New standards for cosmetic surgery in Europe

The Health Tourism Blog has moved to the IMTJ web site. You can now find the Health Tourism Blog here in future.I will continue to post the first few paragraphs of the blog posts here. You can find the full version of this blog post on IMTJ:

Here's an extract of the latest blog post: New standards for cosmetic surgery in Europe


The recent PIP implants controversy has raised more concerns about regulation, operation and standards within the cosmetic surgery industry. In the UK, the Guardian newspaper has recently highlighted private cosmetic clinics that employ surgeons to carry out breast enlargements, nose jobs and tummy tucks who do not hold qualifications as plastic surgeons within the NHS (Private cosmetic clinics employing 'unqualified' surgeons).  There are also concerns about the quality standards and practices of cosmetic surgery clinics both within the UK and across Europe. A new European Standard on Aesthetic Surgery Services represents a significant move to address these shortcomings.

Regulating the cosmetic surgeons

In general, cosmetic and plastic surgeons who carry out cosmetic surgery at one of the private hospitals owned by UK groups such as Nuffield, BMI and Spire hospitals will hold an NHS consultant position, usually in Plastic Surgery or ENT Surgery - NHS consultants who do some private cosmetic surgery work. In contrast, many of the surgeons working for the cosmetic surgery chains such as Transform, Harley Medical Group and the Hospital Group are not NHS consultants.
The British Association of Aesthetic and Plastic Surgeons (BAAPS) has raised concerns about the influx of cosmetic surgeons into the UK from Europe. The BAAPS President told the Guardian, "We very often get applicants from Europe. Although they automatically get on the specialist register, the quality of training they have had is in no way equivalent to a trainee in the UK and they are often not deemed suitable for an NHS post".

According to Transform, "Qualifications obtained in other parts of Europe are at least the equal to those obtained in the UK" and said it was "completely untrue and highly misinformed" to suggest otherwise.
In June 2011, the European Commission published a Green Paper, “Modernising the Professional Qualifications Directive”. This Directive, adopted in 2005, sets the rules for mutual recognition of professional qualifications between Member States.  Consultation on this paper has now closed.

Read more about this in the full version of this blog post on IMTJ: New standards for cosmetic surgery in Europe

Practice makes perfect...a message for medical tourism providers and patients

In the largest ever study of hospital mortality rates published in the UK,"death rates for emergency patients jump 6 per cent when newly qualified doctors start work. The Health Services Journal reports that "the traditional first day for NHS doctors is the first Wednesday in August. Researchers found that patients brought into hospital the week before were more likely to survive.....Researchers could not find a definite reason for the higher mortality rate, but said early August was known as an “unsafe period” in hospitals due to the influx of new doctors"

Now, what can we conclude from this?

Might I suggest that doctors with more experience are better than those with less experience? It goes without saying, really.

So, how does this help the medical tourist who is trying to make a decision about which doctor or specialist overseas to choose for their operation? The problem of patient choice in healthcare whether it is a choice of an overseas surgeon or a domestic surgeon is the "how do I know that he's any good?"issue. In the UK, we're probably ahead of the game in enabling patients to make informed choices about treatment. The NHS web site is has been renamed "NHS Choices" and in recent years there's been a drive to expose data on clinical outcomes and surgeon and hospital performance, and make this freely available to patients.

One of the strengths of the UK healthcare system (and one of its shortcomings!) is that the vast proportion of healthcare is delivered by one healthcare provider - the NHS. This means that data on processes, outcomes, performance and patient satisfaction is fairly standardised, thus enabling valid comparisons to be made between one hospital and another, between one specialist and another.

Let's imagine that I need a knee replacement. Under the NHS, I can choose to go to any hospital in the UK, not just my local hospital. But let's assume that I want to stay fairly local. Here's some of the data I can access about my local hospitals through NHS Choices. For each "quality factor", I have highlighted the best result.

Impressed? Which hospital would you choose? Or which hospital would you rule out of consideration? The above table only scratches the surface of the data that is now being made available to patients. I could also compare the quality of the food, levels of service and so on. And I can also begin to make comparisons between individual surgeons.

Where does this leave the medical tourist? The reality is that there are few countries where this kind of comparative information would be made available to the patient. And the reality is that different healthcare systems often measure things in different ways, so that comparing outcome data from a hospital in Thailand with outcome data from a hospital in India might be very difficult.

So, the medical tourist probably needs to ask some very basic questions about the hospital and specialist. One of which is a fundamental measure of "how do I know that he's any good?” It's "how many times have you done this operation before?" "Practice makes perfect" as the recent study demonstrates. Choose a surgeon with experience in exactly what you require. If you're looking for a knee replacement, choose an orthopaedic surgeon who does knee replacements and virtually nothing else. Don't choose a "general" orthopaedic surgeon who does “everything under the sun" - knees, shoulders, feet, hips etc.

And ask the guy "how many have you done this year?"

