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The Two Tier Health Service in Action


Posted on 06 February 2012

rocket_tits.jpgDr No’s colleague, the Formidable Missile, who cares so much it must hurt, has been campaigning tirelessly on behalf of her PIP ladies. Whether lumping these women together as ladies is a push up too far that affords them a degree of nicety not always entirely fitting is a moot point, but on the matter of doing something to help these women, as Dr No prefers to call them, Dr No is right behind the Formidable Missile’s point. No matter what collusion of vanity and distress prompted these women to put a rocket in their tits, the fact is they presented to their surgeons in good faith, expecting a competent procedure, done using the proper materials. That the booster in their rockets turned out to be sinister industrial grade silicon, and prone to rupture to boot, is a calamity that simply cannot be laid at their door. And for this reason, Dr No agrees with Dr Coales: there is no moral justification for leaving these women to fend for themselves.

Just as when the newly fitted clutch in our car turns out to be a squealer, we turn not to the clutch manufacturer, but to the garage which fitted the clutch for remedy, so too should women with PIP implants turn first to the surgeon who did their operation. The more reputable of these overwhelmingly private operators (and the NHS on the rare occasions when it fitted them) have stepped up to the mark, and agreed, when indicated, to replace, free of charge, the mattress silicon with medical silicon.

But that still leaves many, if not most, of the affected women out in the cold. A number of the private concerns that fitted PIP implants have, in a sinister echo of the implants they fitted, gone bust. Others, including the largest private operators, have hidden behind shabby denials – not our fault, guv, we didn’t approve the implants - and wolf-cries that they too will go bust if forced to put right the faulty materials they used. Offers to replace are only available in strictly limited circumstances, leaving tens of thousands of women out in the cold.

NHS England (and Scotland; Wales has been more generous) have offered to remove PIP implants if clinically indicated (and the indications include anxiety), but will not replace the implant unless it was originally fitted by the NHS. Unless, that is, you travel to Merseyside, where an enterprising NHS trust will pop in a replacement at the time the PIP implant is removed, all for a mere top up payment of £1000.

This is where Dr No parts company with Dr Coales, who is positively ecstatic about the Merseyside deal. For it seems to him that this is clear evidence of a health service providing care not on the basis of need, but on ability to pay. Two identical women with unruptured implants, yet suffering the same degree of iatrogenic – that is, medically induced - torment, will not have their treatment decided on need; instead, the one who can pay will get the treatment; the other will not. It is the two tier health service in action.

Dr No is as displeased as the next person at the NHS having to pick up the tab for private blunders (and make no mistake, we will see more of these capers if Lansley gets his way, and the floodgates are opened to private providers) but the greater imperative, it seems to him, is an equitable service, based not on ability to pay but on need. And the global cost of including replacement on the NHS for those women for whom replacement is indicated need not be that great. Of the 40,000 women affected, 3,000 are already covered by the NHS, a substantial number appear to be covered by private concerns who have agreed to honour their obligations, leaving perhaps some 14,000 (Harley Medical Group) plus 4,000 (Transform) in the lurch. Not all of them by a long shot will be candidates for NHS replacement, leaving us with perhaps 10,000. If we also assume, not unreasonably, that the Merseyside deal has a markup (approved medical grade implants cost some £300-400, and how long does it take to pop one into an already open wound?) and the cost price is nearer £500, then the total cost to the NHS of adding in replacement might be of the order of £5m – far cry from the £120m touted in some of the press.

£5m is still a lot of money, but Dr No thinks it a small price to pay to put these women out of their misery. Some of it will be recoverable at law from the private concerns involved, even if, as Dr No suspects, the bruiser who runs the Harley Medical Group has more lawyers in his back pocket than well-upholstered limos in his front yard second hand car lot. But the the real lesson of this sorry tale, once the affected women have had their breasts put to rights, is this: beware the dark side of private healthcare.

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