NHS shift on implants

 
A defective silicone gel breast implant, which was removed from a patient and manufactured by French company Poly Implant Prothese PIP implants were banned in 2010 as they contain unauthorised silicone filler

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The government position on the safety of PIP implants has not changed, but there has been a dramatic shift in the way it is dealing with this issue.

The reason is the committee advising the Health Secretary Andrew Lansley has said the anxiety women may be experiencing has to be taken into account.

The committee, led by Sir Bruce Keogh, NHS Medical Director, concluded that the worry caused to women by having untested implants in their body is itself a form of health risk.

As a result, women treated on the NHS - will be offered removal and replacement implants if women decide that's what they want after a scan and consultation with their surgeon. All those treated on the NHS will have been cancer patients undergoing reconstructive surgery.

The government expects the private clinics - who carried out 95% of the surgery - almost all for breast enlargement - to do the same.

Moral duty

But if private clinics no longer exist or refuse to help, then the NHS will remove the implants, but will not replace them.

The Health Department said private clinics had a moral and a legal duty to help its patients.

Spire Healthcare and Nuffield Health have both said they will offer free replacement implants if that's what women want.

But it's not yet clear though whether other health firms will follow suit.

The government decision places immense pressure on the private sector to provide free replacement treatment - if they fail to do so it could be a public relations disaster.

But it is worth stressing the position here is different from that in France, Germany, the Czech Republic and other countries who are recommending removal of the implants as a precaution.

Ministers here maintain there is insufficient evidence to recommend routine removal of the implants. The advice from the expert committee has now been published.

Anxiety

This is the key section on page nine of the review report which is leading to a change in the way the issue is being dealt with:

"Whatever the objective evidence on safety, many women with PIP implants will understandably be very worried about the possible implications for their health. In itself, this anxiety is a form of health risk and must be addressed with understanding and compassion by those responsible for their treatment......The NHS will support removal of PIP implants if, informed by an assessment of clinical need, risk and the impact of unresolved concerns, a woman with her doctor decides that it is right to do so. The NHS will replace the implants if the original operation was done by the NHS.....The group (ie the expert committee) endorses this offer. It expects providers in the private sector to take similar steps.

The Department of Health is keen to stress that if the NHS has to step in to treat private patients it will do all it can to recover the costs of surgery from the private sector.

How much all this will cost is hard know. If 40,000 women wanted their implants replaced at £5,000 a time that would come to £200 million.

The expert committee makes it clear that the issue of safety has not been settled because inadequate data has been provided. It says:

"On the currently available information, the group considers that the statistical evidence on the rate of ruptures for PIP implants compared with other implants is incomplete and this risk cannot be assessed accurately. For this reason it is unable to come to any view on comparative rupture rates."

This issue clearly has a long way to go and women treated in the NHS and private sector must now begin to consider what they want to do.

 
Fergus Walsh Article written by Fergus Walsh Fergus Walsh Medical correspondent

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  • rate this
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    Comment number 98.

    Pressure must be brought to bare on the private hospitals who seek to shirk their duty of care to their patients.
    If the private hospitals believe they have a case against organisations who declared PIP safe, they can take it up with them - but only AFTER they've treated their old patient who require treatment. Private hospitals will be insured for this type of mishap in any case.

  • rate this
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    Comment number 97.

    Can someone please explain, in the case of a woman who is suffering toxic effects from leakage of gel, from one of these criminally-supplied implants, what the ethical basis would be for the NHS to refuse to treat her? Equally the basis for refusing to remove another from danger or fear of same? I'm not suggesting the NHS should supply safe replacements, just address the immediate medical need.

  • rate this
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    Comment number 96.

    Whether the NHS carries out breast reconstruction following cancer treatment, for complete absence of breast or severe assymetry; this doesn't strike me as reasons of 'vanity'. The purely cosmetc type breast procedures (in which a lady goes up a size or two) are carried out in private hospitals so the NHS shouldn't be footing the bill for problems with these. Private hospitals must.

  • rate this
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    Comment number 95.

    Sorry coram-populo or whatever your called !!! My blog name is still joblot and I'm not fighting for the insurance companies I have nothing to do with them??? I'm just one of those mothers of two children who is frightened and didn't ask for this to happen! Support is the word thats missing something this country lacks in unless u rock up with ten kids and refuse to work then u can't get enough!

  • rate this
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    Comment number 94.

    I think many women who have such surgery are perhaps vain and silly, but that has no bearing.

    They have a medical position, needing treatment, (not just exchange of faulty goods), because of wrongdoing, not any arguable moral failure on their part.

    The NHS treats the results of smoking, drug taking, reckless driving and irresponsible sex, so why be exceptionally judgmental on these women?

 

Comments 5 of 98

 

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