Andrew Lansley, the health secretary, is heading for a confrontation with the private cosmetic surgery clinics embroiled in the faulty breast implant scandal after they refused to comply with what he described as their "moral duty" to offer free surgery to worried women.
Investigations by the Department of Health have found no link to cancer, nor any reason for the routine removal of PIP implants, despite claims in France that they have a high rupture rate. But on Friday, Lansley said the low quality level of the silicone used in the French-made implants meant the NHS would offer free removal for women who were concerned and that private providers were expected to do the same.
Nuffield Health, BMI Hospitals and Spire have agreed to comply, but the government received a stern rebuke from Transform, the self-styled leading cosmetic surgery firm, which refused to agree with Lansley's demands and went on the attack against the government's handling of the scandal. Nigel Robertson, Transform's chief executive, demanded an urgent meeting with Sir Bruce Keogh, the NHS's medical director, in an escalation of the row which is threatening to become a major embarrassment to the government.
Robertson said: "The proposals announced by the Department of Health for the resolution of this situation have done nothing to reduce anxiety levels. We have asked for an urgent meeting with Sir Bruce Keogh to gain clarification of the statement and subsequent comments made in media briefings so that we are best able to plan our response."
Transform, whose turnover last year was £36.2m, is one of four major firms thought to have been involved in 60% of the 40,000 operations in which PIP implants were used. Linia Cosmetic also said it would only replace implants for free when "appropriate", adding: "We find that instead of clarifying the issues, government advice has not been clear and may increase confusion. We believe government is not fully accepting its responsibility and hiding what is essentially a massive regulatory failure."
The other two companies – the Hospital Group and the Harley Medical Group, – failed to return calls on Saturday about their policy on extractions. Callers to a helpline at the Hospital Group, which is owned by American businessman Paul Allen, were told that they would "not necessarily receive free treatment".
Sally Taber, director of the Independent Healthcare Advisory Services, the body representing the private health providers, refused to take questions on the conduct of her members and in a statement offered only free consultations for women who are worried.
Taber, who attacked the health department for its regulation of the industry, said: "All public and private sector surgeons used these [PIP] implants, which were not the cheapest on the market, in good faith with the knowledge that they had been approved by the Department of Health agency, the Medicines and Healthcare products Regulatory Agency. Our current advice to patients is to visit the website of their clinic provider and follow the advice detailed there. Patients can be assured that all of our member organisations are prioritising patient care above all else and all have undertaken to provide consultations without charge for women who would like to consult a surgeon."
Under the proposals announced by Lansley on Friday, the NHS will cover the costs for women who had the implants fitted by the health service and who are anxious to have them removed. It will also remove the implants if the private clinic no longer exists or refuses the patient. It is thought that 95% of women had the operation privately.
Andy Burnham, shadow health secretary, said he believed the government should do more to force all the private health companies to pay for extraction operations. He said: "While we accept the advice the government has given on the basis of evidence they have seen, we are disappointed that they are not providing more help to women affected.
"As a result, thousands of people are left in a difficult situation by this review. The government must appreciate how, for the vast majority of women affected, their statement on Friday was inconclusive. By implication, the suggestion was that the best course of action is to have implants removed. But they provided no practical help to the vast majority of people affected.
"It is an unacceptable state of affairs for any woman now to be left in a position where she is worrying about her health, and has no peace of mind, but is unable to afford to do anything about it. It is not enough for the government to say that the private providers have a 'moral duty' to their patients.
"Many women and their families will have been looking for a much stronger response from the government and will feel left in the lurch by this unsatisfactory statement."
A Department of Health spokesperson said: "Both the health secretary and Sir Bruce Keogh, NHS Medical Director, have been absolutely clear that the NHS will support the removal of PIP implants if the patient has concerns and with her doctor she decides that it is right to do so. We have been explicit that the NHS will help those who are either turned away by an unscrupulous clinic or whose clinic no longer exists."
