MPs question Welsh policy on replacing faulty breast implants
A report by MPs into the breast implant scandal has questioned the Welsh government's policy on replacing them.
The Welsh government has offered to pay to remove and replace banned PIP breast implants for those treated privately, while in England the NHS will remove but not replace them.
It said implants should only be replaced on the NHS where there is a clinical need.
Welsh ministers say they aim to help all women in Wales needing treatment.
The Commons report also criticised the approach taken in England.
The Welsh government said that around 1,000 women in Wales had PIP implants and, of those, 309 had already been referred for treatment.
Welsh Health Minister Lesley Griffiths angered UK Health Secretary Andrew Lansley by announcing all patients with the banned implants could have them replaced on the NHS, including those who received private treatment.
A report by the Commons Health Committee said expert witnesses thought the Welsh government's policy "overestimates the problem".
What are the risks?
- The silicone inside the implants is not medical grade - but was intended for use in mattresses
- Tests have not shown any increased risk of toxicity from this filler compared with normal implants
- But mechanical testing has shown the implant covers have an increased risk of rupturing
- The gel inside can cause irritation, increasing the risk of inflammation reaction - making removal more difficult
- There is no increased breast cancer risk
- One case of a rare form of cancer called anaplastic large cell lymphoma (ALCL) was recently reported in France
- French and US experts suggest there is a small but increased risk of this cancer in women with breast implants in general
Witnesses did not agree with Mrs Griffiths that there would "invariably be a clinical need for replacement" and that "the NHS should therefore provide replacements as a matter of course".
MPs also criticised the fact that UK health ministers refused to allow English patients to pay privately to have replacement implants from the NHS as part of the procedure of removal.
The committee said this refusal "flies in the face of common sense".
In England, patients who had implants privately can have them removed, but not replaced, on the NHS if the clinic will not help.
The committee said that meant patients being operated on twice and urged the NHS in England to remove and replace, with a charge for the latter.
UK Ministers said allowing people to pay for treatment would set a precedent.'Risk of infection'
Referring to expert witnesses, the MPs said they did not agree with Ms Griffiths' view that there would invariably be a clinical need for replacement "as a matter of course" on the basis that not replacing the implants could lead to scarring, loose skin, need for drainage and risk of infection.
The MPs said that NHS medical director Sir Bruce Keogh stated that such a view overestimates the problem and underestimates the quality of surgery offered by consultant NHS surgeons.
In its conclusions, the report says: "The committee agrees that replacement implants for private patients should only be provided on the NHS where there is a clinical need."
A Welsh government spokesperson said: "The minister has said consistently there is no clinical evidence to suggest PIP breast implants should be removed routinely.
"Where a woman has received a PIP breast implant privately, the private provider has a duty of care to replace, where there are concerns. However, where a woman is unable to seek redress from the private provider, the NHS in Wales will remove and replace these breast implants where deemed clinically appropriate."
Ms Griffiths said: "Health is a devolved matter, and my response to the PIP issue has been based entirely on what is best for women in Wales needing help from the health service in Wales.
"I note with interest the contents of today's report but the UK government has no jurisdiction over health in Wales."
Rebecca, from south Wales, had PIP implants in 2008.
"After having three children I was left with no breast tissue at all, low self-esteem. I was getting quite depressed about it, and had the money at the time and decided to go for it privately.
"It improved my emotional state and my confidence. I just felt more feminine. My life changed.
"I found out the week after New Year that I had PIP and ever since then it's been very emotional.
"I've actually been prescribed sleeping tablets by the doctor because I didn't sleep for 13 weeks.
"It's just having no answers at the time. The lack of information that was getting through to the GPs regarding what to do.
"I'm having my (implants) replaced. For psychological reasons I can't imagine not having them there now and going back to having nothing, with scarring and loose skin. I think it would just put me back in the emotional state that I was (in) before I had them done.
"I wouldn't be able to pay for it (if the Welsh government was not paying). I feel for the ladies in England who haven't got that choice.
"I just feel so lucky that the Welsh government has got this protocol in action and they're actually helping women like myself."
The spokesperson said it supported replacement implants if it was in the patient's best interest.
"The Welsh government position on PIP implants has been clear and consistent, and is aimed at helping all women in Wales who are assessed by a doctor as needing treatment."
Sally Taber from the Independent Healthcare Advisory Service, which represents private cosmetic clinics backed the Welsh government's actions.
"Now we've got this further report we really must work together," Ms Taber told BBC Radio Wales.
"I work together with the Welsh government and I have to say they have worked well with the organisations.
"No independent hospital in Wales implanted a PIP implant. They didn't use them."
In a leaked letter earlier this year, Mr Lansley requested that the UK Department of Health be given advance notice of public health decisions made by the Welsh government.
To qualify for NHS treatment in Wales, including replacement implants, patients need to show they have the PIP implants, that they live in Wales, have a GP in Wales and that their private clinic has refused to support them.