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.


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

    Comment number 18.

    How mealy mouthed incompetent and indecisive this government... First the women were told they were safe, then there were hints of lies coming from the private sector companies that did this but the government still said they were safe... but hey, they set up a review... Now it's "Uh... We dunno." But they're doing because women are 'anxious', how generous of them!

  • rate this

    Comment number 17.

    .. for god sake does the NHS turn smokers and drinkers oh and over eaters away. I am very proud to be british due to the fact the nhs does not discriminate and treats people with respect. I agree in the first place the clinic/insurers should pay to have the implants REMOVED AND REPLACED but if this is not possible surely the nhs should intervene.

  • rate this

    Comment number 16.

    Not sure why women are getting so uptight about "government response" Presumably women got implants put in without consulting the government. If they are worried then they should go back to the people who fitted them and ask them to remove them. In reply to Mark Livers3edge, customers usually foot the bill. Women have a choice, its nothing to do with the government.

  • rate this

    Comment number 15.

    I totally agree private or not were all human xxxx

  • rate this

    Comment number 14.

    I had implants on NHS 20 years ago,and had them replaced in 2007 due to a problem, also on NHS. The last few months i have been having problems again and am due for a scan nxt week. Anyone with these implants has something inside their bodies thats not fit to be there through no fault of their own and should be treated the same, whatever their reasons for having them!!

  • rate this

    Comment number 13.

    We waste enough money on people that don't pay taxes, that come to our country and don't lift a bloody finger so where is the line to be drawn ?????

  • rate this

    Comment number 12.

    There is a lesson in here somewhere.

    Women save and pay for a service from a private company, if it goes wrong they're pretty much on their own. Accountability is passed around and the customer ends up footing the bill.

    Look out folks, this is where the NHS is heading...

  • rate this

    Comment number 11.

    Vanity is not always the motive to those narrow minded ones ! I work and pay taxes for people who need care through smoking drinking and been overweight so why should my health not be priority too just because I had a breast enlargement that I was told was as safe as HOUSES do u really think we would have it done otherwise ?

  • rate this

    Comment number 10.

    I'm not directly affected by this, but would just point out that, yet again, the private sector makes all the profit with its usurious charges for this kind of operation, and when it all goes wrong, the public sector is forced by this Gov. to accept the liability, and sort out the mess/pick up the pieces. When will we learn to charge the private sector properly for its incompetence and cheating?

  • rate this

    Comment number 9.

    Over 90% of these have apparently been implanted in the private sector: it would be interesting to know what proportion had been done by surgeons working mainly in the NHS.

    But isn't the bottom line here that the responsibility lies with the surgeon who selected the PIP implant? So perhaps not Spire or Nuffield, but the medical defence organisations that insure doctors should foot the bill?

  • rate this

    Comment number 8.

    Those who had these implants for purely cosmetic reasons, unless there is a direct threat to their lives, should go back to the private clinic that carried out the cosmetic surgery. The NHS should not have to find hundreds of millions to sort out a problem arising from people purely wanting to change their appearance

  • rate this

    Comment number 7.

    As I see it there are 2 groups - those that HAVE to have an operation and those that don't - but WANT to.

    The 1st group will have been, with the approriate medical assessment, done by the NHS. The 2nd by the private sector.

    This 2nd group decided to have work done and paid the bill - and took the risk. If my house falls down due to bad workers should the government pay? The DOT for a bad car? No

  • rate this

    Comment number 6.

    For the 95%, the private clinic should assess FOC, and then remove/replace if medically necessary. Unless under "warranty", the patient should expect to pay based on how long they've had them (they would be replaced every 10-15 years anyway). Clinic initially pays the rest and then sends bill to M. Sarkozy.
    For the 5%, NHS remove/replace if medically necessary and send full bill to M. Sarkozy.

  • rate this

    Comment number 5.

    I have been a tax for 30 years, if i need the help of the NHS then i clearly am entitled to it, as for this is not just a vanity issue it is a health issue, lots of women have breast implants for other reasons, not just vanity.

  • rate this

    Comment number 4.

    my implants were done because of breast cancer on the nhs buts my daughter's were done privately because of personal reasons which has dramatically changed her life, she saved for 5 years to have it done its not her fault the private sector let her down i hope she gets a reduce price replacement

  • rate this

    Comment number 3.

    Where vanity was the original motive, NHS (ie the taxpayer) should not be footing the bill. There are far more deserving uses of NHS resources- make those responsible, or their insurers stump up here.

  • rate this

    Comment number 2.

    Its right for the NHS to replace/remove these implants if they've been used as reconstructive surgery from breast cancer.Women who had them done for reasons of vanity should go back to the organisation that did the ops.The NHS should be a last resort for these, not the first.

  • rate this

    Comment number 1.

    Actually not ALL of the NHS implants will be for post-cancer reconstruction. A minority will have been funded under strict criteria, such as congenital absence of breast tissue or marked asymmetry of breast tissue.


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