Botulinum Toxin and Cosmetic Fillers (Children) Bill
Friday 16th October 2020
(4 years, 1 month ago)
Commons ChamberRead Full debate Botulinum Toxin and Cosmetic Fillers (Children) Act 2021 Read Hansard Text Read Debate Ministerial Extracts
Laura Trott (Sevenoaks) (Con)
I beg to move, That the Bill be now read a Second time.
Let us be clear, no child needs cosmetic fillers or botox. However, this is not, unfortunately, how many of our young people feel. Social media exerts a huge pressure on young people to conform to aesthetic ideals, which are simply not attainable without cosmetic surgery or interventions, and this, combined with their increasing availability on the high street and in people’s homes, means that we have an increasing normalisation of cosmetic interventions among the young. These procedures risk ruining young people’s lives.
Alarmingly, this is an unregulated area, so the data that we have on prevalence is very thin, but a survey in 2018 showed that 100,000 under-16s had undergone cosmetic enhancements, the most common of which were fillers. This is worrying not just for the mental health of our young people, but for their physical health, too. We do not expect something that we can easily and very legally get done in the comfort of our own home to be something that can blind us, but, shockingly, that is the case.
For those who are not familiar with fillers and with botox, let me explain: fillers are gel-like substances that can be injected into the lips or the face to add volume and plump the skin. Temporary fillers last eight to 16 months, and there are permanent fillers as well, which have an increased risk of complication. There are currently no restrictions on who can inject fillers into the face. Botulinum toxin, more commonly known as botox, is injected into the skin to smooth lines and wrinkles, and it is not hard to understand the attraction of that. It is a prescription-only medicine, but doctors can delegate responsibility for injecting the botox to anyone at all with no qualifications.
Botox and fillers can be incredibly dangerous. Complications can include, but are not limited to, blindness, breathing difficulties—if it is injected into the neck—infection and the filler moving away from the intended treatment area into other areas of the face. Many people, mainly women, have been left with rotting tissue, lip amputations and lumps. I remind the House that, if any of these complications occurs, the practitioner injecting the substance needs to have no medical training whatsoever, so neither will they be able to deal with the potential complications, nor are they required to have insurance, so they do not have to pay for the very expensive cosmetic surgery that may be required to fix the problem.
Dr Luke Evans (Bosworth) (Con)
Does my hon. Friend therefore feel that, when people do run into these problems, the NHS will have to pick up the tab?
Laura Trott
My hon. Friend makes an excellent point. It is the NHS that has to pick up the bill for these problems, but it is not the NHS that will always pay for cosmetic surgery to fix them, so young people can be left with lifelong scars as a result of their surgeries, so he raises an excellent point.
The worst of it is that these risks are not theoretical or rare. I stress that this is an unregulated area, so instances of severe complications are not formally documented. However, thanks to brilliant campaigns by many Members of this House, the campaigning organisation, Save Face, and investigations carried out in the media, horrific stories have come to light. There were more than 1,600 complaints to Save Face last year, and it is estimated that 200 people have gone blind following these treatments, but it is the cases of the under-18s that have really stuck with me.
It is worth dwelling on a specific case study, which is representative of the countless stories I have heard. An under-18 female, who I will not name, booked a lip filler treatment after seeing a social media post promoting a discount. When she arrived at the clinic, she applied numbing cream herself to her lips. She was not asked her name. She was not asked details of her medical history. She was not even told what product was being used. She was not told of any possible side-effects. She was not consulted.
The treatment itself took less than 10 minutes. On completion, she was hurried out to pay the final balance. A few days later, she was experiencing significant pain and loss of sensation on the left side of her face. She contacted the person who treated her. She was ignored. Her symptoms became worse. She contacted her GP. She was told she should go and see another practitioner. When she eventually found a reputable local aesthetic healthcare professional, she reviewed her lips and concluded that the filler was compromising the blood flow to the tissue. She nearly lost her lips. This is an under-18 girl who nearly lost her lips through a procedure freely advertised and legally administered with no warnings or regulation whatever. Sadly, that example is not rare enough.
At the opening session of the all-party parliamentary group on beauty, aesthetics and wellbeing’s inquiry into the sector, Rachel Knappier appeared. She suffered from a botched filler, injected by a practitioner without any medical training, which resulted in her needing critical care. She told the APPG that there is
“nowhere for these people to turn to”
when things go wrong. She continued:
“Cheap adverts on social platforms are encouraging young impressionable people to seek an instant change to their appearance…to seek what is portrayed as the image of perfection.”
I could expound at length on the historical lack of oversight on women’s health issues. From PIP breast implants to vaginal mesh, we have simply not seen enough focus on these important issues by Governments over decades. This is a private Member’s Bill, however, and is necessarily limited in scope. I am pleased that the current Minister for Patient Safety, Mental Health and Suicide Prevention and her predecessor, my hon. Friend the Member for Thurrock (Jackie Doyle-Price), have started to change the trend.
James Cartlidge (South Suffolk) (Con)
My hon. Friend is making a brilliant speech. She is talking about the scope of the Bill, but will she clarify something? It is not clear to me whether it covers England, or England and Wales or the whole of mainland Great Britain.
Laura Trott
I thank my hon. Friend for his intervention. The scope of the Bill is England. It focuses specifically on the lack of protections for under-18s. The absence of a legal age limit for botox and for dermal fillers means that any 15-year-old could walk into a shop and get their lips injected by someone with no qualifications whatever. Despite the proven health risks and implications for psychological wellbeing, young people can legally access invasive cosmetic procedures on the commercial market or in their homes without any requirement for a medical or psychological assessment. Unregulated practitioners are not required to hold insurance and may not have the medical knowledge to manage complications. That cannot be allowed to continue.
The case for change is absolute. It is unacceptable that we allow children to be exposed to life-changing risky procedures with little to no regulation. My Bill would criminalise the administering in England of botox injections and cosmetic fillers to people under the age of 18. There are cases where medical conditions may require such treatment, such as migraines. These treatments could continue if carried out in accordance with the directions of a doctor. However, we must take action to bring fillers and botox procedures in line with other body modifications that carry similar health risks, such as tattoos. The Bill would impose a duty on businesses to ensure that they do not arrange or perform these procedures on under-18s unless approved by a doctor. We can no longer allow the unscrupulous actions of some people to impact on our children’s lives, and those administering the procedures must be held accountable. The most frequent reaction I have received in response to my Bill is, “Surely, that is illegal already.” I join in that disbelief, and this House must now put it right.
James Cartlidge (South Suffolk) (Con)
I am slightly surprised to be called so early when my hon. Friend the Member for Christchurch (Sir Christopher Chope) was ahead of me on the call list.
Mr Speaker
He may have been ahead, but if he is not here, you are certainly the winner!
James Cartlidge
The Bill is about fillers, and we could have had a filibuster—you never know.
I congratulate my hon. Friend the Member for Sevenoaks (Laura Trott) on her brilliant speech. This Bill is clearly well justified. She set out the scope of it and the key powers in it, and she has done herself immense credit.
I need to declare an interest. For many years, I have benefited from an artificial enhancement to my appearance. It may not be obvious to most people in the room, and before the speculation starts, it is not botox. It is made of something called hydrogels. I am, of course, referring to my contact lenses.
The point is a serious one. It is a good feature of the Bill that it will still be legal for children to have botox treatments where it is necessary for medical surgery. We talk about “enhanced appearance”. In my case, if I did not wear my lenses, whatever it did to my appearance, it would certainly affect everyone else’s, because my prescription is minus 7.5 in the left eye and minus 9 in the right eye, and I have a strong astigmatism. Without my lenses or glasses, I would not be able to see anything. I had glasses in secondary school that were so thick, it was like someone had attached two pint glasses to my head. When I got contact lenses, it helped with sport and many other things, and it gave a huge boost to my self-confidence and self-esteem. I will not comment on whatever it did to my appearance, because that is not the point. I understand and empathise with those who want to invest in procedures or enhancements that give them greater self-confidence about their appearance. It is an entirely reasonable thing to do, and millions of people do it up and down the country. I am not necessarily aware of the cases involving children, but many people use botox perfectly reasonably and are very happy with the results. It is a booming industry, and I suspect most procedures are successful.
As much as I welcome the Bill and believe that my hon. Friend the Member for Sevenoaks made a good case, we on the Government Benches in particular—there are not many on the Opposition Benches—should, by default, take the devil’s advocate position with respect to any regulation that will restrict what people can do, no matter how worthy. I feel I have to do that, given that my hon. Friend the Member for Christchurch, who was supposed to speak before me, probably would have examined that position in some detail.
These are heavily regulated times. I have a table booked in a restaurant in my constituency on Sunday for the six members of my family. Because Essex has gone into tier 2, I got a phone call to ask whether any of us are from Essex. At a time when we are regulating every aspect of daily life—which, of course, is for reasons beyond our control, because of covid—we must be extra careful in examining the case for all new regulations, even if it is morally very strong.
Anthony Mangnall (Totnes) (Con)
I thank my hon. Friend for the point he is making, because I agree that too much regulation could be a problem. This ties in with the ten-minute rule Bill presented a few weeks ago by my hon. Friend the Member for Bosworth (Dr Evans) about the impact of social media on people’s image. Does he agree that we must educate people about their image, how it is perceived and what social media companies are doing around that, so that we do not necessarily have to implement regulation all the time?
James Cartlidge
My hon. Friend makes an extremely good point, and that is, in many ways, what I am driving at. There is always a balance between whether we regulate and restrict or trust people’s judgment. There will even be people aged 16 or 17 who consider surgical enhancement procedures and are very rational and do not suffer from any form of mental health issues or self-confidence issues, for whom this sort of procedure would result in a satisfactory outcome. We have to remember that. The question in regulating is the traditional one of whether the benefit in protection of the vulnerable minority—we assume it is a minority; statistics are hard to come by—is worth while, given the impact it may have on a greater number who may not need that regulation but will now have a freedom stifled. That is the old chestnut.
I have heard what my hon. Friend the Member for Sevenoaks said—I thought it was a very good speech—and I have read all the notes and a lot of the research on the internet, and I am of the view that, definitively, this is a very necessary and justified Bill. It is necessary for the state to intervene and restrict the availability of these services, products and interventions for young people, because what outweighs the downside of regulating is the fact that we are protecting vulnerable people from an outcome that—in some cases, if not many cases—can be terrible or disfiguring, and they can go on to regret it for years to come, potentially at great expense. On that basis, it is certainly justified.
It is particularly justified in the context of children’s mental health, which I feel very strongly about. I have the Adjournment debate today on a very tragic suicide in my constituency. It reminds me that one of the very first traumatic constituency cases I had to deal with related to a young lady’s self-awareness issues—basically, an eating disorder—and although it was not fatal, there was an attempted suicide. It was a terrible case, and it really opened my eyes as a new MP to the issue of eating disorders.
Since then, I have had the pleasure to engage with the charity Beat. Its local spokesperson in my constituency is Laura Shah, an absolutely wonderful lady, who has explained the issues to me. In fact, given that my hon. Friend the Minister will be speaking later, I should put on record—he may not want to say this because of his naturally humble outlook—that he was once the parliamentary champion for the Beat charity, and he got its parliamentarian of the year award. I say that because I know he would not volunteer it himself. That is a noble achievement because it is a very good charity, and it underlines the fact that there are wider issues.
The other point—my hon. Friend the Member for Totnes (Anthony Mangnall) intervened on me about this—is about social media. I am profoundly worried about social media, its impact on young people and our inability to regulate it. It is not a failing; it is very difficult to regulate the sharing of media and the enhancement of media. Of course, we can imagine young people going to a practitioner to receive such surgery based on an image they have seen where the person has not actually had it, but has simply been artificially enhanced digitally.
Duncan Baker (North Norfolk) (Con)
My hon. Friend is talking about social media. I am a father to two young, good-looking, blonde-haired, blue-eyed girls—their looks come entirely from their mother. During lockdown, as I think every parent here would agree, our children probably watched far too much social media and YouTube content. My children watch hairdressing videos from America—something my hon. Friend would appreciate given his fine locks during lockdown. The serious point is that the content they are fed about what they should look like and what their body image should be should worry all parents. I warmly welcome the Bill brought forward by my hon. Friend the Member for Sevenoaks (Laura Trott), because it is so important that young people get to understand that they should have confidence whatever they look like. I warmly welcome what has been put forward today.
James Cartlidge
My hon. Friend is absolutely right. On my hairdressing expertise, all I will say is that I really am from Barnet. In fact, I used to live in New Barnet, and for some reason the hairdressers’ I used to go to in New Barnet was not called New Barnet Hairdressers. I never quite understood that one. He makes a very good extremely point. By the way, I think he is looking extremely dashing today, and he should not put himself down. I am sure his input into the beauty of his children was fair and proportionate—[Interruption]—yes, for Norfolk genes! [Hon. Members: “Move on!”] I will sit down now—but I am just going to say that there is a serious point here about social media and how on earth we regulate it, but here is the key: what we are talking about today is something that occurs in the physical world. These treatments are out there and are tangible, and we can and should regulate them for children.
I will finish with one important point. I asked my hon. Friend the Member for Sevenoaks about the issue of territorial application. This Bill covers England, as far as I am aware, although it does refer in the detailed clauses to the other parts of the United Kingdom. That obviously raises a question about people who, if it is illegal in England, might cross the border into Wales or Scotland, especially if they live nearby, and still receive these treatments. It would be interesting to hear from the Minister what expectation he has of these regulations being matched in the devolved Assemblies, because that could be an issue. Whether it would happen illegally anyway, even if we banned it, is another question, but if it is legitimate in other parts of United Kingdom but not in England, there is a potential issue we should think about. I am happy to wind up there, because I think this is a very good Bill and I will be supporting it today.
Jane Stevenson (Wolverhampton North East) (Con)
It is a pleasure to follow my hon. Friend the Member for South Suffolk (James Cartlidge), who spoke so passionately about children’s mental health, which is at the core of the Bill. I thank my hon. Friend the Member for Sevenoaks (Laura Trott) and congratulate her on bringing this really important Bill to the House.
The use of botulinum toxin and dermal fillers has become big business over recent years. These non-surgical procedures are now a £2.75 billion industry in the UK. They started out as a subtle way to knock a few years off and to look a bit younger, but in recent years they have been used to a much greater extent and to achieve a much more obvious cosmetic effect. They can be used to change the shape of facial features—to disguise a bump on someone’s nose, to redefine their jawline, or to plump up their cheeks or their lips. They are becoming incredibly popular.
We live in an age when everyone has a video camera in their pocket and our daily lives are shared on social media and broadcast on such a wide range of social media channels. Magazines bombard us with airbrushed images of celebrities. I know that my hon. Friend the Member for Bosworth (Dr Evans) seeks to require doctored images to be clearly labelled on social media, but sadly, at the moment, our young people look at very unrealistic images.
Dr Luke Evans
Does my hon. Friend agree that the problem with images online, especially if they are doctored in their proportions, is that they create an unrealistic aesthetic that is unachievable in real life? That is the problem with social media versus aesthetics in the real world.
Jane Stevenson
I absolutely agree, and I commend my hon. Friend for his work in this area.
I am thankful that in my early teenage years, I did not have to face the kinds of pressures that young people today have to face. I have concern for my two goddaughters, Lily and Eve, who are in their early teens, growing up with these constant pressures to look a certain way that is unrealistic to achieve. Thankfully, my awful 1980s hairstyles in an attempt to look like Bananarama or the latest pop group, and my appalling dress sense of my early teens, are now a dim and distant memory—a very distant memory—but young people today know that images taken of them every day will live online for their whole lives.
Our teenage years are challenging enough as we grow up, and many young people are now turning to these treatments as a way to feel better about themselves or to copy the look of someone they admire. In my work in schools over a decade, I noticed that sixth-form girls were increasingly having eyelash treatments to lengthen their eyelashes, or fillers to make their lips plumper. It is incredibly sad. As my hon. Friend the Member for Sevenoaks said, no child needs botox or fillers. It is completely unrealistic.
