There are fundamental weaknesses in the way cosmetic surgery is carried out in the UK, an official review body says.
The National Confidential Enquiry into Patient Outcome and Death finds many cosmetic surgery centres are failing to assess and care for patients properly.
In particular, the poll of 361 sites found patients were at risk from a culture which saw teams ‘have a go’ at operations they rarely performed.
Furthermore, nearly 70% of sites refused to participate in the study - despite being required to do so - and are, therefore, effectively not regulated.
The following are the key findings of the report based on the 361 sites which did respond:
1. Many cosmetic surgery sites are offering a menu of procedures some of which were only performed infrequently.
2. While 96% sites indicated that patient outcomes were monitored, routine psychological evaluation prior to cosmetic surgery was carried out in only 35% of sites, and assessments were routinely performed by clinical psychologists in 4% of those sites.
3. A two-stage (deferred) consent process was not performed in 32% of sites.
4. 33% of independent hospitals with inpatient beds providing cosmetic surgery did not have a cosmetic surgery consultant rota for anaesthesia.
5. 30% of sites performing cosmetic surgery did not have a Level 2 care unit.
6. Only 44% of operating theatres were fully equipped to undertake cosmetic surgery.
7. 18% of sites performing cosmetic surgery had no emergency re-admission policy.
The report’s recommendations include:
1. Regulatory bodies, such as the Care Quality Commission, should more closely monitor the adherence to national requirements for audit and scrutiny of sites under licence. The scope of regulation should include all sites including those only undertaking consultation.
2. National professional cosmetic surgery bodies should issue guidelines as to the training, level of knowledge and experience required for a cosmetic surgeon to achieve and maintain competence in the procedures which he or she undertakes.
3. Those considering having cosmetic surgery should be advised to check Care Quality Commission registration of any site they attend.
4. Guidelines for the equipping of theatres and the perioperative monitoring of patients must be followed.
5. Good practice demands a two-stage consent process for those undergoing cosmetic surgery.
6. A national cosmetic surgery outcome database should be considered.
7. More formal training programmes must become established, and like any other surgical training, these should be subject to rigorous assessment of competence, which should lead to a certificate attesting to the surgeon’s level of competence in specified procedures. The present reliance on inclusion on the specialist register does not give any assurance that a surgeon has received adequate training in cosmetic surgery.
8. Cosmetic surgical practice should be subject to the same level of regulation as any other branch of surgery.
9. Independent health care providers should only allow practising privileges to those cosmetic surgeons who can demonstrate that they have achieved and are able to maintain competence in the procedures which they offer.
10. Defence organisations might consider whether it is appropriate to indemnify practitioners who are unable to demonstrate the attainment and maintenance of appropriate levels of competence for the procedures which they perform.
11. Psychological assessment is an important part of any patient’s cosmetic surgery episode and should be routine. This part of a patient’s care must be delivered by those adequately trained and reliable psychological assessment tools need to be developed.
12. Regulation should be introduced to prevent the use of financial inducements to influence the process of informed consent.
Commenting on the report, Bertie Leigh, chair of NCEPOD, said: “In cosmetic surgery we find numerous teams who are apparently prepared to have a go at procedures that they rarely perform. Unsurprisingly but worryingly, it is the more difficult procedures that are undertaken most rarely.
“There are 31 places doing the relatively common and straightforward breast augmentations who do them less than 10 times a year. This is occasional surgery by any standards. Yet more troublingly, when we look at breast reduction, which is relatively complex surgery, 79% of centres undertaking it do so on less than 20 occasions a year.”
Leigh calls on the GMC to provide clearer guidance to doctors working in this area, and suggests the Care Quality Commission needs to improve its monitoring of the sector.
Consultant plastic surgeon and British Association of Aesthetic Plastic Surgery president Mr Nigel Mercer agrees with the recommendations of the report.
He 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.”
Mr Simon Kay, consultant plastic surgeon and member of the British Association of Plastic, Reconstructive and Aesthetic Surgeons, said: “We support the need for a robust framework that will protect every patient and ensure excellence and safety in clinical delivery of cosmetic surgery.
“Cosmetic surgery is safe and effective when carried out by well trained surgeons in comprehensively equipped and staffed environments, upon suitably selected and well informed patients. It is unacceptable if these conditions are not provided to everyone seeking cosmetic surgery.”
