THE COSMETIC SURGERY(STANDARDS OF PRACTICE) BILL 2016: REGULATING COSMETIC SURGERY- THE NEXT STEPS?


 

On Wednesday 19th October the Labour MP Kevan Jones introduced a 10 minute rule bill – the Cosmetic Surgery (Standards of Practice) Bill (a private members bill) in the House of Commons. This Bill is aimed at improving standards of patient care and is supported by the Royal College of Surgeons,  

“to make provision about the training, qualifications and certification of medical practitioners conducting cosmetic surgical procedures; to establish a code of practice for the provision of information to patients on the options and risks in relation to such procedures; to make provision about permissible treatments and the advertising of such treatments; and for connected purposes.”


One instance given by Mr Jones was in relation to a constituent, Dawn Knight who had eyelid surgery which led to her being unable to close her eyes to sleep at night as too much skin was removed.  Her eyes remain constantly sore, gritty and tight. (BBC News “Cosmetic Surgery I have to tape my eyelids up http://www.bbc.co.uk/news/health-37548875) She was given a lifetime guarantee. The surgeon who undertook the procedure was found to be bankrupt and the company who arranged the procedure denied responsibility. The part of the hospital she contracted with went into liquidation earlier in 2016.   

The Keogh Report in 2013, following the PIP breast implant scandal, recommended that a committee be established by the Royal College of Surgeons to set standards for cosmetic surgery practice and training. In addition it was also to provide for formal certification of those surgeons competent to undertake such procedures. This Bill proposes that this is taken forward.

The involvement of the Royal College of Surgeons in the improvement of the cosmetic surgery industry is important.  The government recognized their central role in improving standards of cosmetic surgeons in the Keogh Report, and the College themselves by accepting that role were seen to accept that change and improvements were indeed necessary.  Following Keogh’s recommendations in 2013, and after consultation with various medical bodies, the Royal College of Surgeons finally published the, ‘Professional Standards for Cosmetic Surgery’ in April 2016, outlining the principles behind their proposals for competence and training and for keeping up to date for cosmetic surgeons.  These were published and to be read in conjunction with the GMC, ‘Guidance for Doctors Who Offer Cosmetic Interventions’.

 

During 2016 the RCS are now planning to launch a range of new tools and services to improve the quality of care for cosmetic surgery patients. They are therefore currently establishing a system for certification of qualifications for each anatomical group of specific cosmetic surgery treatments, to be renewed every five years (www.rcseng.ac.uk/cosmeticsurgerystandards).  This would be in addition to registration by the GMC.  This would involve evidence provided at appraisals of relevant clinical skills and experience; and professional skills and behaviours.  However, this is only voluntary and not mandatory, and is not yet in place.

The backing of the Royal College of Surgeons for the Bill would underline that they feel that the Bill is needed currently in order to further protect patients of cosmetic surgery in the UK.  Also their support for the Bill indicates that the RCOS think that more is needed than their own current planned system for certification.  This is concerning when one considers that the government are using the planned RCOS certification system as a catch-all for any criticism of any cosmetic procedure - and they run into the hundreds - including for example, the Optical Express Ruined My Life campaign of 2014 about the lack of regulation of laser eye surgery.  

The Bill refers to the fact that the Department of Health requested the Law Commission to draft legislation, and this was done in 2014. The legislation was widely supported, but the coalition Government failed to enact it, as have the current Government.

Therefore the Bill is seeking to go further than the RCS new certification system currently under development by giving the GMC new legal powers to recognize the RCS qualifications and make these mandatory.  As Kevan Jones argues,

      “The Royal College of Surgeons would like only surgeons with appropriate skills and experience to undertake cosmetic surgery. I strongly support that, and I think that most members of the public would do so. To facilitate this, the GMC needs to be given legal powers to formally recognise additional qualifications or accreditations such as those that the Royal College of Surgeons are developing in cosmetic surgery. It should then be mandatory for those offering cosmetic surgery not only to have these but to make it clear to the public that they have them when advertising their services.”



 

The Bill also addresses marketing of cosmetic products. In introducing the Bill Kevan Jones stated that,

“Some of the techniques that are used would be more appropriate for selling double glazing than cosmetic surgery, with its related risks. They include two-for-one offers, along with glossy brochures with no explanation of the potential risks of undertaking the surgery. The whole thrust of the advertising is to sell such procedures without any counselling or advice on whether it is appropriate for an individual to undergo them. “

He argued that there should be a mandatory cooling off period to enable individuals to reconsider, something which was supported in the Beauty Demands briefing paper earlier this year. He also argued that there should be mandatory counselling before they undergo these procedures. In addition guarantees should be accompanied by insurance to enable injured patients to be able to obtain redress.

The Bill refers to a recent speech by the Prime Minister to the Conservative Party conference, in which she stated that the state should intervene where the market fails, “We have here a classic example of the market not only failing but being used to exploit people, which is ruining their lives and costing the NHS millions of pounds a year. The Government are aware that action is needed in this area, and there is no reason why they should not act.”



The Bill was supported it will be published and will be given a second reading on Friday 24th March 2017. This Bill represents a potentially very important step in relation to the regulation of cosmetic surgery practitioners. It remains to be seen whether it will be taken forward.  After an earlier debate on regulation in this area brought forward by Mr Jones in October 2015 the Government indicated that it wasn’t proposing to take forward legislation itself in the area but would focus on non-legislative steps. It is argued however that legislation and formal regulation of this area is now needed -relying on “soft law” methods such as codes is not enough and teeth are required to drive forward a real change in practice and in culture in this area.

A 10 minute rule bill is extremely welcome in the area of cosmetic surgery regulation.  It is better than nothing.  But is it not high time that the government offered more formal recognition of the suffering of patients who have been mutilated and have life-changing injuries?  Injuries that the taxpayer and NHS are paying to put right.

 

Melanie Latham, Reader in Law, Manchester Metropolitan University and Jean McHale, Professor of Healthcare Law, University of Birmingham

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