Sadly, consumer protections have not kept up with the industry, and we hear some horror stories; my hon. Friend shared one a moment ago. When they are injected by people without medical training, these treatments are extremely dangerous. Many people seeking beauty treatment do not realise that botox is a prescription-only medicine that should be prescribed only after a face-to-face consultation and by a licensed prescriber.
Anthony Mangnall
My hon. Friend is making a very good point. She raises the issue that people treat botox as something trivial, and that there needs to be greater sincerity about people going through that procedure, putting aside whether it is necessary or for cosmetic reasons. Does she think that further steps need to be taken to make people more aware? This goes back to the point about education that I made in my intervention on my hon. Friend the Member for South Suffolk (James Cartlidge).
Jane Stevenson
Yes, I absolutely agree. People have to go into these treatments with full information so that they are giving informed consent, which, of course, under-18s cannot realistically give on such a serious matter.
The cost of these treatments is certainly not insignificant. A reputable, qualified, experienced practitioner can charge between £300 to £1,000 for botox treatments. Dermal fillers have a similar cost. The effects last about 12 months before they will need to be repeated. For most adults, those are significant amounts of money. For young people, the high cost leaves them seeking cheaper alternatives. They use non-healthcare professionals, sometimes hairdressers or beauticians, many of whom have trained for mere hours rather than several years.
In the wrong hands, these treatments frequently go wrong. The number of cases of botched jobs has doubled in the last year, from 616 cases in 2017-18 to 1,300 last year. There are, as we have heard, potential health risks, including blindness, tissue necrosis, infection and scarring. There can also be a significant psychological impact when a treatment does not give the desired effect, or when it does not deliver the desired boost in self-confidence. I think that that is at the root of the mental health point.
Dr Luke Evans
Does my hon. Friend agree that when complications happen, particularly when someone does not feel their aspirations have been achieved, that creates a vicious cycle, because the temptation to go back and have yet another procedure means that they are entwined in associating the procedure with their body image and the negative effect that can have?
Jane Stevenson
Absolutely. I completely concur. We see that in the treatments becoming more obvious and lip fillers becoming bigger. We see girls with very unrealistic lip sizes these days, which is worrying.
I agree with my hon. Friend the Member for Sevenoaks that the industry needs more regulation. Certainly, we want the security that one can go to somebody who knows what they are doing, and has the insurance and the skill to correct a procedure that does not go to plan. The NHS should not be picking up cases where an obvious failure of skill has occurred.
Anthony Mangnall
My hon. Friend is again making an important point about ensuring that registered practitioners undertake these practices. Could she just add a few more points on whether she thinks a national register needs to be created, so that this cannot be practised by people who do not have the correct skills to be able to perform it?
Jane Stevenson
It certainly needs a lot more regulation. The Bill does not seek to impose that, but minimum training levels to inject someone’s face with a filler or with botox is certainly desirable. On insurance, that could be regulated, too. I am sure further legislation will appear.
Fay Jones (Brecon and Radnorshire) (Con)
I add my congratulations to my hon. Friend the Member for Sevenoaks (Laura Trott) on bringing the Bill forward. My hon. Friend the Member for Wolverhampton North East (Jane Stevenson) is making suggestions for further areas of regulation that could be looked at. Does she agree on the need for consultation when the process is carried out? I was staggered to read in the research by my hon. Friend the Member for Sevenoaks that almost 40% of the people who made a complaint said they had no consultation whatever. Does my hon. Friend agree that that needs to be addressed?
Jane Stevenson
I absolutely agree. As these treatments become more common, it becomes like getting a haircut or having your nails painted. It is something that people can do in their school lunch break or after school. It is really concerning that they are not taken seriously. People do not feel consulted and they certainly have not been made aware of the medical risks of these procedures.
In summing up, I absolutely support the Bill. The age limit of 18 seems entirely reasonable and aligns these treatments with other treatments that carry health risks, such as sunbed use, teeth whitening and tattooing. I commend my hon. Friend the Member for Sevenoaks for this thoughtful, sensible Bill that puts young people’s mental health at the heart of the matter. I am very happy to support the Bill.
Mr Speaker
Just a little information for the House. Sir Christopher is stuck in traffic, but he has sent news that he will be here for the next debate.
Simon Baynes (Clwyd South) (Con)
It is a pleasure to follow my hon. Friend the Member for Wolverhampton North East (Jane Stevenson), and I commend with heartfelt gratitude my hon. Friend the Member for Sevenoaks (Laura Trott) for bringing this private Member’s Bill to the House for Second Reading. I say with gratitude, because like my hon. Friend the Member for North Norfolk (Duncan Baker), who was with us before, I am the father of two daughters—they are aged 18 and 20. Fortunately, they have never had any personal experience of what we are discussing, but I and my wife have had considerable personal experience of learning about the world in which they live; many Government Members have referred to social media, which I will come back to. They live in a very difficult world with regard to body image, so I say as a father that the Bill from my hon. Friend the Member for Sevenoaks has even greater importance to me than I think it does to everybody else.
We discuss the Bill within a broader context, because the 2017 Conservative manifesto contained a commitment to ensure the effective registration and regulation of those performing cosmetic interventions. The Department of Health and Social Care has been working with stakeholders to explore the regulation of premises, practitioners, products and consumer safeguards, and that includes work to assess whether we have adequate safeguards and regulation of practitioners who perform some of the more invasive cosmetic procedures. The measures being explored would apply to all ages, so this Bill sits within the broader context of tightening up on these measures.
As my hon. Friend proposing the Bill said, it is wrong that practitioners do not need to be medically qualified to perform the procedures. In fact, it is quite extraordinary that we are in a situation where that is the case.
Fay Jones
I am sure that my hon. Friend will talk about this, but we have heard that there could be some geographical limitations to the Bill, in that it may not cover the devolved Administrations. As he does such a good job of representing his constituents in Wales, may I offer to work with him and the Minister to make sure that this is rolled out in Wales by the Welsh Government?
Simon Baynes
I thank my hon. Friend, and I could not agree more. As she rightly anticipates, that is a point that I am going to make and I think that it is extremely important, speaking as a Member for a border constituency, Clwyd South. The border between England and Wales is a major issue of discussion at the moment, but the borders are porous and it is vital that this exists on a similar basis on both sides of the border.
We have discussed in detail the potential health risks, and this was put extremely well by my hon. Friend the Member for Wolverhampton North East when she described this as potentially expensive botched jobs. The issue of expense is extremely important. The Bill is right to seek to prevent under-18s from accessing botox or dermal filler procedures for aesthetic reasons, and that goes to the heart of many of the problems that have been discussed by Save Face, and particularly by my hon. Friend the Member for Bosworth (Dr Evans)—I commend him for his campaign. Save Face manages a national register of accredited practitioners who provide non-surgical cosmetic treatments, and it is extremely important that we back up its campaign. It campaigns for high standards of practice, knowledge and training to ensure that patients do not have to compromise on safety or aesthetic outcomes. Its director, Ashton Collins, said on BBC News:
“Some of these girls have been…hours away from having parts of their face surgically removed, which is not only physically traumatic, but”
has a
“mental health aspect…as well”.
I think that this is a very important point.
Dr Luke Evans
My hon. Friend mentions the impact on girls, but would he also consider the impact for many men? The cosmetic industry for men is growing, as is the use of steroids to try to bulk up for the gym. That fits in with botox being one of the choices that young men are looking to as well. Does he agree that there is a danger in the debate that if we concentrate so much on women, we forget about men?
Simon Baynes
I could not agree more with my hon. Friend. That is an extremely important point. As he rightly says, the body image consciousness of young men is also an area that leads to great vulnerability. Of course, it is an area where people would expect there not to be the same degree of vulnerability, because they are young men and strong and everything else, but it is an area of great importance. It goes back to my original point, which was about setting discussion of the Bill within a broader context of cosmetic interventions and other aspects that I think are dangerous for people.
Anthony Mangnall
It has always struck me as particularly worrying when adverts say that 50% or 80% of people say that something is successful, but with only a very small dataset. That is happening across adverts on daytime television and in a whole load of other situations. I know that it is also happening in this sector. I am interested in whether my hon. Friend has any further thoughts on how we might be able to combat that. If datasets are to be used in persuading people to take up a product or to have a surgical procedure, those datasets must be comprehensive.
Simon Baynes
I strongly agree with my hon. Friend on that score. One of the aspects of this discussion that has been extremely pertinent is the need for consultation. It really seems to me extraordinary that people can undergo such procedures without proper consultation—a point made very eloquently by my hon. Friend the Member for Wolverhampton North East. If someone has proper consultation, they have to refer to the data, as my hon. Friend the Member for Totnes says, and then the procedures start to take place within a structured, controlled environment.
Suzanne Webb (Stourbridge) (Con)
Does my hon. Friend agree that one of the problems is that people see these procedures as beauty treatments, when in fact they are medical procedures that bring risks and consequences?
Simon Baynes
Yes. I thank my hon. Friend for that intervention. Again, I go back to the point I made at the beginning. As the father of two young daughters, I see the world that they have to inhabit in terms of social media—and inhabit it they do, because it takes up a lot of their life, particularly, as was mentioned earlier, within the context of lockdown, where their ability to see their friends and family is very limited. The whole world of social media has become much more prevalent, so there is a dichotomy between the desire to have the perfect body and the perfect face and what is a very dangerous and difficult intervention. The fact that these interventions have been hitherto unregulated seems quite extraordinary when we actually sit down and read about them, or discuss them in the Chamber.
Another point that has been made is the cost to the NHS of unpicking these problems. The Bill is therefore very important not only in regulating the procedures, but in leading to less work for the NHS when they have gone wrong.
Dr Luke Evans
That is a really important point about accountability. Does my hon. Friend feel it is right that the NHS becomes the carer of last resort?
Simon Baynes
I agree with the point that my hon. Friend is making. The NHS is of course, in a sense, the carer of last resort, and I do not want to say the wrong thing within that context, but it is not right that the NHS should have to pick up the pieces from dangerous procedures that take place within an unregulated environment for young people. If that is the point that he is making, I fully agree with it.
It is also important that these procedures will remain available where there is an assessed medical need, and when provided by a registered health professional. The regulation of businesses will be enforced by local authorities, as I understand it, which will help to keep children safe in these procedures. Often local authorities have a very close understanding of what is going on within their community. We have touched on the fact that the growth in non-surgical treatments increases the need for consumer protection. It is important to work with stakeholders to strengthen the regulation of cosmetic procedures in general. We have touched on that point, but it is important. As has been said, it is also vital that we do everything we can to protect the mental health of children and young people, including through promoting body positivity. We have discussed that at some length, but I cannot stress enough, from my own personal experience of that young age group, how promoting body positivity is desperately important.
Finally, these regulations will help to raise awareness of the impact of botox and dermal filler procedures among all age groups. That is important because if parents and grandparents understand better the dangers of these procedures, they will be able to give meaningful advice to their children or grandchildren. In conclusion, I again congratulate my hon. Friend the Member for Sevenoaks on bringing this Bill to the House. It has my full and heartfelt support.
Claire Coutinho (East Surrey) (Con)
I thank my hon. Friend the Member for Sevenoaks (Laura Trott) for bringing forward this important Bill. I am privileged to have her as a geographical neighbour and friend. I know that her background, particularly in education policy, and now from serving on the Select Committee on Health and Social Care, means she is always focused on the wellbeing of young people, and I see that shine through in her work here.
As a child, even in the kindest possible terms I would have been described as “unfortunate”. My hon. Friend the Member for South Suffolk (James Cartlidge) talked about his minus 7 eyesight, but I can raise that—to minus 11. My bottle glass glasses that I had by the age of five were surrounded by very fetching plastic rainbow frames. I accompanied them with a pudding bowl haircut and a dress sense that was “interesting”, to say the least. But as a child I did not have to contend with social media, and I seriously worry about young people now having to do so. I am lucky that the photographs of me during that period are not online and not widely shared, and I do not have to contend with facing up to some of the shortcomings of my appearance.
Sally-Ann Hart (Hastings and Rye) (Con)
I have not seen those photos, but I am sure they are beautiful, because every child is gorgeous. Does my hon. Friend agree that for any child to think that they need to have botox or cosmetic procedures is so wrong and so sad, and it is an indictment of the society we find ourselves in today?
Claire Coutinho
I thank my hon. Friend for that point, because it is the crucial one. Growing up not having to contend with social media, I did not focus on these things—I did not think about them. I loved maths and reading, and I rarely thought about the way I looked, but that is not so for the children of the current generation.
Anthony Mangnall
We are, in one respect, the last generation to have lived in a time without social media. We recognise the difference between before and after social media, so we at least have a sense of depth and perspective about the impact it has on our life. Does my hon. Friend accept that there is a rapidly increasing problem of people going on to social media at such a young age and that not understanding a world without it is going to have much longer implications down the line?
Claire Coutinho
My hon. Friend makes an excellent point. The long-lasting implications do not just relate to the way people feel about the way they look; there is a wider sense of anxiety about their social connections and their sense of self-esteem, so that point is well made.
Last week, I was happy to visit a wonderful school in Lingfield in my constituency, where I spoke to a bunch of 10 and 11-year-olds. They asked fantastic questions, about not only my work in Parliament, but everything ranging from where I might go if I had a flying car to my favourite book characters.
Claire Coutinho
Well, I thought I would quite like to go to Antarctica. I was told that it would be rather cold, so I said I would wear a very big jumper. It struck me when I was looking at those children that in a couple of years’ time, when they are 13 or 14, the questions might be slightly different. Women in the House will recognise the questioning that we have all experienced, which is sometimes very personal to our looks, our diet, our wardrobe and how we get ready in the morning. That focus on how we look, which seeps into our thinking as we grow older, is unfortunate and sad.
Jane Stevenson
Does my hon. Friend agree that many magazines and newspapers perpetuate that by attacking Members in the House as well as other people in the public eye? Young people see that as something important. Does she also agree that building children’s confidence, through a range of methods, about the fact that they are good at several things—it is not all about how they look—is incredibly important?
Claire Coutinho
I completely agree with my hon. Friend. It is worrying when our sense of self-worth relies on the way we look, so what she suggests is welcome.
Simon Baynes
Going back to the point made by my hon. Friend the Member for Bosworth (Dr Evans), not only is this an issue about how people look but the fact that the look can be changed on social media. There is double trouble: it is how someone looks, and there are other people who are altering images falsely or superficially, which is something that we should bear in mind.
Claire Coutinho
That is a really important point, because when people undergo these medical procedures sometimes the look that they are trying to achieve is a lie, because they are using filters and other social media applications. When someone has filler in their face they do not look like the filter shows them they might look.
Dr Luke Evans
On the subject of social media filters, is my hon. Friend aware of evidence from Girlguiding that three quarters of young girls will not consider posting an image without it being doctored? What impact does she think that has on perpetuating the cycle of bad body image?
Claire Coutinho
I was not aware of that fact, but it is a truly horrific statistic. We should all consider carefully what it might mean for our young people if they feel that lack of confidence in their own personal image. It is incredibly sad, and very much feeds into this debate.
It is commendable that the Bill tackles the risks that could affect people if they are given fillers by a medical practitioner who is unregulated. We heard from my hon. Friend the Member for Sevenoaks about a young lady who might have lost her lips. The risk of scarring, nerve damage and, in some cases, blindness has not been conveyed to people who are trying to access these procedures. I would therefore welcome a regulated sector.
David Johnston (Wantage) (Con)
Is my hon. Friend aware that during lockdown, although clinics were supposed to be closed, Save Face received 179 complaints—
Madam Deputy Speaker (Dame Eleanor Laing)
Order. As a matter of course, the hon. Gentleman must not face the hon. Member for East Surrey (Claire Coutinho) when he is speaking. He has to face the Chair. [Interruption.] Ah, now I can see who he is.
