On 6 May MP John McDonnell and Professor Harminder Dua, President of the Royal College of Ophthalmologists, met with Health Minister Daniel Poulter to discuss the urgent need for regulation of the refractive eye surgery industry.
Dr Poulter advised that, although refractive eye surgery had not been singled out by the Keogh report, the government had decided it would be included in "the work being taken forward" by the Cosmetic Surgery Interspecialty Committee, set up by the Royal College of Surgeons.
NB: I strongly disagree that eye surgery is a cosmetic procedure and was not convinced by Dr Poulter’s assurances. I am also fully aware that the only reason there was any mention of eye surgery in the Keogh report was because of pressure from me, John and Harminder.
I was supposed to attend the meeting, but at the last minute was excluded for reasons of ‘protocol’. John told the Minister that I had information he should hear and suggested it would be a good idea if we met at a later date.
A week later John and I both wrote to Dan Poulter urging him to meet with me. Completely ignoring my request Dan Poulter sent an insultingly patronising letter, telling me he was "familiar with (my) good work", suggesting that I "may want to approach” John for details of their discussion on 6 May! He wrote to John that he was too busy to see me but advised I contact two of his civil servants and meet with them instead. I called and emailed both across six weeks. No response.
In my opinion, the fact that Poulter refuses to meet with me suggests a whiff of lobbying in the corridors of Westminster.
John McDonnell presented a Private Members Bill in Parliament calling for government legislation.
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Regulation of Refractive Eye Surgery
Motion for leave to bring in a Bill (Standing Order No. 23)
John McDonnell (Hayes and Harlington) (Lab): I beg to move,
That leave be given to bring in a Bill to regulate refractive eye surgery, including laser eye surgery.
Nine years ago, the late Frank Cook, a former hon. Member, brought together a group of senior MPs to take evidence and examine widespread concerns about the operation of the growing laser eye surgery industry. Those concerns included high-pressure sales tactics, variable standards of service and a failure to provide adequate aftercare, particularly if the treatment had had unfortunate side effects. At the time, the consumer group Which? and the then National Institute for Health and Clinical Excellence brought forward reports expressing their concerns about the development of the industry.
In 2005, Frank Cook introduced a Bill in the same form that I am promoting today. The aim was to give the industry the opportunity to address concerns voluntarily, before Government needed to act. Eight years on, I and other hon. Members have been shocked that there are still many incidences of the problems that we then identified. In some cases, they have got worse.
I pay tribute to the public and practitioners who came forward to their MPs to explain how they were treated and to expose current malpractice. I particularly want to pay tribute to Sasha Rodoy, from the My Beautiful Eyes campaign, who has supported many victims of the industry. I do not want to tarnish all practitioners in the field, because there are many good practitioners out there, but confidence will be undermined if we do not tackle the problems.
Eight years ago, we found that many of the corporates in the sector employed aggressive sales tactics to secure clients. Recent evidence from clients and former salespeople shows that the problem continues and has got worse. It often starts with a phone call, the offer of a time-limited discount or entry into a competition for free treatment. Patients visit the shop on a no-obligation basis for a consultation; then the phone calls start. We have evidence of people receiving 20 phone calls in a single day. Some salesmen are described as counsellors or refractive technicians, but have minimal training in what the surgery involves and come under intense pressure from their managers to clinch deals no matter what. Patients are often not given adequate information on the potential risks. One former Optical Express salesman described pressure from managers not to give customers all the available information for fear of scaring them off.
Material used by some companies to promote sales has been proven on several occasions by the Advertising Standards Authority to be unfounded, lacking in evidence and misleading. In 2011, the ASA upheld 17 complaints against Optical Express brochures.
Concerns continue to be expressed about the quality of patient assessment. Assessments are often undertaken by a different person to the surgeon who performs the operation or who provides aftercare—there is no consistent approach. Good practice in any surgery recommends that a patient’s consent is assured. A cooling-off period
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is recommended between the assessment and advice provided, and the final decision. Many companies state that a 24-hour or 72-hour cooling-off period is built into consent procedures, but we have evidence that that is not the case. Complex documents are placed in patients’ hands, and they are pressurised into providing a signature on the actual day of the surgery.
There is no legal requirement for a surgeon to be qualified or experienced in this field of surgery. There are no regulations to that effect: any doctor can undertake this surgery. The Royal College of Ophthalmologists introduced a certificate in laser surgery, but only half of practising surgeons have it. It is worrying that certification is on a downward trend: in 2009, 29 surgeons took the exam; in 2011, 13; in 2012, five; and this year, none. Worries have been expressed about the number of surgical operations an individual surgeon is contracted to undertake in one day: sometimes 17 to 20, sometimes more. There is no limit on the number of procedures a surgeon can undertake. That puts time pressures on assessments, pre-op procedures, operations and aftercare.
There are definite risks involved in this surgery. Some estimate that one in 20 patients experience post-operative problems, including dry eyes, blurred vision, starbursts and glare. In many cases, patients have found it extremely difficult to secure aftercare from companies. Many are forced to resort to the law, and it takes months—in some cases, years—to receive effective remedial action or compensation. On many occasions, they are forced to sign compromise agreements including gagging clauses so that they do not expose what has happened to them. In addition, in some instances they later find that the cost of corrective surgery is deducted from their compensation.
I could go through many case histories, but there is not time to do so. Many hon. Members have also brought cases to my attention. Ex-staff have talked about company patient satisfaction surveys being heavily influenced, or even filled in, by staff. On at least one occasion, an expression of dissatisfaction never came to light. I will quote what one person said to me:
“I was misled, misinformed and mis-sold.”
