Daily Mail's figures don't show that NHS "cosmetic surgery" has doubled in ten years

"NHS blows millions on boob jobs and facelifts: Taxpayers foot the bill as cosmetic surgery doubles in ten years" — Daily Mail headline, 5 July 2014

A story that appeared in the Daily Mail at the weekend suggested that the NHS was spending increasing amounts on cosmetic surgery. The Telegraph also picked up the story.

The data tells us how many of certain procedures were performed in England, but not the reasons why. So we don't know how many were for medical reasons unrelated to physical appearance. We also don't know how many might be considered as technically "cosmetic" but were carried out for reconstructive purposes, for example following a disfigurement.

There are also problems with the methods the articles have used to estimate the costs; these are based on the price of private surgery for paying customers. There's nothing to suggest that the same procedures performed in the NHS would correspond to those prices.

The Mail's figures are not about "cosmetic surgery"

Information on certain medical procedures performed between 2004 and 2013 was released by the Health and Social Care Information Centre (HSCIC) following a request from the Daily Mail. The procedures were: breast augmentations and reductions, eyelid surgery, ear reshaping, facelifts, liposuction, and rhinoplasties (often called "nose jobs").

Many operations that are commonly thought to fall under the umbrella of "cosmetic surgery" can be used for other purposes. For example, liposuction can be used to treat Lymphoedema, a condition that typically causes swelling in the arms and legs.

The HSCIC doesn't record the reason given for the procedures, so we don't know how many of them were done for cosmetic reasons. This was made clear in its correspondence to the Mail.

In some cases, the NHS performs surgery that is cosmetic in the sense that it is intended to "improve the physical appearance of the body", but that is part of reconstruction following surgery or some other disease or disorder. For instance it's far from clear that the provision of breast augmentation to those recovering from a mastectomy means that the NHS "blows millions on boob jobs" in the eyes of most taxpayers.

In 2012-13 there were about 34,000 NHS England procedures falling into the category the Mail was reporting on, compared to about 28,000 in 2003-04. The number of facelifts and breast augmentations has more than doubled from 4,829 to 11,641 in the same period. The HSCIC has said that part of the rise for all procedures might be due to improvements in the way the data was collected.

Private sector prices don't tell us about costs

The Mail gives estimates of the cost of each of the procedures to the NHS. For instance it calculates that the NHS might have spent "up to £8.5million" on facelifts in 2012/13 by multiplying the 1,137 procedures in this category by an estimate of £7,500 as the cost of each.

But these estimates aren't intended to show the costs of the operation to the NHS. The £7,500 figure is NHS Choice's upper estimate of the prices in the private sector.

There are a number of reasons why that isn't a good predictor of the cost of the operations performed by the NHS. For one thing, private cosmetic surgeons are presumably making a profit on the operation; so their costs will be lower than the price. For another, differences in the medical needs of public and private sector patients might mean quite different costs for the average procedure.