David Johnston
Is my hon. Friend aware that during lockdown, although clinics were supposed to be closed, Save Face received 179 complaints from people who had undergone procedures, 80 of which were about illicit, botched procedures that resulted in swelling, bruising and uneven lips. Does she agree that that underlines the problems in the industry and why it needs more regulation?
Claire Coutinho
That exactly underlines why this industry needs more regulation. We need to be worried not just about the potential for physical scarring but about the financial risk. A couple of Members have touched on the practitioners’ lack of insurance, which I hope can be considered when we introduce regulations. Their lack of public liability insurance means that the consumer often bears the financial risk of anything that goes wrong.
James Cartlidge
To go back to the point that my hon. Friend the Member for Bosworth (Dr Evans) made, having insurance in place might remove some of the cost that is falling on the NHS and therefore on the Exchequer.
Claire Coutinho
That is an excellent point.
We should not be allowing our young people to face these risks—not only the medical and financial risk, but the psychological risk. It is damaging for a person to go for a cosmetic procedure that they think will fundamentally change their life and then for something to go wrong or for them to realise that that was not the thing that was going to make them happy in the first place. I am very happy that we will hopefully be able to address all those things through this Bill.
There are medical procedures that young people need, such as cosmetic procedures because they have some sort of facial disfigurement, for example, or procedures for migraines, bladder dysfunction, face and eyelid twitching or excessive sweating. They would still be allowed under this Bill, so no one should be worried that they would not be able to get the medical help they need.
Returning to the point about social media, we have all seen the deeply worrying statistics showing how the young people of our age are different from our generation, when we were young. Young people now are more anxious and depressed and have a lower sense of self-worth, and that starts in their early teens because of how social media helps them to see themselves and their standing in the world. The availability of these procedures, particularly if they are unregulated, will make people question themselves more and think, “Maybe I should go and make a change. Maybe I should change my face, my jawline, my nose, my lips.” The ability to access unregulated procedures almost forces the question in a very damaging way.
People have talked about the effect on boys and girls—both sexes undergo these procedures. The unrealistic images on social media lead to a very damaging cycle by setting up a view of beauty that boys take on and girls then want to live up to. I have seen the results of scientific experiments in which young children are presented with a range of images and are asked which are the beautiful ones. They are now starting to pick out the ones that are cosmetically enhanced. That is incredibly damaging.
Anthony Mangnall
Hello, Madam Deputy Speaker. My hon. Friend is making a very important point. What does she think about the industry taking the appropriate steps to ensure that it is in tune with the thinking of this House and that, if the Government are going to pass legislation, it has a role to play in preventing people from having unrealistic images put in front of them?
Claire Coutinho
That is an excellent point.
I will finish on this point. We in this House should be looking not just at the provision of cosmetic procedures but at the use of social media and how it affects our young people and at the teaching of body and face positivity. We should be doing that in all our schools with all our young people to tackle the issue at the root. I am very happy to support this Bill.
Dr Luke Evans (Bosworth) (Con)
This Friday is a day of joy for me for so many reasons. First, I had my point of order corrected—that is a learning point. Secondly, I am following my hon. Friend the Member for East Surrey (Claire Coutinho), who spoke eloquently. Thirdly, this is the first time since being elected that I am able to speak in this House with no time limit, and I am thoroughly looking forward to it. Fourthly, and through gritted teeth, I have to give credit to my hon. Friend the Member for Sevenoaks (Laura Trott), because I would have brought forward this private Member’s Bill should I have been lucky enough to have been selected in the ballot.
Since entering the House, I have seen, through my work on the Health and Social Care Committee and through many conversations with my hon. Friend, that she is dedicated, thoughtful and absolutely tenacious in getting this Bill through, and rightly so. The Bill is really important and has my full support.
We need to be careful in this debate not to demonise botox and fillers, because they are not the problem. We must remember that they have a use in medicine. As has already been hinted at, botox can be used for migraines, for excessive sweating and to relieve pain by numbing the nerve and stopping the nerve from working. That is why it stops wrinkles, because if it is used in a nerve, that part of the face cannot be innervated, so not so many wrinkles are created.
Fillers have a place as well. My hon. Friend the Member for East Surrey hinted at scarring, but they can also be used for acne. Hyaluronic acid, in the right place at the right time, is really important. We should also make distinctions when we talk about these products. Botox is time-limited and wears off, but with fillers it is a mixture depending on what is used and how it is used. Part of the problem is that often people do not know what kind of filler is going into their face.
My hon. Friend the Member for South Suffolk (James Cartlidge) talked about aspiration and I agree with him. There is a place for these products where people want to improve their body. Countless studies show that plastic surgery or interventions on an aesthetic basis can indeed give long-lasting happiness. Take the example of someone who has their nose corrected or a bump taken out: that can have a devastating effect if it is not dealt with and a really positive one if it is. We must therefore be very careful in this debate to ensure that people can get support when they want it and it is appropriate. A big part of the problem is that we get into this vicious cycle of people thinking incorrectly that having a correction will somehow deal with a flaw that is actually deeper in themselves, be it misplaced anxiety or depression.
Suzanne Webb
Does my hon. Friend think that we need to talk about body positivity, starting in schools and colleges, to ensure that people do not feel the need for treatments such as botox? People are trying to go for an unattainable image, and that is of great concern. They can never ever be that person, because the image is doctored by photoshopping or by an injection that paralyses the face and takes away all its natural features. I very much feel that the debate should start with body positivity, and that starts with a family in their house and in schools.
Sally-Ann Hart
My hon. Friend is talking about positive body image. For young people, rhinoplasty and perhaps breast reduction can be to do with a lack of confidence, which may be hindering their ability to get on with their lives. Does my hon. Friend agree, as a medic yourself, that in some cases it is necessary for young people to have serious cosmetic surgery not because of aesthetic reasons but because of an impact on their mental health?
Madam Deputy Speaker (Dame Eleanor Laing)
Order. Just before the hon. Gentleman answers that point, let me explain something. I am using this morning as a sort of tutorial on how the Chamber ought to be run. As the hon. Gentleman said, this is the first time he has been able to speak without a time limit, and I try not to interrupt when we are under pressure with time limits. The hon. Member for Hastings and Rye (Sally-Ann Hart) cannot say “yourself” to the hon. Gentleman, because in that she is addressing not the hon. Gentleman but the Chair—not even the person in the Chair but the Chair. That is a really important principle, and we do not want it to be lost in these unusual times.
Dr Evans
Thank you, Madam Deputy Speaker.
I absolutely agree with my hon. Friend. The differentiation between medical and aesthetic is really important. This is all about accountability, which is the key part of the Bill. There are the good uses that we have talked about, but there are complications as well. Unfortunately, in my practice I have seen those complications. I have had patients come to me who have had botox, and it has created an asymmetry in the face. Fortunately, it lasts only for six months, but that is a long time to sit with a face that a person is not happy with. More concerningly, I have seen patients who have come in with lip fillers that have gone wrong. The lesser side is the bruising and swelling, which will usually go after the first two weeks, but fillers can also become clumpy, with uneven lumps and bumps within the lips. Worse still, I have seen necrosis, which is dying of the tissue, where the lip filler starts to come out. That is absolutely devastating for the person suffering, and there is no accountability or anything to allow them to find out how to get that corrected.
Jane Stevenson
Does my hon. Friend agree that any cosmetic treatment, whether non-surgical or simple beauty treatments such as eyelashes being permanently bonded to the face, carries a medical risk? Does he agree that any procedure with medical risks should involve a detailed consultation and a form of consent?
Saqib Bhatti (Meriden) (Con)
I understand that my hon. Friend has an extensive background in the medical field. From his experience, does he think that there are enough tools in place in education and in the home to help children feel the confidence they need to deal with the challenges of social media and such pressures?
Dr Evans
I am grateful to my hon. Friend for pointing that out. He is absolutely right. The Bill and the medical profession cannot deal with this alone; it is a wider, societal problem. As Members have already hinted at, we are aware of that and it is incumbent on us as parents and in whatever other role we come into contact with young people to try to nurture them and take them through. They can aspire to a healthy image of themselves through eating well, exercising and interacting with other humans. That is what humans do, and we should aspire to do that through education, both in educational settings in the home and through contact with the medical profession.
I see the Bill as a step-wise piece of legislation. Both my hon. Friend the Member for South Suffolk and my hon. Friend the Member for Totnes (Anthony Mangnall)—I am pleased to see that he has remained in his seat, as I half expected him to pop up on the other side of the House or further down the Bench. It seems a little harsh to say “Where’s Wally?” at this stage, so I will not. Both my hon. Friends hinted at a really important point, which is the crux of the matter. Indeed, my hon. Friend the Member for Sevenoaks mentioned it in her speech and it needs to be highlighted. This is about accountability. That is the crucial part of any decision.
I want to break that point down into three areas: practitioners, businesses and patients. When someone goes to see a practitioner, they need to know that they are qualified in what they do, that they can deliver it to a high standard and that, if something goes wrong, they can be held to account. At the moment, the industry is unregulated, and that is a real problem which means that the NHS becomes the carer of last resort.
Businesses have a responsibility as regards promotion. They should be held accountable when they put undue pressure on people who are unsure or exploring what they want to find out about the industry. That goes for adults as well as for young people under the age of 18. When businesses are set up, there should be some form of redress should they not perform to the expected standards. After all, let us think what would happen if we had unregulated operations. If someone needs to have a cyst removed, we do not allow them to walk in off the street and have it taken out by someone with no accountability or training. The principle is the same. The only difference is that rather than something being taken out, something is being put in. It is a big concern for me.
Anthony Mangnall
My hon. Friend is making an important point. I wonder how he envisages the practicality of creating a register of all the businesses that currently practise in this area. Given his medical insight, I would be interested to hear how that might work.
Dr Evans
I thank my hon. Friend for raising that point. I believe the industry has put in place a voluntary sign-up for standards. The point was made earlier—I am sorry, but I forget who by—that the industry itself is asking for regulation to be put in place, because it understands that good practitioners are very good at doing these procedures safely and wisely. We want to encourage businesses to take responsibility for putting standards in place.
Jane Stevenson
Does my hon. Friend agree that another serious concern is that less scrupulous practitioners will not use a light touch and seek a cosmetic improvement, but will seek to upsell and invite people to have more and more procedures in the name of making more money?
Dr Evans
Absolutely. My hon. Friend points out something worrying: if someone is vulnerable in the first place when they go for a procedure, unsure about why they are there, and is coerced into taking some further measure, that is a concern. It leads into a vicious cycle of returning again and again for an update on something that may never be achieved.
All that leads on to the idea of consent, which is really important for both patients and practitioners. We need to make sure that when someone goes for a procedure it is fully explained to them what the procedure is, why they are having it and what the consequences are, including the short-term and long-term complications. If someone goes to theatre to have an operation, it is spelled out to them. They have to sign a declaration to say that they understand it, and they and the person carrying out the operation are held accountable to that standard. That is really important. Sadly, that accountability is lacking, particularly in respect of fillers. That is the concern, because it leads to a variation in standards, an unregulated industry and the horrific cases that my hon. Friend the Member for Sevenoaks highlighted.
All that I have described applies to adults, but of course we are talking about under-18s. It is really important to make the point that this is about drawing these procedures into line. We already have statutory regulations that say that a person cannot have a tattoo until they are 18. The Bill would simply bring into line an industry that is burgeoning and blooming. That is the important point.
This is about protection, accountability and, most importantly, choice. We should encourage those who want to go ahead for the right reasons to have the right procedure done in the right way, and held to account in the right way. We need to protect, nurture and educate those under the age of 18 and allow them to make the decision when they become 18.
Anthony Mangnall (Totnes) (Con)
It is a pleasure to speak in this debate. I congratulate my hon. Friend the Member for Sevenoaks (Laura Trott). She is a fantastic champion on this issue and her constituents should feel incredibly proud of what she is doing today. I should add that this Bill complements the ten-minute rule Bill introduced by my hon. Friend the Member for Bosworth (Dr Evans) not so long ago.
I hope to address a whole host of things in the course of this debate, but I shall start by reflecting on some of the words that Members have already spoken. My hon. Friend the Member for South Suffolk (James Cartlidge) spoke incredibly powerfully about the need not to over-regulate, and to encourage education throughout schools, through the media and, perhaps more importantly, through social media. We cannot make that point too strongly. It is a necessity in this modern day and age, when social media is at the fingertips of every schoolchild and, indeed, every adult. We need to be able to engage the industry and the sector to inform and help the debate along, to make sure that people’s view of their body image is a positive one, not one that constantly and continually needs change.
Dr Luke Evans
My hon. Friend talks about education. Indeed, should a person be curious about going ahead with these procedures, is it not right that the extent of what may well happen to them should be fully explained so that, when they go into that consultation, they can make that decision with the full unfettered knowledge of what may proceed?
Anthony Mangnall
Absolutely. I hope that that can be done from a professional point of view. I also hope that Members of Parliament, who have learned from this debate, can go into schools to discuss this issue and the outcomes of the Bill, which I hope very much will pass its Second Reading later today. As the hon. Member for Strangford (Jim Shannon) is not in his place, I will try to make many interventions on this point as well, because it is such an important issue.
My hon. Friend the Member for Wolverhampton North East (Jane Stevenson) also talked about the need for regulation and for comprehensive documentation on those practitioners, which is really important. We know that a huge number of practices that currently perform this procedure are not regulated and are not on the books. People can too easily get access to these practices, so that needs to change. Perhaps a register should be brought forward to ensure that there is firm documentation and that we understand who is doing what and where.
My hon. Friend the Member for Clwyd South (Simon Baynes) talked about body image, and he talked about his two daughters. Although I am not a parent, or at least not that I know of, there is an important issue here: if parents can step in and educate their children on that role and join up with schools in making sure that there is a comprehensive, joined-up approach to tackling social media and tackling what newspapers and magazines are doing, that will be key to solving the issue. He very aptly talked about the idea of double trouble, and that is the point. As my hon. Friend the Member for East Surrey (Claire Coutinho) said, we are the last generation to experience a world without social media. Any generation that comes after us will have to put up with the constant impact of social media, and that is a significant problem.
Dr Luke Evans
One problem that has been hinted at, and it has been ever thus, is fashion and trends. A big complication that we have with cosmetic surgery, particularly with regard to the longer-term use of lip fillers, is that this may well be permanent. Therefore, a person may be featuring a fashionable trend that lasts, perhaps, six months, but, yet, 10 months down the line, they may be seen as somewhat unfashionable.
Anthony Mangnall
That is indeed the case. Importantly, we must not let this be a fad of the time. It has to be something that is thought out. If there is a medical reason for someone undergoing an operational procedure, that is absolutely correct, but we cannot let the whims of social media or the fad or the style of the day dictate how someone might end up living for the rest of their life.
Suzanne Webb
Although we talk about it possibly being a fad, is it not more important to consider the fact that we do not know the impact on these young adults of having botox at such an early age? There is also the fact that we should all just embrace our natural features. We will all age, and hopefully gracefully, but if people have botox at such an early age, we do not know the impact that that will have on that ageing process. What they may need in future times is more botox perhaps because of the damage they have done to their face.
Anthony Mangnall
I hope that my hon. Friend will take it as a compliment when I say that she is ageing beautifully.
Ms Lyn Brown (West Ham) (Lab)
I have sat through this debate and been a little discomforted by some of the remarks that have been made. I say that very gently. I support the hon. Member for Stourbridge (Suzanne Webb) in her gallant attempts to get an understanding in this Chamber that young women and young men are beautiful in who they are and not in what they have done to them. That is the message that we should be sending out. I know that I have aged wonderfully, so I do not need the hon. Gentleman to tell me so. May I just emphasise the hon. Lady’s words, as I completely and utterly agree with the position that she has been enunciating over the past 20 minutes?
