“Fundamental weaknesses” in cosmetic surgery delivery

16 September 2010

THERE are “fundamental weaknesses” in the way cosmetic surgery is delivered in the UK, according to a report by an official review body.

The new National Confidential Enquiry into Patient Outcome and Death (NCEPOD) calls on regulatory bodies to monitor cosmetic surgery providers more closely.

The review of 361 sites found deficiencies in obtaining consent for surgery, a lack of training for cosmetic surgical procedures and that some centres offer procedures that are rarely performed. It said closer and tougher regulation is required, and revealed half the sites it contacted failed to answer its questions, despite rules saying they should.

Lead report author Dr Alex Goodwin, NCEPOD Clinical Co-ordinator, said: “Cosmetic surgery is far too dispersed with too many teams prepared to ‘have a go’ at procedures that they rarely perform. And, failures in monitoring patients after surgery are a recipe for disaster.”

The report, entitled On the face of it, reveals that more than half (56 per cent) of cosmetic surgery providers don’t have all the equipment needed to deliver surgery safely and many (18 per cent) don’t have a policy to readmit patients who suffer post-surgery complications. The study also found that a third (33 per cent) of independent hospitals with inpatient beds don’t have an anaesthetic consultant rota.

Dr Goodwin also raised concerns over breaches in guidelines for advertising cosmetic surgery and the lack of regulation of electronic media. He said this may put “undue pressure” on people who are considering cosmetic surgery. And he highlighted the lack of psychological assessment of patients before they consent to treatment.

Report author and surgeon Mr Ian Martin said that staff caring for patients must be adequately trained to deal with all eventualities but researchers found only 15 per cent of the hospitals provided surgical training. He added: “If there were fewer sites providing cosmetic surgery, the increase in procedures would encourage an improvement in surgical competence and training”.

Researchers reviewed all sites that offered cosmetic surgery privately, including some NHS hospitals that have private wings.

The report criticised the lack of experience of some of the teams and found that, with the exception of breast enlargement operations, the majority of sites were not carrying out enough procedures to keep their skills up.

It is accepted that sites should be carrying out more than 20 operations a year to give them enough experience. But only one in 10 managed this for ear-pinning, a fifth for breast reductions and a quarter for facelifts. The worst offenders were not named.

The Royal College of Surgeons expressed concern at the report and pledged to establish a group that would bring together “all those involved in setting standards for cosmetic surgery”.

RCS president John Black said: “This incisive report shows that patients are not being properly protected. The RCS is not a regulator, but sets the standards for surgery that the regulators use – this study makes it clear specific action is necessary. NCEPOD make a series of recommendations for the Care Quality Commission and General Medical Council and we shall aim to provide clear standards to those bodies to help them fulfil that.”

The Department of Health said it expected tougher regulation in the future. In October, a new system is being introduced in England which will cover the cosmetic surgery industry. It will allow the Care Quality Commission (CQC) to fine and prosecute the worst offenders.

Amanda Sherlock, CQC's director operations said: "It is unacceptable that some cosmetic surgery providers don't have the basic standards of good medical practice in place.”