"The NHS will last as long as there are folk left with the faith to fight for it"
Aneurin Bevan

Monday, 2 January 2012

The priority of the worried sick over the worried well

Breast reconstruction after mastectomy is one issue, breast augmentation is a totally different issue. The former is repairing the effects of a clinical procedure, and the later is best described as cosmetic surgery: it is healthcare consumerism. This blog is about women who have demanded to have breast augmentation.

The NHS is care according to clinical need and is not healthcare consumerism.

Should the NHS remove the substandard PIP implants? Go back to the basic principle I mentioned above: care according to clinical need. Is there a clinical need to remove the implant? If it has ruptured then yes, there is a clinical need. However, the French study implies that there is a 3% chance of rupture, so that means there is a very good chance that the implants will not rupture and there is no immediate need for intervention. Since the implant was inserted through healthcare consumerism, the woman should use her consumer rights and demand redress from her surgeon. That is, return to the cosmetic surgery company assert her consumer rights and demand that the surgeon addresses the issue. The implant was not fit for purpose, she had a contract with the surgeon who provided the implants, and her consumer rights are that he addresses the issue and replaces the implant with an implant that was fit for purpose.

There is an issue of the psychological effects on a woman who has these implants. Should the NHS treat that? Of course it should: mental health is a vital part of the work that the NHS does. This is care according to clinical need, the mental health needs of the woman with PIP implants. The NHS has a range of treatments for anxiety and the most easily available is to seek the advice and re-assurance of her GP.

To anyone saying that we should pander to the demands of the worried well who have PIP implants, I would ask them why those women should be a priority over the worried sick, the women who are right now being denied hip replacements because under the Croydon List they are deemed to be in not enough pain to justify the NHS paying for the operation.

If Lansley caves into the demand that the NHS removes all PIP implants then this will be the death of the NHS ethos of care according to clinical need. He will have accepted that the NHS is a demand-based system, like the healthcare system in the United States.


  1. Its more complex than this Richard. You are reducing it to consumerism and competition for resources. But how did we get here? You say the women demanded augmentation. I do not know if this is so. What is certain is that we live in a society where commerce, media, cult-of-the-celebrity have all conspired to make many women unhappy with their appearance. They are if you like victim-consumers.

    I do not think the NHS/taxpayer should be responsible for any agreed remedy here. But nor should we condemn all women who have chosen and often paid for augmentation as though this were sn act of frivolity for which they alone are responsible.

  2. I agree with the above. There are enormous pressures to conform to celebrity/ porn conventions. A GP colleague who specialises in teenage health has noticed that in the last 10 years she has been specialising there is a significant increase in queries from adolescents about the appearance of their genitals in particular and their physical appearance in general. There has been a huge rise in cosmetic genital enhancement, surgical as well as 'vagazzling'. As middle-aged men with a laissez faire approach to bodily adornment, this is a world away from our own concerns, but we would be unwise to believe that it is a matter merely of choice.

  3. ... and then we have "size zero" (or "heroin chic") causing young people other issues.

    The explanation often quoted is that cosmetic surgery gives women "confidence". Perhaps we should question why they lack "confidence" in the first place and look at how to make people value themselves for what they are, rather than making them feel inadequate for what they are not.

  4. Andy says that those whose boobies were put in by a private health company that has gone bust (sorry, couldn't resist it) can come to the NHS for revision/review. GONE BUST!!! Ye Gods, is that what the future of the NHS is going to be? Are we to put our care into the hands of companies that could go bust? I can see a fault in that somewhere......

  5. The other day I heard a Government spokesperson on Radio 4 saying we do not have to worry about the Bill as there will not be problems like this under the revised NHS because private providers will be answerable to the NHS. However, what is the guarantee of that being the case indefinitely? And what about the situation which may become very common indeed of people could become very complicated. Soon the country may realise that the privatisation factor is ultimately too risky in terms of conserving the NHS and the Govt may have to think of new ways to invigorate the NHS. BUt what will happen if the country realises but the Bill still goes through?

  6. amendment to above
    And what about the situation which may become very common indeed of people having part of their treatment on the NHS and part private, for instance if some treatment is not available on the NHS? Liabilities could become very complicated.