• This article was amended on 8 January 2012. We added a comment from the Department of Health in the last paragraph.
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8 January 2012 11:30AM
So if I were a private clinic, I'd just refuse the patient knowing the NHS was then going to pick up the costs while I retain the profit. Familiar story?
8 January 2012 11:41AM
How can Lansley accept that if a surgical mistake is made by the NHS.the victim can be fully compensated
Yet the exact mistake by the private sector can be ignored
Apart from the fact that monies from the Private medical companies paid to one of his interests
8 January 2012 11:43AM
The NHS must not pick up the cost.Private clinics must meet this cost from their profits as would any other business that sells faulty products.We MUST stop passing risk to the taxpayer.Whilst I am sympathetic to those involved this was an elective procedure when performed for cosmetic purposes and is not essential to maintain health.If there is an issue sue the provider who makes profits out of peoples vanity.
8 January 2012 11:48AM
Surely there is no scandel and its an easy conversation for lansley........... Dear head of dodgy plastic surgury company, either look after your patients properly or we will make sure you do not have a licence to opporate in this country.
The saidcompany should then recover the money from the supplier who has admited to liying about the silicone. If they are insolvent tough shit.
8 January 2012 11:57AM
Of course the people who put in these faulty implants should remove them. But if they won't or can't then the NHS should. Alcoholics and the obese and others with self-inflicted disease aren't turned away from essential treatment, so it it's a medical necessity it should be done.
Lansley doesn't inspire confidence with his dithering.
8 January 2012 12:23PM
There is the story right there.
How?, who?, when?, where?,why?.
If there are no newshounds on this trail already, god help us all.
8 January 2012 12:44PM
If no evidence the implants are more harmful, then there should be no obligation on private companies to remove them. However, it's clear that the private companies are not able to regulate the safety of cosmetic procedures and so legislation has to be passed to ensure future problems do not arise. Either the industry needs to put in place a fund for repairing the damage done by bad practices or it should require patients take out insurance when getting procedures done. If the industry is not able to cover its own healthcare liabilities, it shouldn't be allowed to exist.
8 January 2012 12:56PM
Why on earth does Lansley - or anyone else for that matter - think that any private clinic has a '"moral duty" to offer free surgery to worried women.'?
By that rationale, my bank and lenders has a moral duty to offer me better interest rates on my savings accounts and loans and petrol stations have a moral duty to offer me cheaper - or free! - petrol to help me maintain my life and livelihood. Etc. Etc. Etc.
8 January 2012 12:57PM
the only 'moral duty' these, or any other private health company ever has, is to their bottom line; ie, profit.
8 January 2012 1:16PM
im curious, why should the NHS be forced to fork out for this? these women should know there is an inherent risk with any operation least of all with having lumps of silicone put in you... let them fund it themselves i say,, they made their bed now they should lie in it and not rely on the general public to splash out for them tarting them selves up be more appealing on a night out. whilst naturally their will be exceptions such as those who've had cancer and the like who should receive the removal on the NHS let the rest sort it out them selves.
8 January 2012 1:21PM
We have been explicit that the NHS will help those who are either turned away by an unscrupulous clinic or whose clinic no longer exists.
Naughty, unscrupulous clinic! Don't do it again!
Taxpayer to the rescue...
8 January 2012 1:24PM
They clearly do have a duty and the rationale does not enatail the implications you list.
A more apposite comparison is a car manufacturer that has fitted a sub standard part with a high failure rate that can result in a serious accident if it fails.
I can't imahine anyone taking the position that the car manufaturer did not have a duty to replace the sub standard part in all the models to which it was fittted.
For example
It is a straight forward principle, if yiu have sold defective goods you have a duty to put it right.
8 January 2012 1:36PM
Perhaps Lansley will now realise that the 'favours' only go one way - the private health care companies will be nice to him only if he provides them with lots of money that should go to the NHS!
