THE BLOG

The NHS and Cosmetic Surgery: Time to Stop Fiddling Around the Edges

23/07/2014 12:41 BST | Updated 21/09/2014 10:59 BST

Health Secretary, Jeremy Hunt has said that he is firmly against "purely cosmetic work" being paid for by the NHS, when his department is being asked to slash £20 billion from its budget.

This has been seen as a popular move by many - an easy win for the Government - but is frankly an overly simplistic position, which achieves little more that political points scoring and misses many critical points.

As a surgeon who has been practicing cosmetic surgery for over 40 years, having developed what I believe in many cases are life-changing procedures, the arguments are far from black and white.

The NHS is absolutely right to acknowledge that there are clear health reasons for some cosmetic surgery, which should be covered by the public purse. All would agree, for example, that a congenital deformity, such as a cleft lip - whilst cosmetic and not a functional problem - is something that would be considered essential treatment. The same could be said for injuries resulting from car accidents which would require facial reconstruction, for example. Taking this a stage further, many would also accept that there are often clear psychological reasons for cosmetic surgery on major scars and other body deformities, which are not physically restrictive, but could have psychological implications in the future.

The issue - or grey area - is what we actually mean by "purely cosmetic work". The correction of poor self-esteem, due an ugly nose or heavy pendulous breasts in a young person, can make a lifetime of difference, but certainly wouldn't come under Mr Hunt's guidelines for free treatment. Indeed, the overwhelming majority of people which my clinic treats - and also people who should have access to NHS treatment - are those that have a real medical reason for surgery. Judgement, however, is clouded by the popular perception of cosmetic work being seen as vanity projects for wannabe models.

What is at issue, is whether poor self-esteem is a good enough reason to warrant treatment on the NHS. Based on the evidence of life-transforming procedures that have dramatically changed numerous lives of patients of mine, the answer has to be yes.

Should we deny free treatment to a young person, who otherwise faces a life of misery, and at the same time spend far more money on treating an octogenarian terminally ill cancer patient? Logically, it may well be a much better use of NHS time and money to treat the former, but, of course that is not a popular line and certainly not one a politician is ever going to take.

Whether or not one agrees with these priorities, there is a far better way for the NHS to save money on cosmetic surgery, and this is where the Health Secretary totally misses the point.

The PIP scandal in the UK cost the NHS millions. At the same time, it raised awareness of a growing presence of cowboy operators in the cosmetic industry who were poorly qualified, placed profits before medical concerns, highlighting the need for tighter regulation. This was four years ago, but even now the NHS spends far too much time fixing botched jobs from cheap 'high street' clinics.

The fundamental point is that if there was better regulation of the industry, those issues wouldn't exist in the first place and those finances could be directed elsewhere.

The government did have the opportunity with the recent Keogh report on Cosmetic Surgery, which was supposed to offer solutions to problems arising from a rapidly growing, unregulated field of medicine. However, the Government flunked it by watering down the original draft, and then failed spectacularly to implement the main proposals.

So let's not look at fiddling around the edges with political platitudes. Better regulation of the cosmetic surgery industry will save the NHS far more money that denying important cosmetic surgery treatments.