E Jane Dickson: Fake breasts and public health – a perfect storm

The breasts muddle is just a snapshot of what we can expect with the Health Bill and its muddle of provision

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What is it about breasts that stop us thinking straight? We could go down the earnest Freudian route or we could cut to the wisdom of Hedy Lamarr. "Men," said the fabulously upholstered Hollywood siren, "have only two interests, money and breasts." Viewed in this light, the current political imbroglio over the financing of bigger breasts is pretty much the perfect storm.

This week, the Department of Health ruled that while the NHS will remove the dodgy PIP implants from patients who had their breasts enlarged privately, it will not provide replacement implants in the course of the same operation. The decision rests on the founding principle of the NHS that private and public medicine should remain separate. The fact that, for years, private procedures have been carried out in NHS hospitals rather knocks the stuffing out of the principle. But it remains the case that patients cannot usually have a pick'n'mix package of privately and publicly-funded treatment for the same condition, at the same time.

Some 35,000 privately-enhanced women, frustrated in their hopes of a one-stop re-fit, are joined in their criticism of the DoH ruling by the Commons Health Committee, chaired by former Conservative Health Secretary Stephen Dorrell. In a burst of chivalry Dorrell recommended that "we should start looking after the interest of the woman, rather than the small print of the rules". Putting women through unnecessary medical procedures, he went on, "is bad medicine". Meanwhile, enlarged and aggrieved women stare soulfully from the pages of every magazine sharing their personal fears, with no trace of irony, about "invasive and unnecessary operations".

Pressed as to why they elected to stuff their breasts with silicone in the first place, most revert to the mantra of the "empowered woman": "I did it for me."(And if this empowerment happens to chime with gonzo porn sensibilities, well, that's another matter.) I guess their reasons are more various than they appear – I suspect that in generations to come, the artificially-distended bosoms of the early 21st century will be an anthropological curiosity on a par with bound feet or stretched necks – and I dislike the "serves them right" vindictiveness served out on these women. Anger and frustration at the "can't pay, won't pay" attitude of the private health care providers responsible for the dodgy implants is entirely reasonable.

Nonetheless, "I did it for me" is not a compelling political reason to reinflate privately-purchased bosoms at the taxpayers' expense. Indeed, the presentation of such demands to a health service already stretched beyond capacity, borders on the obscene.

There are sound practical reasons for keeping private and public health provision separate. If privately-purchased implants were fitted as part of an NHS procedure and, in 10 years' time, the replacement implants were found to be faulty, who would pick up the tab for compensation? Sympathy and financial support is due to the small minority of PIP victims who have undergone reconstructive surgery after a mastectomy and now find themselves worrying about defective implants. Beyond that, I'd say it's a case of "let the buyer beware". And I mistrust the political animus whipped up by Dorrell and his colleagues against the NHS on a high-visibility issue which affects a relatively small proportion of the population.

Let's say that patients who have undergone private treatment on knees or hips – the choice of many in an era of NHS queues stretching to the end of doom – discover that they have been fitted with defective prostheses. Would the Government be so quick to cry "scandal" and insist the NHS does something about it, quick-smart? Would pictures of pained pensioners jutting their dicky hips at the camera be all over the press like a rash? I doubt it. But the words "breast" and "scandal" just fit so snugly together.

Meanwhile, the real public health scandal – the systematic dismantling of the NHS as we know it – proceeds on its stately course, with smooth talk of "improved choice and accountability". Interesting to note, too, that Spire Healthcare and BMI Hospitals, two of the major providers of PIP implants, were reported as being among the private companies consulting with David Cameron on his plans for a "devolved" health service.

The confusion over breast implants is just a snapshot of what we can expect with the new Health Bill and its muddle of private and public health provision. But it serves as a timely illustration. Do we really want "free-market" health, where in any sudden or systematic crisis, local authorities can act independently in offering remedies for "knock-down" prices? Can complicated issues of compliance and compensation, issues which, year on year, loom larger in public health, easily be resolved in Cameron's vision of "devolved" health care? If we're all to be buyers, we'd better all beware.

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