Surely the affected women can make a claim against PIP/its insurers/the directors of the company for the cost of removal/replacement (I appreciate there will be some difficulties as the company no longer exists but it is not impossible) - they can use this money to pay the private health care companies to do the work.
The private health care companies could do the work now and get a guarantee from the woman concerned that if she manages to recover funds from PIP/it's insurers/etc she will pay the money recovered related to the cost of the surgery/replacements. If there is no recovery of costs from PIP then the private health care companies write off the costs (given how much they make it is only right they bear any unrecoverable costs of doing the work).
8 January 2012 1:45PM
This is about the sum of what the government can do.
Unlike criminal criminals who can have their assets sized unless they can prove it was paid for legally, with white collar criminals stops at the legal definition of the company. Which is while banks needed government cash even though its financial group had assets that could have eased the TAX payers burden. As with the money spent on a NHS and ID Card computer systems that never seen the light of day there is a legal separation between criminality and crime.
8 January 2012 1:46PM
This would be funny if it wasn't such a grim tale ... Lansley headed for confrontation with tory donors over their lack of ethical accountability.
Such irony ...
8 January 2012 1:52PM
The women should not have to sue PIP, that is up to the clinics that bought the implant. To use the car analogy again, if Honda said that they bought the aitbag fitting from a supplier in good faith and suggested car owners sue the airbag supplier that would be rightly rejected.
If you buy defective goods it is the retailer who has the responsibilty to put it right for you, not the manufacturer. The question is who did you have a contract with. The women had a contract with the clinics, the clinics had a contact with the suppliers.
It is up to the clinics to put things right for their customers and for teh clinics to try and recvoer the cost from their suppliers.
8 January 2012 1:53PM
And the alternative would have been to say to extremely worried women that if they had any problems getting their private clinic to remove their implant they'd have to just sort it out themselves, involve lawyers, fight with insurance companies and generally be ready to endure month after month of stress.
You might also have preferred the government to have vowed to force clinics to perform removals, but even if this were a good strategy just how would you feel about allowing the clinic that implanted a defective product to be in charge of more surgery to remove it?
Looks to me the government has exercised a great deal more consideration for the victims of this scandal than you're willing to admit.
As for what to do about these rogue clinics, I'd suggest that can follow. I would be very surprised if they are not sent the bills for removals performed on the NHS. First priority, though, is speedy remedial surgery for the women affected.
8 January 2012 2:01PM
In the future, many, many more operations and medical care will be subcontracted to "any qualified provider", rather than provided by state employees in state owned facilities. These potential healthcare providers, like PIP, are profit making companies, with all the associated commercial pressures.
Even in some quarters of the NHS, the switch to items not licensed for the intended purpose is already seen as an acceptable means to cut costs, towards becoming or as Foundation Trusts. This is against Medicines and Healthcare products Regulatory Agency (MHRA) advice, which has no statutory power. PIP shows the further depths to which the private sector will go to improve profit margins.
Who will carry the can for the inevitable repeats of this scandal when delivery of NHS services is privatised, and the private "qualified provider" refuses to mitigate the real and visceral anxieties of the patients?
8 January 2012 2:01PM
Can't the Government refuse to cover the costs of removing non-NHS implants, thereby forcing patients to sue the private clinics?
Or could the state do the removals and then recover the costs from the clinics? Or would doing the removals be an admission of liability?
Genuine questions.
8 January 2012 2:04PM
There's something distinctly fake about the idea of Lansley being upset with private medical firms for behaving like private medical firms.
Who is he kidding? Who is he aiming at with a posture like this?
8 January 2012 2:08PM
If you're buying double glazing, which is expected to last for years but can fail after several years and after the company that supplied it goes out of business, you can look for a company that is a FENSA member and has insurance-backed long term guarantees (in case the supplier goes bust).
Maybe it's time the private 'health' sector offered something similar, and those that don't can get closed down, either by the law or by loss of custom caused by pressure from the honest players in the business (assuming there are some).
