At exactly 5pm last Sunday, a push notification came up on my phone: “Revealed: faulty medical implants harm patients around the world”. As part of a wider investigation coordinated by the International Consortium of Investigative Journalists (ICIJ), The Guardian had just published a series of articles that examined the implant industry. A quick Google search was enough to understand the magnitude of this investigation: 252 journalists from 59 media organisations in 36 countries had come together to “[reveal the] damage caused by poor regulation”.
Five hours after The Guardian’s article had been published, the newspaper El Confidencial, which had been part of the investigation, revealed that the Spanish Ministry of Health was arranging a meeting with some of the key healthcare stakeholders in Spain to discuss what had to be done. That is when I asked myself what would happen in the UK. Whilst the Spanish medical device market is the fifth largest in Western Europe, the size of the UK’s market is twice as big. How was Matt Hancock, Secretary of State for Health and Social Care, going to react to the Implant Files?
In this article I explore what the political response has been like in the UK, and suggest some potential explanations.
What has been going on in Westminster?
On Monday, a day after the Implant Files had been released, Sarah Wollaston MP, former GP and current chair of the Health and Social Care Select Committee, told The Guardian that the findings were “very concerning”. In a similar vein, Baroness Cumberledge, co-chair of the All-Party Parliamentary Health Group, told the same newspaper that patients can’t rely on the current system. The Lib Dems reacted quickly as well, and Baroness Jolly, the Spokesperson for Health, stated that “unsafe medical devices have no place in our healthcare system. The time when manufacturers can sign off their own products must come to an end immediately.”
However, not many other key political figures responded to the ICIJ’s findings. Except a couple of shy tweets and retweets from Jon Ashworth MP, Shadow Secretary of State for Health and Social Care; Owen Smith MP, Chair of the APPG on Surgical Mesh Implants, and a few other parliamentarians, the Westminster crew hasn’t said much. Only a few parliamentary questions on medical devices have been tabled, and the majority of these (if not all of them) have focused on the already-known issues of surgical mesh implants, and haven’t mentioned directly the ICIJ’s investigation.
What explains this?
The Implant Files were only released one week ago, and there is still time for key politicians and policy-makers to react to the findings. However, unlike in Canada, where the health minister has vowed to strengthen the oversight of medical devices, the British government hasn’t responded in any way, shape or form to the ICIJ’s findings. Some of the factors below could help explain this.
Brexit means Brexit
Two years after May’s famous slogan “Brexit means Brexit”, no one knows what Brexit actually means. This Saturday, Sam Gyimah was the seventh minister to quit over the PM’s deal. Whilst May has been feverously campaigning to sell her Brexit deal, we will have to wait until MPs get their say on whether they approve of it or not, which is expected to happen in less than two weeks’ time.
Understandably, everyone seems to be focused on the impact of Brexit and what would happen in a no-deal scenario. On the 27th November, for example, the Health and Social Care Committee questioned the Secretary of State for Health and Social Care, the CEO of NHS England and academics and experts, on the likely effect of the withdrawal agreement and political declaration on the UK’s healthcare system.
This concern about the future of the NHS after Brexit is shared by many MPs, as further conveyed by the many parliamentary questions that have been recently tabled, and which have predominantly focused on the procurement and supply of medicines and medical devices. Last week, for example, Madeleine Moon MP tabled a question on the future of just in time delivery arrangements.
Whilst the findings of the Implant Files are concerning, the fact that the UK’s HealthTech supply could be majorly affected by Brexit is arguably more problematic at the moment.
No leading figures
In the Scottish Parliament, the Labour MSP and mesh campaigner Neil Findlay has been calling for the establishment of a medical implants register since the Implant Files were released, logging a motion only one day after the ICIJ’s investigation came to light. He has also been tabling various parliamentary questions, putting constant pressure on the Scottish government.
