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Regulation of Refractive Eye Surgery

Volume 570: debated on Wednesday 20 November 2013

Motion for leave to bring in a Bill (Standing Order No. 23)

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 frequent 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 from 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 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.

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).