What needs to be done? Sir Bruce Keogh, the NHS medical director, examined laser surgery practice in his recent report on cosmetic surgery. He concluded that action needed to be taken to regulate the industry. His report was published in April and the Government are yet to respond.
The agenda that the Government need to address is set out in Frank Cook’s Bill, which I have updated. First, the industry needs statutory regulation, as voluntary mechanisms have failed. At minimum, all surgeons must be qualified, certificated and have regular competence assessments from here on in. There should be openness and transparency so that the success rates of individual surgeons and clinics can be published. Patients will then be able to make considered choices. The Government should consider limiting the number of operations that surgeons can undertake in one day: we restrict the hours of lorry drivers and pilots; we should also restrict the hours surgeons work, because patients are being put at risk. We should ensure that high-pressure sales techniques are made illegal in this area. There should be a legal requirement for companies and surgeons to provide full information, in a comprehensible form, on all risks to patients.
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There should also be heavier sanctions for breaches of advertising standards and mis-selling by such companies, because the result of their actions is to expose people to serious health risks. There should be a seven-day breathing space, enforceable in law, between the initial decision and final consent. There should also be guaranteed aftercare and, if things go wrong, remedial action at the expense of the company, not the individual. Finally, there should be a compensation scheme. The mechanism for securing compensation for individuals who suffer loss and damage as a result of such actions should be swifter and less litigious. We have argued this case before, but perhaps it would be easier and less litigious if there was an industry-funded scheme to provide compensation to those who can demonstrate that they have been harmed by such surgery.
It is difficult to get a figure for how many such operations take place, but it looks as though between 100,000 and 120,000 people a year undertake such surgery. That is too many people. Even if the figure for those affected is one in 20, as I suggested, that means that thousands of our constituents are being put at risk by an industry that is completely unregulated. I therefore urge the Government to act now. There are many former patients, excellent practitioners and Members of this House who are willing to work with the Government on a programme to secure action based on the Keogh principles, which are about ensuring high standards of service, openness and transparency, accountability and a proper sense of care for such patients in the long term. This is a serious matter. I know that the Government are currently considering their response to Keogh. I hope that it will be imminent and that this part of the cosmetic surgery industry and the surgery industry overall will be covered in that response.
A large number of Members wished to support the Bill—I have had to select a range of Members from different parties and areas in presenting it—and I thank them for that.
Question put and agreed to.
That John McDonnell, Ann Clwyd, Sir John Randall, Sir Bob Russell, Hywel Williams, Mark Durkan, Jim Shannon, Naomi Long, Sandra Osborne, Michael Fabricant, Nia Griffith and Chris Williamson present the Bill.
John McDonnell accordingly presented the Bill.
Bill read the First time; to be read a Second time on Friday 28 February, and to be printed (Bill 131).
John McDonnell MP will present a Ten Minute Rule Bill in the House of Commons on 20 November 2013.
In 2005 a Private Members' Bill was presented to Parliament calling for regulation of laser eye surgery:
A panel which included the world's most renowned eye surgeons was set up to look at the matter. Optical Express demanded a place at the table, claiming that, as the largest UK provider, they should be included in any discussion and decision making.
The panel was disbanded and the Bill went no further.
John McDonnell MP will present a Ten Minute Rule Bill in parliament later this year to promote legislation and prompt the government to act.
BBC interviews with John McDonnell here:
In response to our pleas that he look at the refractive eye surgery industry Sir Bruce Keogh eventually wrote to John McDonnell in March and said his review would be "covering laser eye surgery' and his recommendations expected to "have a bearing" on the industry. Prior to that Earl Howe, Parliamentary Under Secretary of State @ the Dept Health, had written to John stating that Sir Keogh did not consider laser eye surgery to be a cosmetic procedure.
Music to my eyes as I'd been shouting this loudly since launching My Beautiful Eyes Campaign! Regardless of why some people undergo eye surgery, it is NOT just a cosmetic procedure to be compared with derma fillers or breast implants!
Review of the regulation of Cosmetic Interventions:
Although the report includes recommendations certainly relevant to the refractive eye surgery industry, any type of eye surgery is far more serious and risky, deserving its own review urgently as countless numbers of trusting inncocents have their eyes irreparably damaged EVERY day!
The industry advertise 99% success rate although some surgeons have admitted to 10% problems, whilst both UK and US campaigners believe it could be as high as 20-30%.
Even if we were to accept laser eye surgery risks as being only 1%, that is at least 10% higher than risks of routine medical procedures. Scary statistics!
When John McDonnell MP and I contacted them in August 2012, Sir Bruce Keogh and previous Health Ministers Simon Burns and Secretary of State Andrew Lansley all displayed total disinterest for the My Beautiful Eyes Campaign.
They were each entirely unconcerned that so many people are suffering serious problems caused by the refractive eye surgery industry, being far more excited about the cosmetic surgery industry furore!
Sir Bruce Keogh's own response to my lengthy and detailed emails came from his Business Manager - advising me to fill in an online form!
I am contacted now on a daily basis by more and more people damaged by eye surgery.
To date I have successfully helped many with practical advice and, when appropriate, forwarded them to legal teams who are themselves becoming more knowledgeable and experienced with the methodology of this industry.
That's fine, but we MUST STOP any more being damaged and the only way to do that is to pressure the government to legislate!
It WILL happen - but we need your help as it's only people power that will get this industry under control!
Please support My Beautiful Eyes Campaign: https://fundrazr.com/campaigns/3kL86/ab/53Fw4e