The Blog

Stop Boob Jobs on the NHS?

I'm writing in response to this Daily Mail article.

This is just populist Jeremy Hunt spin....with a nice little dig at the NHS while he is at it.

I've been a GP for 26 years. The NHS has not done "vanity" cosmetic surgery for as long as I can remember. Its difficult to get any cosmetic surgery on NHS. There are some exceptions but you have to justify them through a detailed and rigorous application process. Most people would agree that people who have suffered severe burns, accidents or birth deformities should be allowed cosmetic surgery to try to restore their appearance to something they consider more acceptable because this helps them socially and psychologically. In relation to "vanity" cosmetic surgery - boob jobs, nose jobs etc. it's simply not true that these are generally available on NHS.

Most women applying for breast reductions or enlargements are turned down. As a GP I managed to get one woman a breast reduction who was slim but had abnormally large breasts that were causing her backache and spinal curvature. The application process took months and I had to provide a lot of evidence. Another woman with very asymmetric breasts - one about a size A and the other a D got turned down, even though I made the case that this was having a profound effect on her self esteem and ability to engage in any intimate relationships, which was having harmful psychologic effects on her.

It's at least 15 years since any patient I know has been able to get a nose job on NHS, and even then you needed a psychiatrist's opinion that the nose shape was seriously damaging mental health. A patient of mine- a young man with a big sebaceous cyst in the middle of his forehead that was making him very self conscious and affecting his confidence applying for jobs etc. was turned down for removal on NHS.

For at least 20 years it's been very difficult to get varicose vein operations in our area, even when causing symptoms, because they are deemed to be cosmetic. You actually have to have leg ulcers or bleeding veins to get them operated! There are many such examples that any GP will give you. Hunt is describing what already happens! The story of the "glamour model" who got the boob job was that she had an unusual condition of failure of any breast development. This was thought to be causing her psychological harm and so a case was made for her to have breast implants.

With reference to the boy who admits he put on an act to get a nose job - no system is immune to people determined to play the system. In my experience the NHS tries to get the balance right between its duty to use resources wisely and the need for flexibility and humanity for exceptional circumstances . That some people can take advantage of that is to be deplored but it's inevitable in any system that requires human judgement . As I said, the vast majority of applications for cosmetic procedures on health grounds are turned down.