Anthony Mangnall
I thank the hon. Lady for making that very important point, and I take her guidance incredibly sincerely. That brings me to the point made by my hon. Friends the Members for East Surrey and for Hastings and Rye (Sally-Ann Hart), which is that every child is beautiful and that body positivity as we grow up is incredibly important. We are not asking anybody to change their image. I thank the hon. Lady for her point; I am always happy to take guidance on how to perform in the Chamber.
The impact of social media is long lasting, and our newspapers and media have become more and more emboldened about it.
Simon Baynes
We should also consider the fact that social media can be put to good use in all this. We have talked at length about the difficulties of social media, but social media is also an extremely good method of putting a message across. When the Bill hopefully becomes law, social media will be a way to communicate the benefits of this legislation.
Anthony Mangnall
My hon. Friend is curiously prescient in his intervention. As chair of the all-party parliamentary group on the preventing sexual violence in conflict initiative, I have discussed with all the social media companies how we might engage them in helping to collate and document crimes against women and children across the world and to ensure that that leads to prosecutions. The response from Twitter, Instagram, Facebook and many other social media platforms has been universally positive. We need to build on that, because if we can do it on that issue, we can do it on this one. I hope that this legislation will be used as an effective tool, learning from the different areas in which this has been done already.
Dr Luke Evans
Through my work on body image, I have had meetings with Instagram and Facebook, and they are keen to point out that they want to promote positive images and are working hard to achieve that. One of the issues often talked about in terms of policing the digital sphere is how we identify this, particularly around social influencers. Social influencers have a really important role in this, and they are keen to point out that they already differentiate between organic content and content for commercial purposes. Does my hon. Friend agree that it is not pie in the sky to police honest advertising on social media when it comes to body image?
Anthony Mangnall
This goes back to the intervention that I made earlier about the datasets used by cosmetic companies on adverts. It is extraordinary to read that “80% of all women think this product works” when the dataset is only 105 people. That is not an acceptable way to market a product. It aims to change someone’s perception, using incredibly persuasive advertising techniques, with incredibly beautiful people and saying, “This works.” That is a misnomer, and it is very damaging. Many of us have spent a great deal of time watching television in lockdown, and it is a real problem for parents to see their children influenced in that way.
Claire Coutinho
On my hon. Friend’s point about there being little evidence on whether these procedures will be successful, does he agree that, by regulating, we could ensure that practitioners have insurance, in which case they might face a financial cost if the procedure does not go to plan?
Anthony Mangnall
That ties in succinctly with the point about enforcement for practices that are undertaking these procedures. That will be an important part of ensuring that those who offer these services are fully aware of the implications of breaking the law, when the Bill is hopefully passed.
My hon. Friend the Member for Bosworth used his extensive experience and medical insight to explain the value of the Bill and its implications, and I do not need to go over what he said. However, I would like to make a few points about why I support the Bill and am so pleased to speak in the debate. As we have heard today, the Bill will introduce parity with the age at which someone can get a tattoo. It makes sense to regulate and level up so that we are all equal at the age of 18 in terms of the procedures that we can get, so that no one at a younger, more susceptible age might be influenced by the fads of social media. I have spoken to many of my constituents about that. They are worried about the body image messaging sent out by the fashion houses of Paris, magazines, newspapers and social media, so I welcome the inclusion of that measure in the Bill.
Rob Butler (Aylesbury) (Con)
Does my hon. Friend agree that that point is reinforced by the fact that someone now has to be 18 to buy a packet of cigarettes? Someone has to be 18 to inhale something that is potentially toxic, but currently they can be injected with something toxic at a much younger age.
Anthony Mangnall
Absolutely, and one might say exactly the same about tattoos as well. Someone is at the time perhaps going for something that looks cool and is a fad, but then maybe 20 years down the line, it does not look quite as good as they thought it did. That brings me on to my second point, which is about the business offensive. It was just raised on the idea of insurance and how we make sure that we are encouraging those businesses undertaking these practices to do so in a serious and responsible manner. That is something that the Bill ably encourages those businesses to do, and I hope the Minister will comment on what regulation and what data or dataset can be created to ensure that everyone who is doing these practices is registered. I feel that is key and will help inform the debate and move it along.
Enforcement is always one of the biggest problems. We here in this Chamber can speak on a whole host of different issues and at length try to pass legislation, but how do we end up enforcing it? I note that the Bill seeks to amend schedule 5 to the Consumer Rights Act 2015, and I hope that is enough, but a few more words and a bit more understanding from the Minister and others about how we would enforce it, what immediate steps could be taken and where it would fall in line with other sentencing issues is something that I would find incredibly helpful and interesting.
In an age of social media, we are competing against ease of access, with everything at our fingertips. Everything can be bought from our smartphones or iPad tablets. When we propose such Bills, they must be accompanied with an education programme and a platform.
Sara Britcliffe (Hyndburn) (Con)
On education, we have spoken about younger people, but one thing I have experienced is the rebellious years of university. Students go to university and are on their own for the first time. Does my hon. Friend agree that universities need to be doing more to highlight the risks of these surgeries and tattoos, for example?
Anthony Mangnall
Absolutely. Any place of education has a role to play in the Bill. Again, we will make sure we are expressing that both now and in the future.
Social media has made things very easy and accessible for people. We should seek to address those issues, but we should also seek to reaffirm the fact that every individual is beautiful and born perfect. I commend my hon. Friend the Member for Sevenoaks for bringing this Bill before the House, and I will be very much supporting it.
Laura Farris (Newbury) (Con)
I, too, congratulate my hon. Friend the Member for Sevenoaks (Laura Trott) on bringing this Bill to the House, and it is a delight to speak in the debate this morning, because I recall talking to her about it in the very early days after we were elected. I am glad it is now being ventilated on Second Reading in this Chamber.
I am part of the cohort of Members who was unaware that it was lawful to inject fillers and botox into the faces of children under the age of 18. When I began my research, I was struck that the first case study I found was of a young British girl whose mother was a part-time beauty therapist who entered her into pageants. She was injecting this eight-year-old with a full face of botox before every performance and every competition. If that example was extreme, it did not take very long to find much less extreme examples and to see how ubiquitous the issue was.
VICE magazine did an experiment in 2019 with a 16-year-old girl where they visited 20 beauty salons in Essex and London, and every single one was willing to make the appointment for either botox or filler. They did not ask the young girl to produce any ID. The conclusion of VICE was that it did not particularly matter whether they went to a Harley Street practitioner in an upmarket venue or a high street hair salon where the filler was administered alongside the leg waxing kit in the back room—the reaction was the same.
Of the 20 salons, only 13 bothered to take any details about next of kin or who her GP was. In a sense, they were off-the-books procedures. When the British Association of Aesthetic Plastic Surgeons—BAAPS, as it is more commonly known—was asked about that, its director was very clear, saying that treatments of this nature carry physical and psychological side effects and that most registered practitioners should not contemplate giving them to teenagers. Yet the simple truth is that the light-touch regulation means there is ample opportunity for unscrupulous practices.
Anthony Mangnall
My hon. Friend has just given a horrific account of what an eight-year-old girl went through in beauty pageants. May I just ask her where the research came from and how she got access to that information? It seems to me that the negative impacts out there are not prevalent, and that they will be overridden by the positive impacts that this is going to have.
Laura Farris
I must confess to my hon. Friend that I found that particular story in the scientific tome that is the Daily Mail. I must also confess that when the details of that particular mother came to light and her story was reported, the child was at least temporarily taken into care. That is probably not a surprise to any Member.
I would like to give three reasons for supporting the Bill. The first relates to something that my hon. Friend the Member for Sevenoaks touched on: the skyrocketing number of botched procedures. In 2018, approximately 610 botched treatments of this nature were reported; that had more than doubled by 2019.
Bob Stewart (Beckenham) (Con)
This sounds awful. I am learning by sitting here and listening to this. Has anyone died as a result of these procedures? Apart from perhaps medically, has anyone been affected mentally and committed suicide? Have these procedures killed anyone?
Laura Farris
I am not aware of any case where somebody has, but I am happy to take an intervention on that point. However, focusing on personal injury, we can probably all agree that this is an area of law that is ripe for change, regardless of whether a child has actually died from a complication.
Laura Farris
I will proceed for a moment and give way in due course.
Two points about the personal injury element are particularly pertinent. The first is that the very act of injecting filler or botox into a young and developing face has potentially serious medical consequences in and of itself. The second is that if it does go wrong, the impact, not just physically but psychologically, could be so much more serious than for an adult. My hon. Friend the Member for Sevenoaks gave the example of a young 15-year-old girl who nearly lost her lips; imagine the trauma that surrounds that.
The force of the Bill is not just in its creation of an offence of injecting a filler or botox into an under-18-year-old, but in the scope of the defence set out in clause 2(4)—the reasonably onerous requirement for a practitioner to show that they took “all reasonable precautions” and conducted “due diligence” in establishing the age of their patient before they administered the treatment. The Bill does not just have the effect of creating an offence if the practitioner fails to do that; as my hon. Friend the Member for East Surrey (Claire Coutinho) said, by introducing such a regulation, it brings insurance into the frame and creates a right to make a claim for personal injury against a practitioner—a claim for damages should personal injury arise—in a case of this nature.
The second reason why I support the Bill is that it implicitly recognises the undesirable psychological impact of children embarking on invasive cosmetic procedures. This goes so much further than a manicure or a haircut; it is the beginning of a teenager, basically, changing their face. They do it because of a three-pronged assault that they face: from celebrities, from people who participate in reality TV shows, and from social media. I have to say that I think Instagram is particularly pernicious in this regard.
That is why the Bill dovetails so neatly with the ten-minute rule Bill introduced by my hon. Friend the Member for Bosworth (Dr Evans). When they are taken together, they are more than the sum of their parts, because they recognise that young people face a barrage of photographs of women with an unattainable standard of beauty, where the woman herself has probably been doctored and the image certainly has, too. These young people, at a stage in their lives when they are impressionable, vulnerable and at their least assured of their own identities, are fed a tacit message that it is not just desirable but necessary to adhere to that standard of beauty.
Andrew Bowie (West Aberdeenshire and Kincardine) (Con)
My hon. Friend is making a fantastic speech. She is raising issues around social media. Does she not agree that there are also concerns over broadcasters and that they, too, have a responsibility? Does she share my concerns over the so-called “Love Island” effect? Young children and teenagers watching such programmes are looking at body images that are so far removed from reality that they do great damage not only physically but mentally.
Laura Farris
I could not agree more with my hon. Friend and I thank him for that point. I was talking about celebrities, reality TV shows and social media sites, but the fact is that they are completely blended as mediums. Someone who appears in one will also be present on the other.
Sally-Ann Hart
In reality TV shows such as “Love Island”, it is not just the women who are put on pedestals as perfect specimens, but the young men, too. We must not ignore that young men often feel lacking in confidence as well when they see programmes like that. It is important that we stress that.
Laura Farris
I am grateful to my hon. Friend for her point, which I agree with. I have focused my comments more on young women, but I think the read-across to men should not be disregarded.
Dr Luke Evans
We must not forget that celebrities are people, too. They feel the anxiety and pressure to conform, too. That creates a vicious cycle. Spencer Matthews, very honourably, has spoken about the need to use steroids to bulk up and Laura Anderson has spoken about the need to manipulate her images put into the media so that they conform to a standard. Does my hon. Friend agree that that is part of the problem? There is a vicious cycle of trying to achieve something unobtainable.
Laura Farris
I agree with my hon. Friend. This is not a case of trying to pinpoint individuals and say that they are responsible; it is an overall culture.
I have reflected on what this says to young women. It does not say that it is a good idea to look that way. It says that it is a necessary idea to look that way if you want to be happy and successful, and to have a partner, to have a full social life and to be of value in this world. And actually it says that the opposite, not conforming to those kinds of standards, is equivalent to failure. That is a pernicious message that deserves to be aired by Members of the House this morning.
Laura Farris
I am just going to make a little bit of progress, but I will give way when I finish my next point.
The third reason why I support the Bill concerns young people’s mental health. There will not be a Member sitting in the House today who is not aware of the explosion in young people’s mental health problems. One piece of research I looked at was by the Mental Health Foundation, which took place 18 months ago. It found that one in four teenage girls aged 16 to 19 suffered from a mental health disorder sufficiently serious that they had either self-harmed in some way or made an attempt on their life. That is 25% of 16-to-19-year-old women. Within that particular cohort there was an overwhelming incidence of those young women also spending quite extended periods of time on social media. What were they doing? They were looking at images of other young women, contrasting themselves and drawing out what they perceived to be their own inadequacies.
I support the Bill and I congratulate my hon. Friend the Member for Sevenoaks again, not just because of the physical protections it puts in place for children under 18, but also for criminalising the conduct of dodgy therapists. Most fundamentally, I support the Bill for what we as a society say to teenage girls about their worth and their wellbeing.
Simon Baynes
I wanted to pick up on a point made by my hon. Friend, which she went on to cover in her speech. There may not be mortality statistics per se, but my own view, having spent a lot of time with that age group, is that, as she has pointed out, there is a serious issue with suicide. The 25% statistic she gave is frightening.
Laura Farris
My hon. Friend makes the point elegantly. It is probably difficult to draw a direct line from a child who would like to have, or has had, a botox procedure to somebody who ends up taking their own life, attempting to do so or contemplating doing so, but perhaps those feelings and the lack of self-worth, exacerbated by their youth and the pressures upon them, are all part of the same causal root.
Suzanne Webb (Stourbridge) (Con)
I rise to support the Bill, and I thank my hon. Friend the Member for Sevenoaks (Laura Trott) for bringing this important issue to our attention. There have been so many fantastic and important contributions so far.
My support for the Bill is principally due to my concern that young adults perceive these treatments as beauty treatments as opposed to medical procedures that carry risks and side effects, and the fact that damage to their self-esteem has probably brought them to that point. The issue behind this is mental health. What brings someone to the point where they feel that they need an injection in their face to paralyse what is beautiful about them, which is their natural appearance?
I am a huge advocate of body positivity, and my hon. Friend’s Bill contributes to that. My hon. Friend the Member for Bosworth (Dr Evans) probably does not know that if I had a private Member’s Bill that I wanted to introduce, it would be his. I have spoken about it on other occasions. All of this is so important to me, and it goes back to what I was saying: where does the situation start that a young adult feels the need to change their appearance?
Many young adults have body image problems and aspire to a face or a body that they cannot hope to live up to because it was faked on a computer or at the mercy of a needle. They see images of a role model whose face has been frozen in time by paralysing the muscles in their brow or around their eyes to make them look good—less tired, less old and less real. I would love to see a shift in society where there is not the same pressure on us all to be picture perfect.
Listening to hon. Members, I am truly grateful for the time and era in which I grew up. There was no social media or internet. At times there was not even any electricity, because it was the winter of discontent, but we will not go down that route. We did not have reality TV shows. We did not have “Love Island”. We in fact had black-and-white televisions—there are some in this room who will remember that time well.
Andrew Bowie
I think my hon. Friend might be misleading the House, albeit inadvertently. I simply cannot believe that she grew up in a time with only black-and-white television.
Suzanne Webb
I thank my hon. Friend for that. I wish it were not true, but sadly it is.
All we aspired to was standing in front of a mirror mimicking ABBA—I do not know whether my hon. Friend the Member for Wolverhampton North East (Jane Stevenson) did that. We did not have pressure on us to be anything but ourselves; it is as simple as that. We had Jackie magazine. The images were not doctored in those days. If they were, I would be saddened, but they were not Photoshopped. There was no botox; they were natural images. I hope that I come from a generation that reflects that. We do not feel so much pressure to be something that we are not.