Two days after the Implant Files were released, Catherine Calderwood, Scotland’s Chief Medical Officer, wrote once again to the Medicines and Healthcare products Regulatory Agency (MHRA) to seek assurances that the safety of mesh products had been properly tested. According to the Scottish government, Catherine Calderwood was in this case “following up on previous letters from her and Health Secretary Jeane Freeman in October following a BMJ article which questioned the thoroughness of the regulation of the devices.”
Key Westminster mesh campaigners such as Owen Smith MP could have potentially played a similar role to that of Neil Findlay. However, Smith has decided to simply share his views on Twitter, congratulating The Guardian (and not the ICIJ and the rest of the media organisations) for the Implant Files. Whilst the role of political actors such as Findlay cannot be overstated, he has clearly helped to raise awareness in the Scottish Parliament and highlight the urgency of this issue.
A political compassion fatigue?
Media organisations in the UK in the last recent years have been reporting over and over again how the regulation of medical devices is flawed. In 2012, a joint BMJ and BBC Newsnight investigation raised concerns over metal hip implants. In 2014, the Institution of Mechanical Engineers (IMechE) warned that faulty medical equipment kills 300 patients every year and injures thousands. Whilst the IMechE focused on NHS machinery, newspapers like The Telegraph analysed as a result of this the data from the MHRA, concluding that “in 2012/13 there were the 13,642 of incidents involving medical devices … [o]ne in ten related to an orthopaedic implant such as replacement hip.”
The surgical mesh scandal has been a particular media (and social media) protagonist in recent years. In February, the former Secretary of State for Health and Social Care Jeremy Hunt launched a review into how the NHS addresses concerns about medical treatments, including vaginal mesh devices, which led to the suspension of vaginal mesh surgery to treat stress urinary incontinence in England.
Lobbying and putting constant pressure on politicians and policy-makers might be essential to achieve actual changes. Persistence is definitely key in politics. However, such a strategy may mean that new findings do not surprise political players as much.
Is Hancock going to eventually react?
Whilst it could be argued that the Secretary of State for Health and Social Care Matt Hancock often uses the term HealthTech in a rather ambiguous way, referring to the broader use of technology in the healthcare sector*, medical technology is clearly one of his key passions. On the 19th November, for example, the so-called “HealthTech Advisory Board” – a body that will advise Hancock on his technology vision for health and social care – met for the first time to discuss how new technologies can improve the NHS. This group includes Michelle Brennan, company group chair for Johnson & Johnson Medical Devices Companies.
Given his interest in HealthTech, will Hancock react to the findings of the ICIJ? Whilst he hasn’t made any explicit comments on the Implant Files, his views clearly remain unchanged. Three days after the ICIJ’s investigation was released, the Secretary of State for Health and Social Care one again highlighted the importance of health technology at an event held by Vitality and Apple. Whilst his speech mainly focused on the impact of technology when spotting and preventing illnesses, and on apps and IT rather than on HealthTech per se, he did refer to “the medicine of the future” when speaking about “digital devices and medicines, wearables and AI to predict, prevent and treat people with precision.”
HealthTech undeniably saves and improves people’s lives, and Hancock is fully conscious of this. The investment of over £200m in technology for the NHS among other initiatives have shown that Hancock is a proactive, not reactive, player.
The Implant Files can be regarded by Hancock as a chance to improve the health technology sector in the UK. However, they could also potentially threaten his strategy to “build the most advanced health and care system in the world”.
I believe that fully embracing and endorsing the ICIJ’s findings could potentially mean acknowledging that he hasn’t really understood what he was dealing with up until now. Is Hancock’s approach to HealthTech too simplistic? Has his focus on IT and apps blinded him? Has he devised a wrong strategy? Taking a purely reactive approach to the Implant Files could discredit his thought leadership and his views on the path that the UK needs to take.
Hancock knows what’s going on and will definitely take the findings into account. However, his strategy might be subtler than that of the Canadian health minister. I’m pretty sure that his HealthTech Advisory Board will be discussing this in their next meeting.
*Health technology is defined by the WHO as “the application of organized knowledge and skills in the form of devices, medicines, vaccines, procedures and systems developed to solve a health problem and improve quality of lives”.