Saturday, 31 March 2012

PIP victims devastated that NHS Whistons has halted their PIP R&R top up scheme

The Health Committee published the latest report on PIP implants on March 28, 2012.


The report is promising and even mentions 'The Committee welcomes the Government's undertaking that the NHS will remove non-NHS implants in circumstances where the woman is unable to obtain treatment from her original provider, but urges the Government to agree a protocol under which a replacement implant can be inserted in the same operation if that is the wish of the woman, with the support of her clinicians.'

However yesterday I have been receiving alarming news and reports from PIP victims and a husband that NHS Whistons has postponed and may have even stopped their £1500 top up scheme for removal and replacement of PIP implants on the NHS? One victim's husband relays that his wife was about to pay yesterday for R&R at NHS Whistons/Knowsley Trust but was told that the Department of Health has put a stop to this operation. This has left PIP victims devastated as many could not afford to raise another £3-5K for R&R and saw NHS Whistons as a salvation, a way out, a compromise and it was a win:win as it was at cost so no loss to the NHS Whistons and perhaps even a small profit to be reinvested into NHS services and help pay NHS Whiston's £42 million/year PFI (private finance) mortgage repayments.

Private clinics are stuck in a catch-22, as the government have not declared PIPs as faulty implants, so private clinics like Transform may not claim back on their indemnity insurance policy. Asking private clinics that they have a moral duty to remove, simply is not enough or practical. They have to be given the means to do this, ie be able to claim back on their insurance policies.

One patient was rung by NHS Whistons at 5 pm the night before her PIP R&R operation and was told her morning operation scheduled at 8 am today was cancelled. After intervention from the Health Secretary and a PIP victim's MP, NHS Whistons have announced they will honour operations already booked in for this weekend and the 3 operations that were cancelled on Friday March 30th will now be done on Monday April 2 and are advising patients to keep their appointments. The big question is what has happened? What is stopping NHS Whistons from carrying on with their top up scheme? The Health Bill passed which means NHS hospitals may offer private care and use profits to reinvest into NHS services? It was a win:win situation for the NHS, PIP victims and nation and NHS Whistons was supposed to set the standard for all other NHS hospitals seeing PIP victims, so why halt this now?

A PIP victim has today shared a letter that she received from NHS Northamptonshire which may shed light on this course of events,  'NHS Northamptonshire has been asked to consider a request for the above patient to undergo removal of PIP breast implants at Whiston Hospital in Liverpool for a top up fee.

NHS Northamptonshire has contacted the provider in Liverpool and they are unable to explain how the top-up arrangement meets NHS Legislature. After considering this case carefully, and examining the information provided, NHS Northamptonshire is unable to agree to the request at this time.

NHS Northamptonshire has asked for this arrangement to be investigated by the Strategic Health Authority. Signed On behalf of Individual Funding Request Department.'
Is this the reason why NHS Whistons has ceased their PIP R&R top-up scheme for the time being? However there are flaws with the NHS Northamptonshire argument.
1. According to NHS Choose and Book NHS patients may have their removal done at any NHS trust in England of their choosing.
2. Secondly, the replacement is the private part of the case which the patient is willing to pay separately for and provisions have been made for NHS Whistons to charge £1500 for this arrangement. This is not a request for PCT special consideration funding for the Individual Funding Request Department. Lansley has already sanctioned NHS hospitals to carry out removals on the NHS. And the private replacement top up scheme is already covered in the Guidance on NHS patients who wish to pay for additional private care (DH 2009) legislature which also offers 'Guidance on Top up Payments.'
3. Dame Sally Davies, CMO, produced a PIP guidance on 27 January:
that clearly stated guidance in the annex ('General guidance on this kind of 'top up' payment was issued in 2009 see excerpt at Annex D') as to how NHS trusts may offer private treatment for PIP patients, i.e. a top up arrangement .
4. And finally we have the passage of the Health Bill, which permits NHS trusts to carry out private treatment.
I hope NHS Whistons will resume their PIP R&R top up scheme and hope that the Department of Health, NHS director Sir Bruce Keogh, Dame Sally Davies CMO and the Parliamentary Health Select Committee will collaborate and reassure NHS Whistons that private patients who are NHS eligible who received their PIPs privately may indeed have them removed on the NHS (and any replacement may be offered as additional private care/charge depending on the NHS trust's plastics department and so far, NHS Whistons and St Knowsley is the only trust to offer such a compassionate service to PIP victims. NHS Whistons was one of several trusts who received a government bailout this year, a share of £1.5 billion, as it struggled to meet its annual repayments of over £40 million a year to its PFI for the recent £250 million rebuild. This private top up scheme allowed Whistons to generate additional private income to help keep its NHS hospital running and financially solvent and helped NHS-eligible PIP victims stuck in a catch-22 postcode lottery, as they did not live in Wales to receive free R&R from the NHS as sanctioned by their female health minister!

Update as of April 4, 2012 from the Department of Health Medical Directorate for PIP victims:

'Unfortunately we think NHS Northampton are right and NHS Whiston were wrong to offer "top up" replacements in the way they did. Dame Sally's January letter did not advocate the use of top-up arrangements - it drew simply attention to the existing (2009) guidance which says:

    "Private care should be carried out in a different place to NHS care, as separate from other NHS patients as possible… Departing from these principles of separation should only be considered where there are overriding concerns of patient safety, rather than on the basis of convenience."

On the basis of current clinical advice (as summarised by Sir Bruce at the Health Committee evidence session) we don't think that for the majority of women the criterion of "overriding concerns of patient safety" is likely to be met. Health care organisations would need to consider the guidance in relation to individual patients, and there might be unusual circumstances which would justify making an exception, but a general policy of offering replacement implants for a top-up fee would almost certainly be regarded by a court as unlawful in the light of the guidance.

This is the position under the existing guidance. We are of course looking carefully at the recommendations in the Health Committee's report, published last week. But it would require a change in the guidance and we would need to find a very clear rationale for allowing top-up payments for replacement implants when we don't allow them in other circumstances - the 2009 guidance gives some examples of apparently deserving cases which aren't currently allowed. We think there is a real risk of diverting NHS resources by encouraging demand for a whole range of treatments which, by definition, are not seen as of high enough clinical priority to be generally funded by the NHS.

NHS Medical Directorate.'

So where does that leave PIP victims who cannot afford to raise another £3-5k with some still paying off their original PIP implant operation? A kind husband of a PIP victim, who had struggled to raise £1500 for her appointment with NHS Whistons, has found an alternative solution for his wife and asks to share this on my blog with all PIP victims who have been devastated by the recent halt of the NHS Whistons private top up scheme.

'A clinic in Glasgow, Scotland will carry out the pip removal and replacement for £1,850 if ruptured (and £2100 if intact). The surgeon is renowned and it will all cost my wife £2,000 including travel and accomodation. The website is Please look up the clinic and surgeon provided on there website and post to other women out there.'

Update: if you paid for your original PIP operation with a credit card less than 6 years ago, you may be able to receive a credit card refund under Section 75 of the Consumer Credit Act 1974.