Dr Luke Evans
I am glad to have my hon. Friend’s support. I think it is important to realise that fashion, trends and the air of beauty have always been there. The difference is the intensification and the unrealistic aspect of it these days, as opposed to the days of hexamethonium, when women would take drugs that ended up killing them, or indeed of corsets, for example. That is a really important point. It is the intensification and the unreal achievability.
Suzanne Webb
I thank my hon. Friend for his comments. That is an important point. People put pressure on us to make us feel that there is a way that we are supposed to look. I am afraid that gentleman often make us feel that way as well. We feel that we need to look a certain way to be attractive. We are attractive for who we actually are. We should just be ourselves. That is the most attractive quality in a person that I can think of.
I have seen written work where botox was debated around a “Should they or shouldn’t they?” argument. My simple question is: why would you? Why would you feel the need to do that?
I had not realised when researching this topic that non-surgical cosmetic treatments, such as botox and dermal fillers, generate over £2.75 billion in the UK and account for 75% of all cosmetic enhancements carried out each year. That is great news on the one hand because it is generating income—fantastic—but when we look at it another way, it is a lot of money focused on cosmetic enhancements. It is the word “enhancements” that starts to ring alarm bells, as does the fact that young adults partake of this practice. I thank my hon. Friend the Member for Sevenoaks for taking time to raise awareness of the impact of botox and dermal filler procedures among all age groups, but particularly those under the age of 18.
When I dug a little deeper, I found that, unlike their surgical counterparts, such as breast enlargement and facelift operations, which have clear and defined laws as to who can undertake the procedures, non-surgical cosmetic injections can be administered by anyone. What struck me most was that it is a largely unregulated industry. I support the wish to see the regulation of this practice enforced by a local authority, which will help to keep children safe from these procedures. It will help to ensure that children grow up to be the person they actually are and, as I said before, to age gracefully.
I thank my hon. Friend for raising awareness of the potential health risks of the procedures, including blindness, infection, scarring and psychological impacts. I also want to say again that we do not know the mental health impact of this and what has brought somebody there in the first place. There must be some damage to one’s self-esteem to think that you need to change your appearance. For me, as I mentioned at the start, that is one of my greatest concerns on this and the growing mental health issue within young adults.
Jane Stevenson
I thank my hon. Friend for her recollections of ABBA impersonation; mine was Bananarama, but I follow her lines. Does she agree that, as society has shifted and self-confidence is built on what you look like rather than you as a complete person, we are storing up this mental health crisis for future years? People who are now entering into these cosmetic procedures as they get older will be less able to cope with how they look and less happy with themselves. On the “Love Island” point raised a moment ago, we have seen suicides of those contestants, and it concerns me greatly that if one’s confidence is built purely on what one looks like, this is extremely concerning for one’s mental health.
Suzanne Webb
My hon. Friend raises a really important point. It is the fact that people feel so self-conscious, but it is also about how, by embracing who you are, you take the consequences of your actions. We all fail at times—we cannot always look beautiful, and we sometimes make disastrous decisions about what we are wearing and how we look—but that is how we grow and learn, and that is how we become strong. We become strong individuals in our life by learning through our mistakes and so forth. It is about turning up with the wrong frock or the wrong jacket on, putting too much lipstick on, or just looking flipping awful some days. Am I allowed to say “flipping” in here? That is what it is about, and it makes you a strong character. Manufacturing who you are does not make you resilient for life, and I think that is a very important point.
The growth in non-surgical treatments increases the need for consumer protection, and I believe it is important to work with stakeholders to strengthen the regulation of cosmetic procedures, so that only regulated health professionals may administer botox or dermal fillers to under-18s, which may be required for medical reasons. It concerned me greatly when I heard about the impact on and damage to that person. The story was quite heartbreaking.
I know that botox is a treatment option for people who suffer from chronic migraines. It is used in the treatment of a range of medical conditions, including the management of bladder dysfunctions, face and eyelid twitching, painful involuntary neck muscle contractions and severe sweating, as my hon. Friend the Member for East Surrey (Claire Coutinho) has already mentioned. I am pleased that it will be used in these cases, with under-18s being able to access that treatment.
I believe it is important that these procedures remain available where there is an assessed medical need. I think that is key—the assessed medical need. It is not needed for beauty; it is needed only for a medical reason and when provided by a registered health professional. At present, practitioners do not need to be medically qualified to perform those procedures, which is a great concern. I did not realise that that was the case until my hon. Friend the Member for Sevenoaks introduced her Bill. There are no mandatory competency or qualification frameworks related to the administration of those procedures, which is incredibly scary. The potential health risks, which she raised, include blindness, tissue necrosis, infection, scarring and psychological impact.
My hon. Friend has made a really powerful case for the need to prevent under-18s from accessing botox or dermal filler procedures for aesthetic reasons, making the administration of botox and cosmetic fillers by injection to under-18s an offence, and I thank her for doing so. She also wants to establish a regulatory framework for local authorities to ensure that businesses have appropriate safeguards in place to prevent under-18s from using their services. She has 100% support from me for her Bill, which will stop dangerous and unnecessary non-medical procedures that can ruin children’s lives. Let us not forget that. We do not yet know the consequences for a young adult of using botox. We still do not know the consequences for adults of using botox as a beauty treatment.
The Bill also ensures that any treatments that are required are performed by a medical practitioner, which I really appreciate. For me, the most important part of the Bill, in conjunction with the private Member’s Bill introduced by my hon. Friend the Member for Bosworth (Dr Evans), which tackles body dysmorphia and unrealistic images in social media, is the fact that it contributes significantly to promoting body positivity, which I have long championed, and I will continue to do so. That begins at home and at school, and we need to educate young adults and children from the age of one, two, three, four and upwards. They are beautiful as they are. We embrace who we are and what we look like, and that is what makes us stronger in life. Any measures that do that have my unquestionable and unwavering support.
David Johnston (Wantage) (Con)
May I begin by congratulating my good friend, my hon. Friend the Member for Sevenoaks (Laura Trott)? If a Member is drawn high on the list for private Members’ Bills that is both a blessing and a curse. It is a blessing, because it provides a rare opportunity to put one’s name on a piece of legislation as a humble Back Bencher, but it is a curse, because one’s inbox immediately explodes, as every special interest group, charity and business wants you to use their ready-made Bill. It is fair to say—I hope she does not mind my saying so—that she could have picked an issue that generated more hype and likes for her on social media, but instead she has opted to do something really important. I congratulate her on doing so, as it demonstrates the kind of Member of Parliament that she is.
I have been a Member of Parliament only since December, and I am already struck by the fact that private Members’ Bills seek to do things that are surprising, because I cannot believe that they are not already law. It is extraordinary that people under 18 can be given these procedures and possibly suffer damaging effects as a result. They cannot have a tattoo on their skin until they are 18, yet they can have these procedures under their skin. That demonstrates why the measure is necessary and why the industry as a whole needs greater regulation.
When preparing to speak on the Bill, I spoke to various beauty clinics and salons in my constituency. Some of them offer these treatments, but others do not. NIYA Beauty Clinic in Southmoor does not do them, but thought unquestionably that they should be banned—that it was not appropriate to offer them to under-18s. The Good Skin Club in Wallingford and the House of Beaux in Didcot thought exactly the same. They offer those treatments, but they use highly qualified people to do so, and administer them only to adults. They both felt, as do I and a number of hon. Members, that the danger of people who are unlicensed and do not know what they are doing applies to all ages. We are discussing the under-18s, but there is a broader question about who is administering treatments that can cause bruising, swelling and perhaps blindness, as we have heard, and which can affect people of all ages.
As we are talking about the under-18s, let me say that when I was a teenager people wanted to get hold of alcohol as early as they could, try it and see what it was like. They wanted to stay out late at night, even though they had nothing really to do; they just wanted to be out, hanging around. They wanted make-up, outfits and piercings that their parents strongly disapproved of. All of that is true today, but when I was a teenager they did not want to have these kinds of treatments—they do today. So what has changed? It is clear that if a doctor that has not told someone to have these treatments, they have no health benefit—in fact, they pose great health risks. We will not find many adults who think our children need to have these alterations. What has changed is a lot of what we have heard about in this House today: the impact of social media and advertising; and the poor mental health and low self-esteem that so many children have at the moment. It is the same thing that has led to a rise in eating disorders and in self-harm. So I completely support this Bill, because it tackles a very real danger that those under 18 are facing, but we should all have our eyes on the factors that lead them to take that risk in the first place.
Saqib Bhatti (Meriden) (Con)
I congratulate my hon. Friend the Member for Sevenoaks (Laura Trott) on bringing this Bill to the House. She seems to have captured the mood, certainly among Conservative Members, given the contributions we have heard. I suspect that if there is an opportunity to do further private Members’ Bills, I will be supporting them, because of their attempt to do something positive, really make a change to people’s lives and improve society. That is a great opportunity and this Bill is a great achievement, so I congratulate her.
This Bill is not an attack on the health, beauty and non-medical cosmetics market, as my hon. Friend the Member for Bosworth (Dr Evans) pointed out. That sector has a role to play. I also echo the sentiment of my hon. Friend the Member for South Suffolk (James Cartlidge) when he said that we Conservatives are not the party of more legislation for the sake of it—we are the party of individual responsibility. Like many Members, I was shocked that children under the age of 18 are able to get these treatments, in what can sometimes be described as the “wild west” of non-medical cosmetics. This growing market is worth about £2.75 billion and I am sure it will grow further, given the way in which the trends are moving. I am an advocate for adults being able to make their own decisions, with good information. Let me refer here to the attempt being made by my hon. Friend the Member for Bosworth to get legislation through to have better information on social media, so that children are able to know when pictures have been doctored. These types of images have an impact on not only the mental health of individuals, but the decision-making process, which I will come on to talk about.
I thought it would be good to talk about botulinum toxin. The United States National Library of Medicine and National Institutes of Health call it the miracle poison. I recognise that there are medical benefits from botox and that there is a place for it, but I am shocked that more regulation is not in place. I hope that this Bill makes it into law, to allow for greater regulation in this sphere.
Let me give some context, as I talked about the impression on young people. Many Members may be aware of the social media app Snapchat, whose audience is primarily 13 to 24-year-olds. Some 7% of the 60,000 respondents to its survey said that they had undergone cosmetic procedures for aesthetic reasons; 66% of almost 50,00 said that they would like to change their facial features; 33% said that they would like to alter their nose; and 24% said that they would like to change their lips. That goes to the heart of the issue. This is certainly having an impact and children are tempted by cosmetic procedures.
I believe that the Bill goes beyond just botox to the heart of where we want to be as a House, and certainly where we Conservative Members want to be as a party. For me, this is about saying: let children be children and let them enjoy their lives. Think of the pressures that they have in everyday society, which, by the way, did not start with social media. I remember, when I was growing up, stories of teens reading magazines and eating disorders coming up. This has been a long-standing issue, although social media has accentuated it. My hon. Friend the Member for East Surrey (Claire Coutinho) talked about being a baby. Well, I was a very beautiful baby—confidence, or lack of confidence, was never an issue for me. However, as I was growing up, bands such as Oasis tried to determine what my hairstyle would be. I had a hairstyle with these things called curtains, as they were called at the time—I see some hon. Members nodding; I am sure they tried it, too. My first driving licence picture looked nothing like what I look like now—I will not go any further into that—but we are impressionable, certainly when we are growing up. We are susceptible to trends, whether they are online or among our peers.
I intervened on my hon. Friend the Member for Bosworth because I question whether we have the right tools in place in our homes and schools to try to combat these pressures. It will be an ongoing battle, because we live in this “Love Island” generation, which looks at what is purported to be the right thing to be or what the norm is to look like. My hon. Friend the Member for Stourbridge (Suzanne Webb) hit the nail on the head repeatedly. She said that we should try to be the best that we can be, and that we should try to appreciate who we are and the fact that we are not all the same—that we are different and that we look different. We may have curtains at one point and different hairstyles, and we may want to get fit. Someone described me the other day as starting to get a bit more rotund—it was very mean actually, Madam Deputy Speaker, and I am glad to put it on the record—but the fact is that we have to be at ease with ourselves. We can set the standard in this House in trying to fight back against this trend and trying to use social media in a positive way. I am sure that people will be watching this debate and they will want to hear that we want our young people to be more confident.
For me, that is what the Bill is really about—that fight back. I want to think about the world that my children will live in. If I have daughters or sons, I do not want them to feel the pressure of what society says we should look like. I want them to be at ease with themselves and I want them to value what is in their minds and in their hearts. That is the lesson that I hope our children can take away from this.
I understand that there are those who are concerned that the Bill will take some responsibility away from parents and put it into the hands of the nanny state. Other Members have mentioned that legislation does not permit under-18s to get tattoos based on the permanency of the artwork on their skin. My hon. Friend the Member for Totnes (Anthony Mangnall) talked about tattoos—the cat that someone may have got when they were younger that has turned into a tiger as they have grown older may not have been the tattoo that they wanted. Our law currently permits a form of body modification that fails to address this permanency, and that is why I feel that this legislation is valuable.
I see the Bill as a piece of common sense and I reiterate my congratulations to my hon. Friend the Member for Sevenoaks on proposing it. We have laws in this country to protect young people and the Bill adds to that protection. It does not ban cosmetic fillers on medical grounds; it bans them purely on aesthetic grounds if someone is under the age of 18. It just makes common sense so for that reason I wholeheartedly support the Bill.
Sally-Ann Hart (Hastings and Rye) (Con)
It is a pleasure to be able to speak in this debate. I congratulate my hon. Friend the Member for Sevenoaks (Laura Trott) on bringing this Bill to the House.
My hon. Friends have looked back to their childhoods. I grew up in a family of girls; I had three sisters growing up, and our parents were absolutely fantastic. My mother was amazing—I do not know quite how she managed four girls growing up, with all those hormones raging, but she did—and so was my father. I want to emphasise to all hon. Gentlemen in the House how important it is for girls to have fathers who are encouraging, who tell them they are gorgeous but do not focus only on their looks, who tell them how important education is, and who bring them up with confidence and substance. I thank my parents for the job they did with their four daughters.
The 2017 Conservative manifesto contained a commitment to ensure effective registration and regulation of those performing cosmetic interventions. At present, practitioners of botox or fillers do not need to be medically qualified to perform the procedures, and there is no mandatory competency or qualification frameworks related to their administration. The potential health risks of such procedures include blindness, tissue necrosis and all the things highlighted by other hon. Members.
In 2008, the British Association of Plastic, Reconstructive and Aesthetic Surgeons said that cosmetic surgery should always be conducted in the patient’s best interest. It said that the decision to perform plastic surgery on a teenager should be made only in exceptional circumstances and with parental consent. That type of scrutiny should also apply to beauty and cosmetic treatment practitioners. Although it is normal for teenagers to worry about their looks, it should never be a matter of course for young people to have or to consider cosmetic or aesthetic surgery unless it is for medical reasons. Surgeons work under strict guidelines, and it is their responsibility to weigh up the pros and cons for each person in a responsible and focused manner, in the best interests of their patient.
Virginia Crosbie (Ynys Môn) (Con)
As a teenager, I had a terrible car crash. We have all been looking back at our childhoods. I had a fantastic plastic surgeon—Brian Sommerlad—and I have had the opportunity to thank him and his team in this Chamber. Does my hon. Friend agree that, for medical reasons, we should have support for people at that very vulnerable time?
Sally-Ann Hart
I agree with my hon. Friend on that point.