Applies to plenty other things besides breast implants too.
8 January 2012 2:15PM
I suspect it will follow the vogue, al la banking, for private profit with the cost risk socialised, the capitalist version of socialism.
The scenario you refer to is different from the one being discussed. In the present case this is private medicine full and nothing to do with the NHS.
However, with the semi-privatisation of the NHS the private for profit care would be treatment under the NHS which likely means that liability to you as the patient sits with the NHS.
8 January 2012 2:18PM
Is this some propaganda position by Lansley ?
All that is needed is a statement
" comply or have your ' license to practise' revoked ".
They are refusing to offer a basic standard of care to patients who even paid for at least that. Surely that contravenes the ethical guidlines of their profession.
Shut them down.
If you're serious rather than just making appropriate noise !
All this doesn't bode well for increased private involvement in the NHS does it ?
If a car ,electronics, or other manufacturer fits faulty parts , theirs is the obligation to make good , recall and repair.
Why would it , or should it , be any different for a bought service from private medicine providers .
8 January 2012 2:26PM
'The saidcompany should then recover the money from the supplier who has admited to liying about the silicone. If they are insolvent tough shit.'
That was well thought out.
If they are insolvent then they have no money to recover.
8 January 2012 2:31PM
No it isn't...
The coalition has been keen enough to seek to force through legislation about private sector profiteering from the NHS. They are happy enough to try and steamroller changes to existing pension agreements.
Thatcher managed to drive legislation through enabling rapid sequestration of Union funds.
They are the government . If an emergency measure was tabled , I doubt many would oppose it in light of the subject , and possible victims.
That is all it would take. A barely opposed law directed specifically at shoddy private provision, that simply stated all clinics operating porivately are automatically responsible for any complications arising from the services or material they elect to supply in return for payment.
Governments can do that sort of thing.
Quickly when it suits them.
At other times they just make the right noises , especially when this demonstration of the private sector's lack or professional ethics and morality bodes so badly for a major government policy.
Equally , Lansley knows that Laws dealing with this issue now , might well impact against future private providers operating within the coalition's NHS fiddling, by removing their get out of jail free card to dump cock ups back on the NHS to repair , fix, and compensate , as they were contracted in , ostensibly by, the NHS.
Governments can go to war at the blink of an eye. Dealing with a few rogue private medical providers would be a pushover , if the real will to deal with them existed.
8 January 2012 2:33PM
I think BigB73 realised that hence the "tough shit" qualifier.
If there is any loss due to insolvency that should sit with the party that contracted with the company, i.e. the clinics.
The patients contracted with the clinics and the clinics are therefore still liable to their patients.
Are these not basic principles in relation to contract?
8 January 2012 2:36PM
Quite right, instead of talking about moral responsibilities the government should have been clarifying the rights of consumers under the law.
If the law as it stands is inadequate then they should be acting quickly to stenghten it.
8 January 2012 2:38PM
To my mind this absolutely nails it as far as the implant recipients are concerned:
BUT, the problem for the government is that MHRA appear to have certified that the implants were not defective. It is going to boil down to who has the most lawyers, or more probably, whether there is a sudden and mysterious surge in donations to Tory coffers.
8 January 2012 2:40PM
Sorry, quote in previous post was from:
logos00
8 January 2012 01:52PM
8 January 2012 2:57PM
If time wasn't a factor, maybe but given the cuts to legal aid, they would have to go no win, no fee.
Common sense would say yes but this comes down to corporate law. Given a LTD after your name separates the smart criminals from the dub. I wouldn't hold out much hope for the victims.
8 January 2012 3:15PM
While I agree with you in sentiment, the government for the last 30+ has worked for the city and as in any employer, employee relationship; you don't bite the hand that feeds you.
Look at the economy, 1920's America showed why you don't let the city call the shots. Its happen again and still the government hasn't bitten the hand that feeds it.
