‘On the Face of It’ but without the question mark

Yesterday’s report on the state of the cosmetic surgery industry by the National Confidential Enquiry into Patient Outcome and Death (NCEPOD) makes very grim reading – and should evoke urgent decisive action.

‘On the face of it?’ records that only 361 sites providing cosmetic surgery out of 760 known to exist, were prepared to provide data – and this is a statutory requirement. Is action being taken to oblige and/or find out about the others, I wonder?

Amongst those which did provide data (presumably the better ones), there were massive variations in organisation and practice in cosmetic surgery. This combined with the obvious lack of adequate regulation of the facilities, training and processes makes it abundantly clear that currently, anyone who decides to have some cosmetic surgery is putting themselves at risk.

Some people imagine that I am (and Changing Faces is) against cosmetic surgery – indeed any surgery. That is completely wrong. BUT no surgery should be undertaken lightly. Patients should only be agreeing to any operation after they have been provided with realistic and objective information about its suitability to treat their condition, its risks and benefits, the alternative treatments which are available, the best timing, the follow-up treatments and many other factors – and discussed them with a medical professional who has the right qualifications and expertise to conduct the operation(s), and ideally one who is uninterested in the decision made by the patient.

This ‘consenting process’ can be critically compromised in cosmetic surgery – and that is where the dangers lie. Psychologically-vulnerable patients who may believe that such procedures are virtually risk-free and the passport to self-esteem and self-confidence are at risk of not receiving the type of specialist care they really need or could benefit from.

I do not doubt – but have never seen any solid research on this which would clearly help everyone to judge – that, for some people, cosmetic surgery is brilliant and I know that some cosmetic surgery providers offer excellent services. But as we said in our media release, action needs to be taken across the board to improve safety in the whole industry

The good news is that, according to The Guardian (16 September 2010): ‘the government said the Care Quality Commission (CQC) would shortly take a more robust approach to cosmetic surgery. “Poor practice in some organisations casts a long shadow over the cosmetic surgery industry and undermines the efforts of some highly professional practitioners,” said NHS medical director Sir Bruce Keogh.’

And, according to a website called http://www.publicservice.co.uk: ‘From October 2010, all private providers will have to be registered with the CQC and comply with 16 safety and quality requirements, which will include looking at the suitability of professionals to provide services. The CQC will have strengthened enforcement powers to take action where providers fail to meet these standards’.

We are going to keep a close watch on this because, I am afraid to say, we’ve been here before. In 2004, I sat on an Expert Group to advise the Chief Medical Officer and when our report came out, many voices said ‘we must improve, set higher standards etc’. The CMO duly committed to see many changes including tightening regulations, making sure the qualifications of those doing cosmetic surgery were appropriate etc.

This is not to say that I am not pleased to hear that the Royal College of Surgeons (RCS) is to look into setting new standards for cosmetic surgery. The RCS yesterday insisted that nobody should be practising surgery without contributing to improving safety, so the failure of so many surgeries to take part in the NCEPOD study was “alarming” particularly since there is a very high turnover of small start-up organisations in this sector. The RCS said it was clear that more work was needed in setting specific service standards for cosmetic surgery to improve safety and ensure the best interests of patients were paramount.

RCS President John Black said: “This incisive report from NCEPOD shows that patients are not being properly protected. The RCS is not a regulator, but sets the standards for surgery that the regulators use. This study makes it clear specific action is necessary. NCEPOD makes a series of recommendations for the CQC and General Medical Council and we shall aim to provide clear standards to those bodies to help them fulfil that”. Good news indeed which I hope will happen with speed.

I want to end this blog with a comment from a reader of the Bath Chronicle who writes: “An ongoing issue with the cosmetic surgery industry is the irresponsible and aggressive marketing devices used by clinics to trap patients. Patients are bombarded with time limited offers, 2 for 1 deals, non-refundable deposits and interest free loans such as offering nose jobs for as little as £25 per month. These all propel vulnerable patients onto a path they may later regret. Blinded by the allure of a cheap fix, they fail to research their surgeons or appreciate the importance ensuring comprehensive aftercare is included in the price. Surely there is (need) for restraint on such advertising; we wouldn’t dream of considering multi-deals on kidney transplants acceptable.”

So, ‘on the face of it’ and in all seriousness, the case for strong Government action has never been stronger. But, sadly, ‘on the face of it’ arguments don’t always hold sway. Let’s make sure this time they do.

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