Children who are still growing should not be considered candidates for appearance change unless it is for medical or mental health reasons. Cosmetic surgery procedures should be rarely performed on children who are still growing—for example, in cases of congenital deformity. There is a big difference between cosmetic procedures used for medical and mental health reasons, and those for purely aesthetic ones. Teenagers are physically immature, and may not develop the emotional strength to enable them to cope with a permanent change of appearance, the complications of botox, fillers or surgery, or their failure to meet their expectations
Botulinum toxin—botox—is a powerful chemical agent that paralyses muscle and is used to lessen the appearance of wrinkles. Its use and administration should be restricted and regulated, and it should be administered only ever after careful consideration of the individual client and their circumstances, no matter their age. Cosmetic surgeries or procedures are not always the right answer, and it is very unlikely that someone in their teens will receive any benefit from having botox injections for cosmetic reasons. Young people do not have wrinkles, and every young person should celebrate their youth. They are all individuals and are perfect. We are all a miracle of birth. My hon. Friend the Member for Stourbridge (Suzanne Webb) referred to ABBA, and my hon. Friend the Member for Wolverhampton North East (Jane Stevenson) referred to Bananarama, but I will draw on a more modern pop icon: Lady Gaga, who said that God made us perfectly.
Botox is used in the treatment of a range of medical conditions, which hon. Members have highlighted—I will not go through them again. Recent studies have described the use of botulinum toxin as an adjunct to the treatment of cleft lips. It can be used in medical treatments. It is important that under-18s are able to access medical treatment, and the Bill will not prevent that.
The Bill seeks to prevent under-18s from accessing botox or dermal filler procedures for aesthetic reasons, and I praise my hon. Friend the Member for Sevenoaks for bringing it to the House to highlight this serious issue for debate. The Bill seeks to achieve its admirable aims through making it an offence to administer botox and cosmetic fillers by injection to under-18s and establishing a regulatory framework through local authorities to ensure that businesses have appropriate safeguards in place to prevent under-18s from using their services. It is for those reasons that I am delighted to support the Bill.
Shaun Bailey (West Bromwich West) (Con)
I have been taught that it is sometimes better to keep it short and sweet, keep them wanting more, so I will try to limit my comments to just a few. I start by thanking my hon. Friend the Member for Sevenoaks (Laura Trott), because her Bill demonstrates the reason why we are all here: to ensure that we protect some of the most vulnerable in our society and those who need our help.
I am conscious that at this point in the debate it is easy to be repetitious. I try to avoid being repetitious where possible, but I do want to pick up on some points raised. This is, at its core, about how we view ourselves. That point was well articulated by the hon. Member for West Ham (Ms Brown) when she said that it is about the individual inside and what we offer the world as people. Our physical presence should not be the core of what people see; it should be about who we are as people. That should be it, but unfortunately it is not.
When we look at the statistics, we see that women are disproportionately affected. I was fortunate to be brought up in a household of very strong women. My mum, who brought me up on her own, and her two sisters are strong, opinionated but fantastic women who absolutely gave me my life view. They taught me clearly that, at the end of the day, someone’s gender or what they look like should not matter. If they work hard, they should be able to achieve. I saw through their experiences that women are disproportionately affected, and it is absolutely wrong. That is not to discount, of course, that many man are affected. The figures I have seen show that about 40% of men are affected by botched botox and some of the image issues that come out of this. We absolutely must make sure that we get it right, and the Bill fills such an obvious gap. I think it was my hon. Friend the Member for Bosworth (Dr Evans) who asked—I may be wrong—why on earth this legislation is not already in place. It is beyond my comprehension.
This is not a controversial Bill. It is a common-sense Bill that fills a gap that should have been filled years ago. At its core, as many right hon. and hon. Members have articulated, it is about ensuring that we keep people safe and regulating a £2.75 billion industry. It is about ensuring that young people are protected and not pressured by what they see on TV. We have heard that in many fantastic and well articulated contributions.
I am acutely conscious that other Members want to speak, so I will round up my comments simply by saying that there are many more issues that are slightly outside the purview of the Bill that must be dealt with. My hon. Friend the Member for Sevenoaks absolutely must be commended, because the Bill is fantastic and is absolutely filling a gap that is there today, but today should only be the start. We must tackle those issues around how we view ourselves and the messages that we are sending young people about their place in society and what should be valued as important. It is incumbent on every single right hon. and hon. Member in this place to ensure that we carry forward the fight and say to people, “It is about who you are as a person, not what you look like.”
Mike Wood (Dudley South) (Con)
It is nice to be able to start a speech in a debate on a private Member’s Bill without having to declare an interest, although my children suggest I should perhaps reconsider. As the next piece of business is on drugs testing in prison, I should say that the same applies to that debate.
Shortly after I was elected in 2015, a constituent came to one of my surgeries with a case that was later taken up by Save Face. It concerned a cosmetic surgeon who was conducting procedures from his home in my constituency, claiming to be a nurse consultant and describing himself as on the same level as a doctor. The truth was that he had been struck off for failing to disclose a serious assault conviction related to domestic abuse.
The lack of safeguards around these procedures is shocking, as is the lack of accountability of many of those carrying them out. That is a huge problem for the population as a whole. Fortunately, my constituent’s daughter’s procedure was not botched, but too many are. When they are, they too often have life-changing impacts. That is a terrible scar—quite literally—for many adults, but when it affects children and young people we have a particular responsibility to act.
The growth in botox, fillers and other similar cosmetic procedures is of great regret to Members on both sides of the House, because it reflects a deeper problem in society and the way that people feel about themselves and value themselves. A large part of it is down to the effect of celebrities and influencers in making treatments popular, particularly among young people who see Kylie Jenner in TV shows such as “Keeping Up with the Kardashians”, to give just one example, as a way of measuring their own worth, yet nothing could be further from the truth. That is damaging enough when the actions taken amount only to a filter on Snapchat to alter appearance into some idealised version, but it cannot be right to leave unregulated such permanent life-changing surgery on people who are not yet at the age of majority. There is a responsibility to act in law.
I am pleased by the work that Girlguiding has done to promote body confidence through its Free Being Me programme, helping to address some of the root causes of this trend. There is a clear need for the Bill that my hon. Friend the Member for Sevenoaks (Laura Trott) has rightly introduced to restrict the use of such procedures on children for aesthetic purposes when it is not medically necessary.
Bob Stewart
I am absolutely shocked that anyone who is not medically trained could wield a syringe, particularly on someone who is under 18. That is what I have learned this morning, and I suspect my hon. Friend agrees with me.
Mike Wood
I absolutely agree. When people are unqualified and also uninsured, there is a lack of accountability and recourse when things go wrong.
Too often people focus on the cosmetic part of cosmetic surgery, and imagine that it is a development of putting on make-up, whereas of course it is surgery in every sense of the word. Like all surgery, it has real risks. When it is being used for aesthetic purposes, it is one thing for adults to be allowed to make their choices while being aware of the risks, but we cannot allow that for children and young people. We rightly legislate to protect our young people. We rightly say that under-18s cannot use sunbeds or get tattoos because of the risks and the long-term impacts, but the acute risk that comes with Botox and similar procedures is far more immediate and drastic. As other Members have said, it is an outrage that this is not yet illegal, so I congratulate my hon. Friend the Member for Sevenoaks on bringing forward the Bill. In doing so, she has done a great service to our nation, and I am proud to support it this afternoon.
Sara Britcliffe (Hyndburn) (Con)
I will keep this short and sweet. As a younger person, I find it quite shocking that under-18s can have such a procedure. My hon. Friend the Member for Hastings and Rye (Sally-Ann Hart) said that she grew up with sisters. Unfortunately I grew up with two brothers, and I became the rebellious one, so I would do everything in my power to go against my father, whether it was dying my hair or piercing my ears, which luckily can heal. If I had known about these procedures, I might have contemplated them just to wind up my dad—I do not do that anymore.
I have friends who have had these fillers in their lips, and I have seen the bruising. I have also seen the influence that social media has had on my friends doing that to their lips. They see other people doing it, such as reality TV stars, and they believe they can look the exact same, but that is not the case. The consultation process is vital. I wholeheartedly support the Bill. As a younger person in the House, I think that it is vital, and I think there is cross-party agreement on that.
Rob Butler (Aylesbury) (Con)
Protecting the next generation is a vital part of the work we do in this House, so I congratulate my hon. Friend the Member for Sevenoaks (Laura Trott) on all her work to introduce the Bill. Much of what needs to be said has been said, so I will not be repetitious.
Despite being a Conservative who believes in the free market, I believe that this is an instance where it is absolutely right that, as parliamentarians, we—to coin a phrase—take back control from the commercial market and ban Botox and fillers for children for cosmetic purposes. One point that has not been made yet is that there is increasing evidence that brain development continues well into the 20s. That is much discussed in the field of criminal justice, and especially youth justice, and it is especially applicable to the part of the brain that is responsible for understanding the consequences of decisions. While young people may well firmly believe that they need or want Botox or a filler, they are unlikely to be doing so with complete knowledge and psychological maturity. Just because children are convinced of something, it does not necessarily mean that they are right, as I am sure many parents would agree—and I am not even a parent.
Much mention has been made of childhood memories—for the record, I fall into the ABBA camp. A vivid memory of my childhood is being afflicted by migraines from the age of five, and I still am now, so I am pleased that medical treatment with Botox will remain possible with the requisite strong safeguards and under the direction of a doctor.
I promised to be brief, and I will be. I am very pleased that my hon. Friend has brought the Bill to the House. I thank her for raising the profile of this dangerous practice and for doing such sterling work to protect children.
Justin Madders (Ellesmere Port and Neston) (Lab)
I welcome this debate, and I do not intend to take up too much time, as my party supports the Bill, as I think do all Members who have spoken today.
As we know, cosmetic procedures such as botulinum toxin—or Botox, as it is more commonly known—are used to reduce the appearance of wrinkles, and dermal fillers are used to fill out wrinkles and creases in the skin and to fill the cheeks and lips. Those procedures are becoming more and more commonplace. While the effects of the procedures are not permanent—usually lasting three to four months or six to 18, depending on which procedure has been undertaken—it is recommended, as with all cosmetic procedures, that they should be carried out by an experienced and suitably qualified practitioner.
As we have heard, there are a number of associated risks. Although side-effects are rare, in the worst-case scenarios they can include infection, scarring and tissue death, as well as psychological problems. We have heard a number of stories about serious issues and problems arising from these procedures. It is, then, a concern that currently there are no statutory provisions to restrict access to these procedures for children and young people. As has been said, they should be on a par with other appearance-related procedures, such as tattoos and sunbed use, for which there is already a statutory minimum age of 18. The measures in the Bill are necessary to protect young people from the serious consequences of uninformed and unregulated procedures. The hon. Member for Wantage (David Johnston) summed up the mood of a number of Members when he said he could not believe that this was not already covered in law.
In 2013, the Keogh review of regulation of cosmetic interventions called for greater protection for vulnerable people, noting that young girls in particular were becoming more concerned about their appearance, as we have heard from several speakers. A Mental Health Foundation study found that 40% of teenagers said that images on social media cause them to worry about their body image. Be Real’s “Somebody Like Me” campaign found that 36% of 11 to 16-year-olds throughout the UK would do “whatever it takes” to look good, including considering surgery. Whatever it takes—what a chilling phrase in this context. Worryingly, Save Face, a national register of accredited practitioners who provide non-surgical cosmetic treatments, has reported increasing numbers of complaints from under-18s who have suffered at the hands of unregulated practitioners.
For too long we have not had the robust, consistent and enforceable standards that we need for these treatments and there has been no accountability for malpractice. The absence of standards leaves practitioners with no support and customers with no guarantee of safety. The Bill is a big step in terms of addressing those issues. I congratulate the hon. Member for Sevenoaks (Laura Trott) on bringing the Bill to the House and on her hard work. As we have heard, it is quite a lot of work to get a private Member’s Bill not only debated but passed into law. Her introductory speech was compelling and she made a powerful case about the need for additional safeguards. She was right to say that some of the examples of malpractice that have impacted on women’s health go far beyond today’s discussion, but there are a number of other examples of where things have gone on for too long without intervention.
I wish to recognise the contributions from the other hon. Members who have spoken today. There is clearly a great deal of knowledge and expertise in this debate. The hon. Member for Bosworth (Dr Evans) in particular gave us a comprehensive overview of the medical aspects of this issue. He was absolutely right about accountability being at the heart of the Bill. Most Members spoke about the pervasive influence of social media in particular and its impact on young people in terms of the pressure that it puts on them. Clearly, that is beyond the scope of today’s discussion, but there is certainly a mood in the House in favour of doing more in that policy area.
While I am talking about Members’ contributions, I wish to pay tribute to the work of the all-party group on beauty, aesthetics and wellbeing, and particularly its co-chairs, my hon. Friends the Members for Swansea East (Carolyn Harris) and for Bradford South (Judith Cummins). The group has been highlighting the lack of age restrictions for these procedures and has also raised concerns about advertising and social media promotion that leaves young people vulnerable and at risk. The group’s inquiry on non-surgical cosmetic procedures is the first to assess the regulation of such procedures and its adequacy. The inquiry has brought together people from across the sector to talk about the lack of robust, consistent and enforceable standards and the all-party group is looking to reach consensus on those issues. The inquiry is still ongoing, but I am sure that when it reports it will be a helpful tool for the Government in respect of future legislation, should any be necessary.
Coming back to the Bill itself, as we know, it is intended to safeguard children from the potential risks associated with these procedures. The Bill prohibits specific cosmetic procedures, commonly known as botox and dermal fillers, being performed on young people under the age of 18 in England for purely aesthetic purposes, although, as I understand it, the procedures will still be available to under-18s through registered health professionals where there is an assessed medical need. The Bill provides that the administration of botulinum toxin and cosmetic fillers by injection on a person of the age of 18 will be an offence and that the person who commits that offence is liable on summary conviction to an unlimited fine. The Bill also imposes a duty on businesses to ensure that they do not arrange or perform procedures on under-18s and that will be enforced by a local authority regulatory regime.
The offence is a strict liability offence, which means that if it is committed by a business, or arrangements are made for the administration of one of the substances covered by the Bill for a cosmetic purpose, it will unfortunately be found guilty automatically. However, a defence of reasonable precautions and due diligence will be available to businesses if they can demonstrate that they took all reasonable precautions and exercised due diligence to require proof of a person’s age before any procedures took place. The Bill, if it becomes law, will also provide that any body corporate that commits an offence, or if one is attributable to the neglect of an officer of the body corporate, then that officer, as well as the body corporate, will be guilty of the offence.
Finally, although the Bill does not create any new enforcement or investigatory powers, it does set out that local authorities can enforce the provisions in the Bill using their powers available under schedule 5 of the Consumer Rights Act 2015. Clearly, these are significant new responsibilities for local authorities. Of course we have expressed concern over the way that councils have had their funding stripped over the past decade, so it does raise questions about how comprehensive the enforcement regime will be. That probably is an issue that this House will return to on many other occasions, but it is not a reason for us to reject the Bill today. I conclude by welcoming what the Bill seeks to achieve, and I wish it a speedy passage through the rest of its parliamentary process.
The Minister for Health (Edward Argar)
It is always a pleasure to see you in the Chair, Madam Deputy Speaker.
First, as hon. Members will hopefully recognise, I am not my hon. Friend the Member for Mid Bedfordshire (Ms Dorries). I know that she would very much have wished to be here today, given her work with my hon. Friend the Member for Sevenoaks (Laura Trott) on her Bill. She has asked me to say that, as a close contact with someone who has tested positive for covid, she is, as always, doing the right thing and staying away from the House.
I thank my hon. Friend the Member for Sevenoaks for her efforts in bringing forward this Bill today. I know that my hon. Friend, who is the Minister for Patient Safety, Mental Health and Suicide Prevention, has had many positive conversations with her about this issue.
I recognise, given the amount of time that we have been spending opposite each other in debates in recent days, that the shadow Minister, the hon. Member for Ellesmere Port and Neston (Justin Madders), has picked up on some points that I was already going to pick up on—I suspect that that comes as no surprise. He is right to highlight that this is an issue that unites the House, regardless of party. It is important that I join him in paying tribute to the hon. Members for Swansea East (Carolyn Harris), for Bradford South (Judith Cummins) and indeed to the right hon. Member for North Durham (Mr Jones), who has also taken a big interest in this issue. I also pay tribute to very powerful campaign of The Sun.