NHS Patient Choice - Lessons for medical tourism

In the UK, "patient choice" is one of the driving forces in healthcare. Since April 2008, patient choice has been extended in the UK. Patients can choose which hospital they are treated in....anywhere in the country. Patients can choose the time of their hospital appointment. In some cases, patients can choose the individual consultant they see. The NHS Choices website lists information about all NHS hospitals, such as their MRSA rates, facilities and ratings and reviews by patients which means that patients can make an informed choice.
The NHS Choose and Book web site enables people to make their choices.
In reality, the patient choice initiative has been a bit of a disappointment. One problem is that not enough patients are actually aware that they have a choice. The Report of the National Patient Choice Survey, England - December 2008 has analysed uptake of patient choice so far.
The key findings:

• The percentage of patients recalling being offered a choice of hospital for their first outpatient appointment was 46% in December 2008, the same as in September but up from 30% in the first survey (May/June 2006)
• 50% of patients were aware before they visited their GP that they had a choice of hospitals for their first appointment, up from 48% in September and 29% in the May/June 2006 survey.

The factors influencing choice

• Hospital cleanliness and low infection rates were given most often (by 74% of patients) as an important factor when choosing a hospital.
• The other five are quality of care (given by 64% of patients), waiting times (63%), the friendliness of staff (57%), the reputation of the hospital (55%) and location or transport considerations (54%).

So what can medical tourism businesses learn from this?

If UK patients can compare NHS hospitals on MRSA rates, post operative infection rates and outcomes, why can't they do this for overseas hospitals? Or perhaps, why is it difficult if not impossible to find a hospital treating medical tourists that publishs such data or makes it freely available on their web site?

Many people in the UK have the right under EU law to travel abroad for treatment. The EU Directive sets up a framework around this. but the basic right of free movement already exists. So, why aren't people taking advantage of this?

• They don't know they have the right.
• They don't "trust" overseas hospitals.
• They would rather wait for treatment on the NHS in their local area.

Awareness of overseas treatment options can be generated by the providers themselves. One of the best tools to consider is the use of patient stories to create local press coverage and thus raise awareness. See this story in the Scotsman. Let's see more of them!

EU votes on medical tourism directive

Members of the European Union's various committees vote this week on whether to make changes to the EU Directive on cross border healthcare. The Directive aims to provide a framework for patient mobility, whereby patients in one member state will have the right to treatment in another state.

The UK's General Medical Council (GMC), which regulates the country's 230,000 doctors, is running a lobbying campaign to protect Britons seeking healthcare in Europe from what it describes as "dangerous" doctors. the GMC wants the new EU laws to give patients access to the disciplinary history of incompetent clinicians.

Quoted in the Guardian, Paul Philip, the GMC's deputy chief executive says:"The vast majority of doctors do a very good job under very difficult circumstances. However, when UK patients travel to mainland Europe, there is a risk they could be treated by a doctor who is not fit to practise or not fully qualified to give the required treatment."

UK patients have full access to GMC records and are able to check whether a doctor has been disciplined, or is the subject of a disciplinary hearing. The GMC wants doctor organisations in other countries to provide similar patient access to information about their doctors.

In the first 9 months of 2008, the UK NHS paid for over 500 British patients to have treatment elsewhere in Europe. Some patients were also funded by their primary care trusts. It is estimated that another 80,000 Britons funded their own treatment overseas.

A code of practice for medical tourism

At Treatment Abroad, we have introduced the first medical tourism code of practice for healthcare providers. The "Code of Practice for Medical Tourism" aims to encourage best practice in medical tourism through a commitment by healthcare providers overseas to a voluntary code of practice.

The standards of business practice and customer service in the medical tourism indutry are variable. But having said that ...they are probably much higher than many critics of the industry suggest. (In our recent survey of 650 medical tourists, 97 per cent of patients said they would be willing to travel abroad for treatment again).

The Code is an opportunity for agencies and healthcare providers to reassure patients considering overseas treatment that they are adopting best practice.

If the medical tourism industry continues to grow, it needs to adopt some common standards and best practices. Hence the Code of Practice for Medical Tourism. Healthcare providers and agencies who sign up to the Code will be identified as adopting a “best practice for medical tourism” and will be recognised on http://www.treatmentabroad.com/.

In addition providers who are approved will be able to display the Treatment Abroad accreditation mark on their website and patients will be able to access accreditation details online.

In order to receive accreditation, organisations are asked to demonstrate best practice in a number of areas covering provision of information, the patient experience and contractual terms, conditions and guarantees. The application will be reviewed by an independent consultant.

We believe that this is a positive step for the industry and offers a chance for providers to demonstrate their commitment to best practice in dealing with patients from overseas.

Further information about the Code of Practice for Medical Tourism is available at:www.treatmentabroad.com/medical-tourism/code-of-practice

EU proposals promise boost to medical tourism

European Commission proposals to be released next week will increase patient mobility within the EU and give NHS patients access to hospitals across the Continent; patients in other EU countries will will also have access to NHS hospitals.

The proposals will confirm the ruling of the European Court of Justice on overseas treatment for waiting list patients who are suffering "undue delay". Yvonne Watts, a British patient who was on a waiting list for hip replacement paid to go to a French hospital for her hip operation; she then went to the European Court of Justice to claim the costs of the operation from the NHS. The Court confirmed the legal right of patients to seek treatment in another EU state, if they have to suffer "undue delay" in their country of residence.

The new proposals could result in a boom in NHS sponsored health tourism. Patients would pay for travel and accommodation costs, but the NHS would foot the bill for the treatment.

Details of the new proposals are expected to be made available this week.