP implants on their premises. Further investigation showed that standardised patient information – mandatory with the NHS and across most private healthcare sectors – was simply not being kept by many providers. Further, it transpired that outcomes, the yardstick by which medical successes and failures are measured, were also conspicuous by their absence, and with this came a complete inability to distinguish between good and bad surgeons and providers.
Uniquely amongst health care specialities, there is no one overseeing body representing the cosmetic surgery industry, no standardised code of practice, no collecting or collating of data across the industry, no comparing or sharing of outcomes, successes and failure.
The reasons behind this systemic failure were partly political – successful governments put regulations of the private healthcare sector firmly at the bottom of the healthcare agenda – but also because of the way the cosmetic industry in the UK had grown up outside the mainstream health public and private sectors. There is almost no crossover between the NHS and cosmetic surgery and, unlike other medical specialities, cosmetic surgeons are not paid via insurers, they are, one way or another, paid by the patient.
It took the disaster that was the PIP scandal, followed by the hard-hitting Keogh Review, to shake the industry, the professional bodies and the government from its complacency. The recommendations and changes that have been introduced since then have, in the main, been accepted as a necessary and even welcome change. Carried out correctly and on the right patients, cosmetic surgery can have a positive life-changing effect. It is vital for the sector as a whole to educate people so that more patients make better choices about their providers, which in turn will lead to consistently better outcomes and better perception of the sector.
So, what is the future?
One major change to the industry will be the decision made by Competitions and Markets Authority (CMA), who initially investigated the relationship between insurers and hospitals, to put the remit for data collection and information into the hands of the Private Healthcare Information Network (PHIN). The CMA specified that they wanted the data to be made public in such a way that they could understand and evaluate the information to enable them to make an informed choice about who should be the best surgeon from them. They also require that PHIN publishes the new information online for consumers by May 2017.
No one is underestimating the size of the task facing the PHIN. The job will involve dealing with around 12,000 consultants practising from 500 private hospitals serviced by over 200 private health providers. There are 11 specific indicators required by the CMA including activity level, length of stay, patient satisfaction, rates of unplanned re-admission and outcomes. Everyone seems to be ready to work together to accomplish what is actually a very positive and beneficial step forward for the industry.
All the experts agree that there is an absolute need for one overall independent body – perhaps founded by the industry with a mandate from the government – to regulate, monitor and standardise the industry. There have been other suggestions too; should GPs be trained to advise their patients and could cosmetic surgery be taught at medical school?
Given the massive demand for cosmetic surgery, at some point the Government will have to bite the bullet and decide whether the cosmetic industry comes under its watch or not and, if not, they must delegate the task to someone who has the final say in monitoring it.