Turning to my hon. Friend the Member for Sevenoaks, I know her well and I have known her since before she was a Member of this House. She is always eloquent and effective in her campaigning, and she truly cares about these issues, so it is a privilege to speak in this debate. I also know, from her campaigning, her determination to achieve results and that she always does so. With that in mind, it is a pleasure and, indeed, a relief that, on behalf of the Government, I can offer my wholehearted support for the introduction of an age restriction for cosmetic procedures, and I hope that this Bill—this very important Bill—will receive the wholehearted support of the House.
Let us be clear, this is an ever-expanding multimillion-pound industry and there is more work to be done to ensure that it operates safely. In recent years, there has been a huge rise in the number of people seeking botox and fillers, which has led to an equally large rise in the number of people offering such treatment. The physical and psychological implications of cosmetic procedures are not to be underestimated and need careful consideration. The Bill rightly focuses on protecting young people from receiving botox and fillers until they are able to fully weigh those implications, and I support those aims.
The growth of the cosmetics industry is well documented, and we have seen a fundamental shift in attitudes to cosmetic interventions. It is important to acknowledge the economic and wellbeing contributions of the broader beauty and aesthetics industry. The value of the non-surgical cosmetic interventions market is predicted to rise to over £3.6 billion in the UK by 2021. People have the right to choose what to do to their own bodies, but it is vital that the regulatory framework around the cosmetics industry enables consumers, particularly vulnerable consumers, to make an informed and safe choice.
As my hon. Friend set out, children are currently able to access invasive cosmetic procedures on the commercial market without any requirement for a medical or psychological assessment. Understandably, that has come as something of a surprise to many Members who recognise that they perhaps assumed it was illegal already. I think that my hon. Friends the Members for Wantage (David Johnston), for Newbury (Laura Farris) and for Hyndburn (Sara Britcliffe) alluded to that. There are many reputable and experienced practitioners working in the sector, and this is not an attack on them, but that is by no means universally the case.
It is vital that young people are protected from practitioners who provide botox or fillers for a young person where there is no clinical need on purely aesthetic grounds. We are in danger of mistakenly thinking that having a cosmetic procedure is as straightforward as going to the hairdressers, whereas in reality, as we have heard today, the risks associated with such procedures going wrong are serious and long lasting.
Those risks were set out by my hon. Friend the Member for Sevenoaks and by my hon. Friend the Member for Bosworth (Dr Evans), my constituency neighbour, drawing on his extensive medical experience. My Department has been working to identify where improvements could be made and regulations strengthened to ensure the safety of the most vulnerable consumers. My hon. Friend’s Bill has identified an important area where the safeguards can and should be improved now. My Department is also considering whether further protections should be put in place.
I will make a couple of further points, Madam Deputy Speaker, before drawing my remarks to a close. This is not about making judgments. Young people, as we have heard, are bombarded every day with filtered selfies on social media, influencers and celebrities selling a glamorous lifestyle, which, they suggest, depends on the way someone looks. It is a dangerous and misleading prospectus.
We have heard from many Members today. My hon. Friend the Member for Stourbridge (Suzanne Webb) made her point very powerfully. It is always a pleasure to hear from the hon. Member for West Ham (Ms Brown), who rightly made a typically powerful intervention. She talked about the need for positivity and recognising that everyone is beautiful as they are and the importance of that attitude. The pressure on young people around body image is immense. That is something I saw in my work on eating disorders before becoming a Minister, working with the amazing charity Beat, to which I pay tribute.
The increased accessibility and affordability of cosmetic treatments, alongside that pressure on young people to look a certain way, has perhaps led to a sense of the normalisation of procedures. Our role in government is to support young people in making safe and informed choices and, where necessary, to protect them from the potential harm that procedures can do to their health. We currently place the responsibility to make a considered decision about something seemingly commonplace, but which could have serious consequences for their health, on very young shoulders at a time of physical and emotional development. There are already statutory age restrictions in place for tattooing, teeth whitening and sunbed use, and it makes little sense that there are no similar protections for invasive injectable cosmetic procedures. Alongside the Bill, my Department is exploring a range of options for increased oversight of practitioners, including a system of registration or licensing.
My hon. Friend the Member for Sevenoaks, as I alluded to earlier, highlighted the potential health risks of the procedures covered by the Bill. I will not repeat them, but it is safe to say that I agree with her assessment of which products should be covered by age restrictions. The proposals in the Bill will ensure that the procedures for under-18s are placed firmly within a clinical framework. They permit the procedures to continue under the directions of a doctor and to be administered within a regulated environment for medical purposes.
This Bill is the right thing to do. It represents an important and real step forward, and once again, I congratulate my hon. Friend the Member for Sevenoaks on her important and impressive work and offer the Government’s full support to the Bill.
Laura Trott
With the leave of the House, I will make some final remarks. There have been some passionate and personal speeches today, and I am very grateful for the support from all parts of the House and from those on the Front Bench. A key thing that has emerged is the impact of social media—a pernicious impact in far too many cases.
My hon. Friend the Member for East Surrey (Claire Coutinho) put it well when she said we have a generation who are the most anxious, the most depressed and with the lowest sense of self-worth. We must do all we can to support our young people. My Bill will deal with some of the symptoms of the problem, but not necessarily the cause. My hon. Friend the Member for Bosworth (Dr Evans) is doing a good job on some of the problematic causes of this issue, and I hope his work is taken forward.
My hon. Friend the Member for West Bromwich West (Shaun Bailey) said that this Bill should only be the start, and he is right. My hon. Friend the Member for Wantage (David Johnston) rightly pointed out that the dangers of unlicensed and unscrupulous providers apply to all ages, not just the young. It is absolutely correct that we need more consultation, as my hon. Friend the Member for Clwyd South (Simon Baynes) pointed out; more accountability, as my hon. Friend the Member for Bosworth pointed out; and minimum qualification levels, as my hon. Friend the Member for Wolverhampton North East (Jane Stevenson) rightly highlighted. I am glad to hear that the Department will be taking registration and licensing forward.
As my hon. Friend the Member for Meriden (Saqib Bhatti) said, the Bill is not an attack on the industry. There are so many providers that are doing this well and are looking after the people they are treating, but we must stop the ones who are not. We must make sure that women—there are men involved as well, but 92% of these procedures are done on women—are protected, and that should be true for all ages.
My hon. Friend the Member for South Suffolk (James Cartlidge) rightly pointed out that we need to be careful about over-regulation, but equally, we must ensure that procedures are safe. We do not expect to go down to our local pharmacy and for the nail varnish to burn our fingers off. Equally, if someone is going to have an invasive procedure, the state should make sure that it is safe.
There was a specific question from my hon. Friend the Member for Totnes (Anthony Mangnall) about enforcement. Local authorities will be able to enforce in their local area, and businesses or providers will be subject to unlimited fines.
The purpose of my Bill is simple. No child needs cosmetic botox or fillers, and such treatments on the vulnerable must be banned. Too many young people’s lives have already been seriously impacted because of cosmetic procedures gone wrong. As my hon. Friend the Member for Wolverhampton North East says, it makes no sense that it is illegal to tattoo a person under the age of 18, but it is not illegal for practitioners to provide these extremely high-risk services to vulnerable and insecure young people.
The Minister rightly set out the Government’s work on the regulation of cosmetic procedures to date, and I thank him deeply for his support. I also place on record my thanks to the Minister for Patient Safety, Mental Health and Suicide Prevention for her help and her work in this area. It has been remarkable and is correcting an oversight that has gone on for too long. We must stop the dangerous and unnecessary non-medical procedures that can ruin children’s lives, and I welcome the Minister’s support today in ensuring that we are now one step closer to achieving that. I commend the Bill to the House.
Question put and agreed to.
Bill accordingly read a Second time; to stand committed to a Public Bill Committee (Standing Order No. 63).
Botulinum Toxin and Cosmetic Fillers (Children) Bill
Wednesday 25th November 2020
(3 years, 12 months ago)
Public Bill CommitteesRead Full debate Botulinum Toxin and Cosmetic Fillers (Children) Act 2021 Read Hansard Text Read Debate Ministerial Extracts Amendment Paper: Public Bill Committee Amendments as at 25 November 2020 - (25 Nov 2020)
The Chair
Welcome to this Public Bill Committee. Before we begin, I have a few preliminary announcements. Members will all understand the need to respect social distancing guidance; if necessary, I will intervene to remind you. Note passing should be electronic only. The Hansard reporters would be grateful if Members emailed their speaking notes to hansardnotes @parliament.uk.
The selection list for today’s sitting is available in the room and online. It shows how the selected amendments and clauses have been grouped together for debate. Formal decisions on amendments and clauses will be taken in the order they appear in the Bill.
Clause 1
Offence of administering certain substances to a child
Carolyn Harris (Swansea East) (Lab)
I beg to move amendment 1, in clause 1, page 1, line 17, after “practitioner” insert “and deemed the procedure to be medically necessary”.
The Chair
With this it will be convenient to discuss amendment 2, in clause 1, page 1, line 21, after “practitioner” insert “who deemed the procedure to be medically necessary”.
Mr Kevan Jones (North Durham) (Lab)
It is a pleasure to serve under your chairmanship, Ms Rees. I broadly support the amendments, which I understand are of a probing nature. When we have the stand part debate, I will raise other concerns with clause 1, but I should start by congratulating the hon. Member for Sevenoaks for bringing the Bill forward.
The amendment tabled by my hon. Friend the Member for Swansea East is really about medical practitioners. We all want to think that medical practitioners are of the highest quality and abide by the law, but in this area that is not always the case—even in cases that are medically necessary. For a number of years, I have been involved in highlighting the lack of regulation when it comes to botox and fillers and the cosmetic surgery industry more broadly. The good thing about this Bill, although it is quite small in terms of changing the law, is that it is a welcome first step. There is cause for a lot more regulation in the area generally.
At the moment, the prescription of botox for cosmetic procedures is controlled, but there is clear evidence that medical practitioners are prescribing it in a way that leads to queries over the medical supervision. I would like to put my trust in the General Medical Council, but I have to say that my experience is that it is woefully inadequate in protecting the patient. A number of Members have met my constituent Dawn Knight, whose medical negligence case against her doctor took nearly five years to conclude.
I accept that there are situations where the prescription of botox, even for under-18s, is medically needed, but that needs to be explicitly in the Bill—that would then provide protection. I accept that there is then going to be an argument about the courts having one description and the GMC another. The problem is, however, that the GMC is failing. We need the law to be very clear that medical practitioners need a medical reason for prescribing botox for under-18s. Without having the wording in the Bill, people might somehow argue that because they are a medical practitioner, they can prescribe it whatever. The idea being advanced through these amendments, arguing about the medical necessity, would make the Bill stronger.
I accept that my hon. Friend the Member for Swansea East has tabled probing amendments, but we need to look at the issue as the Bill progresses. I will raise some of the broader issues, including my concerns about medical practitioners, in the clause stand part debate.
The Chair
Do any Front Benchers wish to speak at this stage? No? In that case, I bring in Carolyn Harris.
Carolyn Harris
Thank you, Ms Rees. I am not being presumptuous by sitting in the shadow Minister’s seat; I am merely observing social distancing. I would not presume to elevate myself to such great heights.
I would first like to congratulate the hon. Member for Sevenoaks on having secured parliamentary time to debate this important issue, and I welcome the Bill’s principle of protecting vulnerable young people. The amendments I have tabled are simply intended to improve the Bill. They aim to ensure that no person under 18 years of age receives a non-surgical cosmetic procedure unless it is deemed medically necessary, and medical advice has previously been sought.
As the co-chair of the all-party parliamentary group on beauty, aesthetics and wellbeing, alongside my hon. and dear Friend the Member for Bradford South, I recognise the importance of this Bill and its aim of protecting our young people. The APPG is currently conducting an important inquiry into non-surgical cosmetic procedures, and we have found that all representatives from the beauty industry and beyond are united in supporting a restriction on all persons under 18 years of age.
I am concerned that the Bill, as it is currently worded, would allow registered medical practitioners, as well as regulated health professionals under the direction of a registered medical practitioner, to carry out procedures on any person under the age of 18 without needing to provide medical evidence. I want to be absolutely clear: no practitioner should be exempted from this measure simply because of their qualification level.
It is important to make the case for rare exceptions, as non-surgical cosmetic procedures have uses outside aesthetics: for example, when treating certain muscle conditions such as dystonia, which is a type of uncontrollable muscle spasm. At the beauty, aesthetics and wellbeing APPG session yesterday, on ethics and mental health, it was emphasised by our expert witnesses that medical exemptions must be at the discretion of medical professionals such as psychologists, not left to the devices of the practitioner. One thing I found very disturbing is that we were given evidence by eminent experts in this field who told a story of some medical practitioners seeking excuses to carry out procedures during lockdown that would have justified them being able to practise. I felt that the Minister should know that.
I know that the hon. Member for Sevenoaks accepts the principle of these amendments, and I urge the Minister to consider how to protect vulnerable groups in our society, especially young people who are influenced by social media, peers, and in some cases the industry itself. I know that the hon. Lady will keep us informed about progress, and I urge the Government to make sure that we find a way to protect these young people going forward.
The Minister for Patient Safety, Mental Health and Suicide Prevention (Ms Nadine Dorries)
It is a delight to serve under your chairmanship, Ms Rees. I pay tribute to my hon. Friend the Member for Sevenoaks for all the hard work and commitment she has put into bringing the Bill forward. She had the delight of being drawn first in the ballot, but the passion and commitment she has shown to this issue, which is close to all our hearts, is second to none.
I thank the right hon. Member for North Durham and the hon. Member for Swansea East. Since I took up this post, the right hon. Gentleman has contacted me, written to me, spoken to me personally, and cornered me in the Tea Room and the corridors to talk to me about this subject many times. I know that he is passionately committed to the subject and the amendments that we are here to talk about. He has been relentless in his pursuit, letter writing and lobbying on the issue.
The hon. Member for Swansea East never rises to speak unless she firmly believes in what she is saying. She is an MP of principle and belief. It is a delight to have her in the House and we are the better for her presence here.
Can I clarify something, Ms Rees? Do you want me to make my comments now or are we going to the hon. Member for Swansea East first?
Ms Dorries
Thank you, Ms Rees.
The hon. Member for Swansea East has tabled her amendments. I wish again to reiterate the Government’s support for this legislation. On amendments 1 and 2, I should say that the Government are responsible for understanding the impact of any regulatory policy through the completion of a post-implementation review within the first five years following implementation. The review should assess whether the objectives of the regulation have been achieved and are still relevant, the cost of the policy and any wider unintended effects of the policy.
The indicators of the success of this policy would be a reduction in the numbers of businesses offering or performing treatments on under-18s. That may assessed through means such as measuring public, practitioner and stakeholder awareness and experience of the policy, to understand the policy’s reach and effectiveness, and gathering intelligence on the level of enforcement by the police and local authorities.
I was concerned to hear the hon. Lady’s comments about practitioners who were finding reasons and excuses to continue practising. That is something that I know my hon. Friend the Member for Sevenoaks has been made aware of, and we will keep it under review.
Laura Trott (Sevenoaks) (Con)
It is honour to serve under your chairmanship, Ms Rees. Before I start, I thank everyone in the room today. This has long been an overlooked area of policy, but with the work of everyone here, perhaps that will not be the case for much longer. As the right hon. Member for North Durham has said, it is a welcome first step.
I pay particular tribute to the work of the hon. Members for Swansea East and for Bradford South, and the all-party parliamentary group on beauty, aesthetics and wellbeing that they lead. The group’s findings have underpinned the substance of the Bill and I thank them for sponsoring it.