Look at the PM thinking today. The share holders should govern bonus payments. The fact that it's not the shareholders profits paying the bonuses but the TAX payer, seems to have bypassed his and the governments thought process entirely.
I personally think that you are falling into the trap of believing we live in a democratic country, it's not, nor has it ever been. All that has happen is that the city has replaced the House of Lords or perhaps that should be, the House of Lords has become the city.
8 January 2012 3:53PM
Perhaps a second operation to remove these implants is the greater and avoidable risk because you are simply 'worried'. A stupid demand placed on the NHS by Lansley who has clearly gone bonkers - or is it because this involves a French company
8 January 2012 4:04PM
Yet another example of socialism for the rich and capitalism for the poor.
8 January 2012 4:09PM
No ... I think you missed the whole point of the post.
The whole point of my post was to illustrate the fact Lansley has zero real interest in those women or their plight (self-inflicted , or not).
He , like the vast majority of his political breed, is merelmaking the right noises to appear to be 'fit for purpose' , when he is really just another con-job.
If he was in the slightest bit bothered legislation could be rushed through in next to no time (in parliamentary terms)
That is the point...
There is an easily achievable 'fix' the government can seek, and enforce , upto and including denying offending clinics from making 1 penny more profit from medical procedures.
However , that would explode their own myths.
The problem is they do not want to, for many of the reasons I stated.
However, it remains a fact , there is much more they could do.
We will soon have had approaching four decades of Thatcherite inspired politica and economics , it has patently been an abysmal failure. Ally that to the US taste for the similarly flawed Reaganomics with its innate creed of deregulation and abject laissez-faire, and the world's financial disaster is easy to understand..
it is time we stopped believing the drivel they feed us , as if we are all simple minded, and ignored the silly excuses they trot out and demanded a damn sight more than the feeble service politicians supply.
8 January 2012 4:12PM
Moral duty, responsibility? Why not take away the licence of all private clinics that refuse to make good their shoddy work... whenever it happens. Why did they purchase French PIP implants in the first place? Could it be something to do with price? Are women advised about the number of implants available, and the reason why some cost more than others? Or are they told we have been using this particular implant which is manufactured in France because we have found it t be the best. My guess is that the Secretary of State for Health will not flex his muscles... atrophy having long been the standard by which the Treasury regards anything that requires money, save fighting ludicrous foreign interventions.
8 January 2012 4:20PM
Amazing how these women have the money for plastic surgery in the first place, but not to fix a problem resting with the manufacturer of the false boobs - let them pay or sue the company for damages. Also amazing that the NHS has the money to treat a million drunks a year, not to mention drug addicts, give free plastic surgery and give THEIR ELDERLY PEOPLE the bums rush out of the hospital doors. What kind of a country is that. I am not talking about the women who've had cancer and breast surgery as a result.
8 January 2012 4:36PM
Again you are missing the point. The government does not work for the electorate, it is an employee of the city, paid for by party donations, consultancies and directorships.
You're asking for them to make a stand against their own. It's never going to happen.
All I'm asking is that society picks up the pieces of these victims lives and try to put them back together rather than stand by watching them die while hoping for some moral victory to be won will never happen as it will be settled in a back room deal.
8 January 2012 4:38PM
It seems to me that cosmetic surgery clinics are akin to the wild west of healthcare.
Perhaps this would be a good time to set higher standards etc. for all these clinics. It might push the price up for cosmetic procedures but if people are prepared to fork out several £k for whatever they feel is wrong about their appearance then a litttle more money wouldnt hurt to ensure good practice.
8 January 2012 4:44PM
Times have changed. I remember years ago, surgeons wheeling in the back door of NHS hospitals, private patients, needing critical care. Now they wheel their mistakes in the front door. We bailed out the free enterprise banks now the NHS is to bail out free enterprise health care. Socialism for the rich, captialism for the poor.
