Regulation of Cosmetic Surgery (Hansard, 14 June 1994)

I beg to move,

That leave be given to bring in a Bill to establish registration procedures for cosmetic surgeons in order to set minimum standards of training and practice; and for related purposes. How many of us have wished at some stage in our lives to change the shape of our noses, our waistlines or some other feature? As we grow older, we may long to get rid of the bags under our eyes and the spare tyres round our middles.

In Britain, 60,000 people a year now opt for cosmetic surgery to do just that, and they are spending millions of pounds. Clinics in the private sector offer a multitude of different procedures to improve most parts of the human body. In our current society, which places such a heavy emphasis on youth and good looks, such clinics often claim to offer the quick, easy, painless and permanent route to a perfect physique and a wrinkle-free face.

Although plastic surgery in the national health service is generally very safe, the NHS—as we well know—is bursting at the seams, and there are long and growing waiting lists. Consequently, those who are in medical need of plastic surgery—such as burns victims, cancer patients or those with limb deformities—tend to be treated first, while those desiring cosmetic surgery are turned away. Some unscrupulous cowboys have identified and exploited the demand that the NHS is unable to meet; as a result, people are being permanently scarred and even losing their lives—so far, without the Government's batting an eyelid.

The fact is that anyone can set up shop as a cosmetic surgeon, with no qualifications at all. Indeed, unless such people specifically claim to be doctors or surgeons, they will not even be committing any offence. As soon as the so-called surgeon obtains the prospective patient's consent, he can legally operate without any expertise whatever. Horrifying though it may sound, even members of the Government could perform liposculpture in a private clinic; as long as they did not lie—which, of course, they never do!—it would be perfectly legal.

Most of the mistakes made by these butchers are rectified by plastic surgeons practising in the NHS. To repair botched surgery can take several operations and cost up to £10,000—a cost which, of course, is borne by the NHS. There can also be a long wait for surgery, especially as the disfigurements involved, although horrific, are not life-threatening.

Many such clinics gain a good deal of business from advertising in national newspapers and women's magazines. They use misleading images and claims, offering "the looks you always desired" or "to change your whole outlook on life". The Advertising Standards Authority has written to me providing a number of existing guidelines for cosmetic surgeons. They state that no advertiser should take improper advantage of any characteristic or circumstance that may make consumers vulnerable—for example, by exploiting their credulity, or their lack of experience or knowledge, in any manner detrimental to their interests. No categorical statements should be made, such as "walk-in, walk-out procedure" or "always a minor procedure", especially in the case of liposculpture. That is because any form of invasive surgery may involve complications.

519 Those guidelines, nevertheless, have been systemically broken by many disreputable operators. In order to create the illusion of credibility, clinics claim that their surgical staff are Fellows of the Royal College of Surgeons. That may very well be true, but the particular surgeon could be a pathologist with no expertise or experience in cosmetic surgery. To draw an extreme comparison, let us imagine a Boeing 747 being piloted by someone who trained on crop-spraying planes.

The president of Royal College of Surgeons, Professor Norman Browse, wrote to me stating: it is the College's view that no person should perform surgical procedures unless they are properly trained. Even our animals have better protection. At the moment, doctors cannot operate on an animal unless they qualified as a vet, yet, as things stand, a vet could perform cosmetic surgery on a member of the public. Such unprofessional conduct may well result in the vet being struck off, but in practice this would not stop him or her continuing to practise cosmetic surgery in the private sector.

The medical profession has always been controlled and regulated by strict ethics. However, with the huge sums of money now involved in private cosmetic surgery, the voluntary codes of practice have been breached by some outfits to make quick, easy money. Those cowboys perform surgery in the most appalling conditions at great risk to the patient. A woman who got in touch with me was given liposculpture in a ground floor office in Harley street. She said: I think the operating table was a dental chair. They asked me to turn over onto my stomach, or my side, but the chair was the wrong shape and it was very difficult. I was asleep most of the time, so I think that the anaesthetic must have been a general. At some stage during the operation (I was told that it was towards the end) I woke up. I was in tremendous pain and began screaming. They were still taking fat from my legs. The doctor told me afterwards that he had to continue with me awake, or my legs would have been uneven. It hurt me badly. My legs were uneven. The procedure is advertised in women's magazines as "minor and gentle". It turned out that the cosmetic surgeon was a general practitioner. He had performed a surgical operation without any surgical training and had administered a general anaesthetic without an anaesthetist.

At present, clinics that offer only "day-care" surgery can exploit a loophole in the law which means that they do not need any facilities to cope with the emergencies and complications which can arise with some of the procedures involved in cosmetic surgery. That type of "office surgery" is highly dangerous and needs to be stamped out.

520 The level of official complaints is relatively low, but that is due to the complex psychological attitudes involved. The General Medical Council believes that patients seeking cosmetic surgery may frequently be psychologically vulnerable and may not have the necessary knowledge to make an informed decision. If an operation worsens a disfigurement that was causing great distress, or creates a new one, the victim will obviously be increasingly embarrassed and filing a complaint is probably the last thing on his or her mind. One such victim told me that when her surgery went wrong, It shattered my whole life and left her "feeling suicidal".

Victims who complain have to follow a complex and potentially confusing set of procedures. To prosecute for negligence they must sue the doctor involved; this is costly and drawn out, requiring patients to draw attention yet again to their disfigurement.

The clinics advertise free glossy brochures to advise potential customers but the brochures are designed to encourage people to have as much done as they can afford. The aim is to sell body parts by mail order. Surgeons at such clinics often work on commission, so the more operations they perform, the more money they pocket.

The problem has been swept under the carpet for far too long. It is a complex subject, but too many people are suffering acutely at the hands of cowboys who have been given a free rein to abuse the British public's trust in the voluntary system of medical ethics. The Under-Secretary of State for Health, the hon. Member for Bolton, West (Mr. Sackville), has said that it is not a matter for the Department of Health, but the responsibility clearly lies with the Department. Action must be taken as soon as possible to stop any more innocent people being subjected to this butchery at the hands of some greedy and unscrupulous people.