Sarah Ellson, head of the public and regulatory law group, Field Fisher Waterhouse
Beauty and the beast of regulation
The cosmetic surgery industry should strive now for self-regulation before a DoH review reaches its conclusion
A recent survey showed that many people consider the cost of surgery more important than the qualifications of the people undertaking it or the aftercare provided.
Of course, as we saw with the PIP implant story earlier this year, when it all goes wrong, the focus swings back to quality assurance and redress.
Professor Sir Bruce Keogh, who is leading a Department of Health review of cosmetic surgery, last month asked people to give their views and share their experiences of the industry and cosmetic procedures. His call for evidence raises important questions about practice and improvements needed in the sector.
At the end of his review we can expect a set of recommendations covering regulation of procedures. Having been involved in healthcare regulation for many years, I think one of the key problems with the review is that some of the cosmetic services Keogh intends to include are provided by non-healthcare professionals. Tooth whitening, for example, is offered by boutiques, not just dental professionals, while some drugs and devices, such as dermal fillers, are being used other than in accordance with their licence.
The current system is fragmented, with loopholes for those wanting to avoid regulation. Consumers do not know how to seek out accredited providers and, given the range of practitioners who carry out cosmetic procedures, from beauticians and tattooists to specialist surgeons, coming up with a way of regulating and accrediting the sector is complex. For that reason a broader and potentially more flexible accreditation may be required. A price-sensitive public is unlikely to tolerate the total professionalisation and medicalising of these treatments, even if that would be best for our safety.
There are good arguments for accrediting not just the person involved in providing the treatments but the entire localised system delivering that service: the clinic, outlet or treatment centre. Such a framework would allow for checks to include not only the people involved (their qualifications, training, licensing and so on), but also the devices they use, the equipment, premises and record keeping. I suggest it should also include a review of insurance arrangements and a minimum commitment to aftercare.
We are reassured by ATOL and ABTA when we book our holidays. It is possible, by educating consumers about a recognised accreditation mark, to enable people to know what to look for when seeking assurance from cosmetic practitioners.
Of course, someone would need to provide and pay for a structure that accredited, dealt with those who claimed false accreditation, processed complaints and removed accreditation from providers who ceased to maintain the necessary standards. If the accreditation status gives a clear branding benefit, and consumers are persuaded of the value of purchasing treatment from an accredited provider, then the sector may be prepared to develop a form of self-regulation.
There is a small window of opportunity for the industry to take the lead on this issue but a lack of cohesion and recognition of the imperative to act quickly may leave the sector subject to an imposed regime of regulation in the future.
Readers' comments (2)
Dr. Rhys Branman | 4-Sep-2012 4:15 pm
When choosing a physician to do these surgeries one must look at a number of criteria. The American Board of Cosmetic Surgery (ABCS) is an organization that upholds a set of standards for training in cosmetic surgery in the United States. Consequently, when choosing a cosmetic surgeon it is wise to investigate if he or she is certified by the ABCS for best results. Beyond educational training and certification, a patient should research how often a cosmetic surgeon has performed a particular procedure. However, keep in mind that the number of times, and how recently, a procedure had been performed does not make up for lack of standardized monitoring or accredited formal education and licensure.
Dr. Rhys Branman
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Professor Steve Green | 5-Sep-2012 0:58 am
Hi Sarah.
Many thanks for raising these important points.
You are indeed correct. While top-down regulation of a healthcare provider by a government quango is one way to do things, persuading providers to compete to become accredited by a reputable independent accreditor may sometimes make more sense.
It may well not be enough to just check out the surgeon themselves. If the organisation in which he or she is plying their trade is not up to much, then the end result is not likely to be up to much. the work of even the most skilful surgeon turns to utter mush in the face of poor infection control, while who wants to be operated on by someone who isn't genuinely qualified to do what they say they can do.
Surely it would be good if protection from this sort of thing that British patients prioritised and looked out for - rather than just the price of the procedure! We only live once, and you can end up dead, maimed or disfigured - and with no redress - if things aren't done right.
I must declare an interest. I am with QHA Trent, the UK-based independent holistic accreditation scheme (www.qha-international.co.uk). We do not compete with any regulators (indeed, regulators are not there to compete with anyone, or at least they shouldn't be) and we exist to augment what those regulators are seeking to achieve, namely to improve the safety and wellbeing of patients and staff.
QHA Trent does of course charge money - we have to to survive as we are entirely independent - but in all honesty we are not that expensive compared to, say, some well-known consulting firms.
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