8 January 2012 4:56PM
NHS should not treat alcohol related incidents for free
8 January 2012 5:11PM
So much for the private sector eh Lansley,and there's you thinking giving them the NHS would improve their morals,how naive or stupid can one man be?
8 January 2012 5:14PM
If a woman has a mastectomy, then I completely understand her desire to get breast implants and I would even agree that they could be funded on the NHS. However, in any other case, it is simply an issue of buyer beware. If people want to buy something so ridiculous then on their own head be it. I don't have much sympathy. I laugh when I hear someone on the T.V. say "they made me more confident". If you equate confidence with chest size then you're a fool and you deserve whatever you get.
8 January 2012 5:24PM
You're missing the bus , never mind the point.
In other posts I have stated that the women should be treated .
I have also stated that if the government had the will to make something happen , it could.
It chooses not to.
Thus it demonstrates that life is less important to them than enabling the private sector to make profit.
You stated that ...
I pointed out correctly that such a statement was totally incorrect.
You are apparently unable to grasp that my posts have been saying that the goverment will not act because it chooses NOT to , not as you stated because they are unable to.
You had probably better leave it as you just do not seem open to nuance at all.
To strip them down to the bone , my posts say...
It is a simplification to say the government can do no more...
They can...
They will not , because they choose not to,
because they will not upset the wealthy investor classes who own and finance them.
However , the women need treating , just as smokers do , alcoholics, addicts,... even tories. ( that was a bad joke).
BUT... It is deceptive to claim the government can do no more...
If they had a shred of will to do so , they most certainly could...
8 January 2012 5:35PM
@Peace141
And where do you plan on drawing the line on self inflicted injuries?
Drugs, drinking, exercise, diet as the decision on your treatment path could stop at the portion of fish and chips you had several years ago.
@aims22
They didn't go to a back street clinic with no license to operate.
8 January 2012 5:47PM
We would like to see some photos of the breasts of these women so we can judge for ourselves.
8 January 2012 5:52PM
You would be correct if this was a democratic government, it's not. The only reason it is getting this much rhetoric is that nobody wants to stand at the next elections with the badge saying 'I let thousands of women die of breast cancer'.
Which given a lot of the responses here seems to be a mistake on their behalf. Irrespective of how the cancers get triggered, surely civilised sociality can afford to fix them.
I don't recall the bankers getting so much bile posted towards them during the initial bailout as I see against these poor victims of a criminal act.
8 January 2012 6:11PM
In Germany all implant patients are told they must be replaced every 8 years because of the high risk of rupture or silicone bleeding out of implants. There was an article in the Lancet confirming this advice about 10 years ago.
Bear in mind this is supposed to be for the good officially approved implants.
Therefore all these women, whether post cancer patients or not, knew they were in for a full op. every eight years, for as long as they wanted to have an implant in place, until the final explant op.
In your dreams, this advice was given!
8 January 2012 6:15PM
So you're advocating that people should have more rights when buying a TV than undergoing a surgical procedure. Or are you advocating that all rights should be removed - you know, like dangerous toys and 'buyer beware' prevails?
This is another example of the privatised profit and nationalised risk. Nothing else. Again.
I agree with you on the chest size/confidence thing. But that isn't the real point.
8 January 2012 7:03PM
The chances of the govt actually cracking down on these clinics is about as likely to happen as:
The crackdown on high boardroom pay set by mates of the directors
The crackdown on offshore tax havens
Lord Lucan leading out Sherghar ridden by Elvis Presley in this year's National.
Sure they say naughty naughty but we all know this is for the sake of trying to look good to the British taxpayer.
In other countries such as Austria for example, clinics are offering removal of these implants for free.
Only the good ol' UK private sector and their puppets in the government could get away with this.
8 January 2012 7:17PM
What a disappointing statement by Andy Burham.
Rather than taking the opportuinty to highlight problems around private health care, ie regulation, and being money rather than morally bound, all he does is slag off Langsley. Great.