SURGICAL INNOVATIONS
T RCS to examine cosmetic
surgery standards
he Royal College of Surgeons is to establish a group
which brings together those involved in setting standards for cosmetic surgery following a new report by the National Confidential Enquiry into Patient Outcome and Death.
The study, entitled On the face of it, reviewed the organisational structures of cosmetic surgery providers and found that many were failing patients. Of particular concern to the College was evidence of ‘occasional surgery’ with operations being spread over too many units with some surgeons not doing enough to maintain skills. The findings that some units lacked equipment and were not undertaking full psychological assessment of patients were also of grave concern.
The RCS says that nobody should be practising surgery without contributing to audit in order to prove safety, so the failure of so many units to participate in this study is alarming – particularly as one reason seems to be the very high turnover of small start-up organisations in this field.
RCS president John Black said: “This incisive report from NCEPOD shows that patients are not being properly protected. The Royal College of Surgeons 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
Sep/Oct 10
we shall aim to provide clear standards to those bodies to help them fulfil that.”
Consultant plastic surgeon and president of the British Association of Aesthetic Plastic Surgeons, Nigel Mercer, said: “These figures present a distressing picture, but one which is sadly not surprising to us as they only confirm what we have been saying for years – that there is an absolute need for statutory regulation in this sector. Aesthetic surgery needs to be recognised as the multi- million pound specialty it is and not just a fragmented ‘cottage industry’.
“The BAAPS have a proven track record in promoting patient safety and education and has long been calling for enforceable regulation of this sector of medicine. Just as someone eating in a restaurant wouldn’t have to personally inspect the kitchen, the public should have the right to expect providers of aesthetic surgery to be properly overseen and regulated on their behalf by the government.
“We agree with the overall recommendations from this report. Proper training is essential and needs to be lifelong and easily available - in fact we’re holding our annual scientific meeting next
week, which is attended by trainees and surgeons alike. It is essential for all surgeons to keep up to date and to aware of the latest techniques. People considering aesthetic surgery should also be properly assessed before treatment and we have helped develop tools and checklists to ensure that patients are properly screened psychologically, which is now part of every patient’s assessment. The NCEPOD study also questions whether medical malpractice organisations should continue to indemnify practitioners who are unable to demonstrate competence. The BAAPS has set up a malpractice insurance scheme, tailored specifically and available only to surgeons who have good claims histories. All BAAPS members also have to submit an annual audit of procedures and complications as a membership requirement. ”
“The fact that some providers perform some procedures only occasionally demonstrates that, even now, some surgeons are prepared to ‘have a go’ when they’re clearly not competent enough – at the cost of the patient’s safety. A coroner stated recently that aesthetic surgery should be primarily about safety and not just about what you (the surgeon and patient) can ‘get away with’.
THE REPORT FOUND THAT: • Over one in ten clinics (11.5%) ceased to exist between being identified and being approached to take part
• Nearly 70% refused to participate in the study (as per Care Quality Commission requirement) and are, therefore, effectively not regulated
• One in five (20%) of centres that offer breast augmentation and a staggering 55% of those offering breast reduction perform these ops less than 10 times a year
• One in ten sites couldn’t provide data on the number of procedures performed
• Routine psychological assessments were carried out in less than 35% of sites
• Of the nearly 9 out of 10 (88.6%) that advertise, over a quarter (26%) promote special offers and discounts
• Nearly a third (32%) of providers don’t offer a two-stage deferred consent process, i.e., a ‘cooling off period’ after booking surgery
• Only slightly over half (56%) always do the initial patient consultation with a consultant surgeon
• Less than half (44%) of operating theatres were properly equipped and over one in five (22%) didn’t have a member of resuscitation staff on duty at all time
• A third don’t have out-of- hours consultant rota or a Level 2 (high dependency) unit
• One in five (18%) had no emergency re-admissions policy and relied on the NHS to deal with any complications
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