I completely agree with the sentiments behind the amendments. It is right that we should restrict these treatments for under-18s to only where it is absolutely medically necessary. The advice I have received is that that is covered in the Bill, inasmuch as UK doctors must be registered and hold a licence to practise with the GMC. The GMC publishes specific ethical guidance that says that doctors performing cosmetic interventions can provide treatment to children only when it is deemed to be medically in the best interests of the patient.
I accept that, as the right hon. Member for North Durham said, in some cases at the moment this is not happening correctly when it comes to botox, but to create a new legal precedent around the wording “deemed medically necessary” would add a layer of complexity, given that it is generally for the GMC to decide what is in the best interests of the patient. As he also mentioned, it would also produce two different authorities—the GMC and the court—which would then opine on the same issue. That could cause confusion.
I understand the thrust of the amendments, but if the hon. Member for Swansea East is content to withdraw them, I will work with hon. Members on some form of strengthened wording, which we can bring forward on Report.
Carolyn Harris
I welcome the comments from both the Minister and the hon. Member for Sevenoaks. We would welcome the opportunity to work with the hon. Lady to ensure that we strengthen the Bill. I beg to ask leave to withdraw the amendment.
Amendment, by leave, withdrawn.
Judith Cummins (Bradford South) (Lab)
I beg to move amendment 3, in clause 1, page 1, line 23, after “age,” insert “including by requiring and recording proof of this information,”.
It is a pleasure to serve under your chairmanship, Ms Rees. First, I thank the hon. Member for Sevenoaks for introducing this Bill and successfully bringing it to Committee. It is long overdue. I thank her from the bottom of my heart.
I stand in support of the Bill’s principles and I want to reiterate a point made by my hon. Friend the Member for Swansea East. My amendments seek to enhance the Bill and close the gaps in the wording. This amendment is a probing amendment and it deals with ensuring that a framework for age identification is present when practitioners are assessing a client for a non-surgical cosmetic procedure.
I am concerned that, as currently worded, the Bill leaves open to interpretation what reasonable steps a practitioner must make to establish the age of the person receiving the procedure. I want the Bill to make it clear that practitioners must request proof of age before any procedure is undertaken, verify the authenticity of that document and ensure that it is recorded, to ensure that there is no doubt about a client’s age. We need clear and explicit guidelines to ensure that vulnerable young people do not fall through the net.
My hon. Friend the Member for Swansea East and I established and became the co-chairs of the all-party parliamentary group on beauty, aesthetics and wellbeing. I am worried about how few protections there are for children under 18 years of age when it comes to non-surgical cosmetic procedures.
I was also in attendance at our inquiry into ethics and mental health. It will be no surprise that all our expert witnesses agreed that young people are at their most vulnerable in their teenage years. They are faced with many pressures, including societal pressures, which make ideal beauty standards the norm, especially in this age of social media. We must ensure we put safeguards in place to protect our young people.
I ask the hon. Member for Sevenoaks and the Government to consider this amendment to ensure that proper mechanisms are in place to strengthen the process of age verification for non-surgical cosmetic procedures and to improve the accountability of all practitioners. The amendment requires the practitioner to formally log and prove a client’s age.
Like my hon. Friend the Member for Swansea East, I welcome the opportunity to adapt the wording of the amendment should the hon. Member for Sevenoaks be unable to accept it. I ask that this amendment be considered.
Ms Dorries
Again, I thank the hon. Lady for moving the amendment. I understand that it will not be pressed to a Division, but I give her my absolute assurance that all comments made in the Committee today will be taken away and reviewed by my hon. Friend the Member for Sevenoaks and me before we move forward on to the next stage of the Bill. I thank all hon. Members for their contributions today.
Laura Trott
Again, I agree entirely that we must ensure providers have proof of age before carrying out treatments. However, I worry that the amendment is too narrow, in that it is for the defendant to establish the steps that they took to evidence proof of age. It is already implicit that that could and should include recording information, but it should not be limited to that. For example, it should be for them to establish the veracity of the documents produced, rather than just recording them.
While I completely agree with the intent of the amendment, I argue that it is not needed on the face of the Bill and would be more appropriately contained in guidance, which I would expect professional bodies to produce when the Bill becomes law. I would like to continue discussions with the hon. Members on the topic.
Judith Cummins
I am happy with the assurances that we will be listened to and that our words will be considered throughout the passage of the Bill. I beg to ask leave to withdraw the amendment.
Amendment, by leave, withdrawn.
Question proposed, That the clause stand part of the Bill.
Laura Trott
Clause 1 of the Bill creates a new criminal offence of administering in England botulinum toxin injections and cosmetic fillers to persons under 18. Currently, children and young people can access invasive cosmetic procedures on the commercial market without the requirement for any medical or psychological assessment. As the hon. Member for Bradford South said, that cannot be right.
Mr Kevan Jones
I welcome the Bill, but there are issues with it and those need to be improved.
Clause 1 goes to the heart of trying to stop the wild west that we have in this sector, but my concern is with the get-out-of-jail card for medical practitioners. Again, while most will follow the rules, there is clear evidence that we have medical practitioners signing prescriptions for botox and then selling them on. If we had a robust GMC or regulator that was clamping down on this, that would solve some of these problems, but I have seen no evidence of that at all.
The Bill will make a start on improving this situation, as the hon. Member for Sevenoaks said. There are existing regulations, but they are toothless. Do they provide the powers to intervene? Yes, I think so, but that is not happening. Certainly, the situation with prescription botox needs to be tightened up.
The problem I have, as I said in my earlier contribution, is the allowing of medical practitioners to administer these products to under-18s. I understand that there are perfectly good medical reasons that they are needed, and it would be wrong for the Bill to block those altogether, but I believe that regulation on this could be strengthened, and I know the hon. Lady and the Minister said that they will look at that.
I do not know whether this is something that the Minister could talk to the GMC about or whether we could get it into the Bill, or indeed if it is in the regulations that go alongside the Bill, but before an under-18 is prescribed these treatments, there should be a written prognosis giving the reason that they are needed. There should also be a clinical treatment plan outlining how and why those will be administered over a certain period, as well as a written statement relating to the supporting evidence, the consent of the patient and their guardians, and an agreement with the patient in advance on the expected outcomes. That would strengthen the rules.
Most practitioners will abide by the rules, but I have been looking at the sector for five or six years, and frankly, my experience is that there are medical professionals out there who are just out to make money.
Carolyn Harris
Does my right hon. Friend agree that the practice of remote prescription serves only to further damage the reputation of the industry? During a recent evidence session, a GP stated that they were offering a lifetime botox prescription for £50. That is a dangerous practice and it needs to be considered very deeply before we move forward on the issue.
Mr Jones
I agree. There are adverts on Amazon in this sector, and treatments offered include fillers, although certain other terms are used. People are not allowed to advertise botox, but they get around that by advertising consultations. In response to the question, many practitioners are not qualified at all and hold no medical qualifications, so how do they get access to botox? They do so because people are signing prescriptions. I fear that a situation may arise in which that practice continues, although it needs to stop.
Another issue is that under the definition the botox can be bought because this is basically a free market, as I see it. A practitioner could then administer the botox to a young person with no regard to that individual’s medical history. A medical practitioner, under the definition, could even be defined as a dentist. That needs tightening up. I do not think that would be onerous for doctors, who are quite rightly prescribing botox injections and other things for perfectly legitimate medical use. Doctors and patients are protected when those uses are laid out.
If I had more faith in the GMC to clamp down, I would be content to leave the situation as it is. I am sorry, but having seen the way the GMC operates, I see that the organisation is not friendly to the complainant or to the patient organisation. It protects the doctor. We took self-regulation away from solicitors, and I have concluded that self-regulation should be taken away from doctors. I did not start with that position, but have come to it.
The Minister promised a Bill on GMC reform in the last Parliament, and one is certainly needed, because frankly, the patient is at a disadvantage in a host of areas, not just this one. It cannot be right that it took my constituent’s case five years to reach the GMC, with huge hurdles to overcome to get there. I hear what the hon. Member for Sevenoaks says, but we should try to tighten things up a bit. The Bill will certainly be improved if we can.
Ms Dorries
Again, I thank my hon. Friend the Member for Sevenoaks. Many points have been made today and throughout the passage of the Bill that will give us plenty to consider and review.
The GMC publishes guidelines on the ethical obligations of doctors undertaking cosmetic procedures, including guidance on responsible advertising. There is no question as to the GMC’s performance and it being fit for purpose as an organisation. The GMC maintained its track record of meeting regulation standards last year, and it met those standards amid a surge in demand for registration.
The performance review of the GMC for 2018-19 by the Professional Standards Authority, the body that oversees the healthcare regulators, found that good practice was upheld in all 24 standards of good regulation across education, registration standards and fitness to practise. The review confirmed an effective approach to managing a rise in registration applications, progress with the credentialing framework and work to promote fairness in fitness to practise processes.
Mr Kevan Jones
I hear all that, but I think what needs to happen—I offer this to the Minister—is for her to meet my constituent, Dawn Knight, so she can explain to the Minister the agony that she went through to get justice. The GMC is not user-friendly to patients. The fact of the matter is that, in her case, a doctor was allowed to remain on the register for five years, even though there was clear evidence from multiple women that he had undertaken operations that were, in some cases, life-threatening. Frankly, that is appalling.
Ms Dorries
The right hon. Gentleman does Dawn great credit by raising that case again, and his words have been noted. He is a tireless advocate. The GMC publishes guidance on ethical obligations for doctors undertaking cosmetic procedures, as it does with all procedures that doctors undertake, which includes guidance on responsible advertising, as I have said. There is another opportunity to continue to raise this matter: I will take his comments away and, as I have a patient safety meeting later today, I will raise them in that forum as well, since this is ultimately a patient safety issue.
Sarah Owen (Luton North) (Lab)
First, I want to say a massive well done and thank you to the hon. Member for Sevenoaks for bringing this important Bill to us and getting it in Committee. The question is not necessarily about the existing guidance, but around the enforcement of that guidance—I think that is what my right hon. Friend the Member for North Durham is saying. It is not just about saying that the guidance is there; we need to see strengthening of that enforcement.
Ms Dorries
The most I can say at this point—Dawn is a case in point—is that I will take away the comments made by the right hon. Member for North Durham, and I know my hon. Friend the Member for Sevenoaks has also heard them. We will consider those comments. It might be that this matter cannot continue within the scope of the Bill, but we will look to continue it. This does not stop here: my hon. Friend the Member for Bosworth (Dr Evans) is introducing the Digitally Altered Body Images Bill under the ten-minute rule, so there will be another opportunity to raise these points. Within the confines of patient safety, this is an issue that we need to continue reviewing.
Mr Kevan Jones
Will the Minister look at prescriptions for botox as well? There is clearly a market out there and there are medical professionals signing prescriptions and then selling them on, fuelling this market and leading to people who are not qualified giving that botox. Could she look at that?
Ms Dorries
Of course. I heard that comment in the right hon. Gentleman’s initial remarks. This is a difficult market to police—it is regulated, but it is difficult to police and to know who those practitioners are and where they are selling prescriptions on to. If he knows of any practitioners who are doing that, or is aware of any practitioner who is writing out bulk prescriptions for botulinum toxin and selling them on to other, more ruthless practitioners, or to people who are not even registered to practise, I ask him to please let us know, then we can take that forward.
Mr Kevan Jones
May I suggest another way of doing this? If the Minister speaks to the prescription licensing body, it will know exactly who is signing huge amounts of botox prescriptions, and one possible way to investigate large numbers of botox prescriptions is to ask whether those people can justify what they are doing. If we go online, we see umpteen adverts for botox treatments, and those people who are doing this are not doctors, so where are they getting them from?
Ms Dorries
Again, the right hon. Gentleman has done his cause justice by raising those concerns and saying what he has in Committee. We will have a look at that.
Laura Trott
Thankfully, the future of the GMC is slightly wide of the scope of the Bill, so I will leave those matters to the Minister. However, the right hon. Member for North Durham made the point well that there is widespread abuse by doctors who prescribe botox for cosmetic purposes, particularly for under-18s. It is absolutely right that we are looking to fix that through the Bill, and we will talk further about the wording on it.
The right hon. Gentleman rightly made the case for wider reform of that area, which has not been regulated to the extent that it should have been over the years. The Bill will, I hope, be a first step in addressing that, as we discussed earlier.
Question put and agreed to.
Clause 1 accordingly ordered to stand part of the Bill.
Clause 2
Offence by persons carrying on a business
Mr Kevan Jones
I beg to move amendment 4, in clause 2, page 2, line 31, at end insert—
“(c) a person advertises or otherwise promotes the administration, in England, to another person (“A”)—
(i) botulinum toxin, or
(ii) a subcutaneous, submucous or intradermal injection of a filler for a cosmetic purpose, where A is under the age of 18;”
The Chair
With this it will be convenient to consider new clause 1—Report on preventative measures—
“(1) The Secretary of State must prepare a report on steps that are being, and will be, taken to seek to prevent offences being committed under this Act.
(2) That report must include any steps to prevent the advertising or promotion of the cosmetic use of botulinum toxin and fillers on children.
(3) The report must be laid before Parliament no later than the end of the period of six months beginning with the day on which this Act is passed.”
Mr Jones
Again, this is a probing amendment to get concerns on the record. These issues affect not only under-18s, but people in the wider sector. The amendment deals with the broader issue of the way that the industry has developed. The concern is that botox is a prescription medicine, but if someone were to look at online adverts, they would think it was something that they could just pick up on the street corner. In fact, it can be picked up on the street corner, because the individuals who advertise the injections are not regulated.
Online, people offer home injections, botox parties or injections on premises that are not regulated in any way to ensure that basic hygiene is in place. The other worrying point is that the individuals who carry out the injections are not qualified in any shape or form. There are clear instances when people ask, “Well, what’s the danger?” There are dangers to injecting anything into someone’s body, but particularly in some of the areas in which botox is injected, such as the eyes and other areas. Such injections can lead to nerve damage and quite severe problems, and a medical professional would obviously know not to do them. With someone who is completely unqualified, there is a huge danger that under-18s, and even older age groups, could be affected by those problems.
Judith Cummins
Would my right hon. Friend’s amendment cover the eventuality that I described? That was related to me by the APPG’s most in-touch consultant, my daughter, who told us about her friend who, for her 16th birthday, had a lip filler injected by her cousin.
Mr Jones
That is the point. Part of this is about a process of education to teach people what the dangers are. These products are marketed and sold to people—especially young people—as if they are just like make-up.
Well, they are not make-up—this is a medical procedure that can have life-threatening consequences if it goes wrong. It is clear that some of the advertising on Facebook and other sites is directed at under-18s. The Minister mentioned body image, and the Mental Health Foundation’s report from last year on that issue shows that the marketing is for young people.
This is a probing amendment to get this issue on the record. We need to look at ways to ensure that young people are protected from advertising. It is not newspaper advertising; that is for old-fashioned people like me. It is advertising on Facebook, Instagram and elsewhere. I have raised this issue with Facebook. Of course, we get the usual guff from Facebook: “Oh well, we take them down.” I have even written to Sir Nick Clegg asking whether he will do anything about it. Getting an audience with or response from the Pope would be easier than getting a response from him. Those platforms are making money out of this, and they are targeting their adverts at young people, not older people.
Do not get me started on the Advertising Standards Authority, which is a completely toothless, useless tiger, frankly. It takes down some adverts, but they keep proliferating. The social media companies need to do something about it, because young people are being put at risk and because there is a market. Botox is supposed to be a medically controlled substance, but it is not; it is advertised. The way the companies get around that is that, although they cannot advertise botox, they can advertise a consultation, which just happens to be for botox. Facebook, Instagram and others could take down those adverts overnight and just stop them, but they are not doing that because there is clearly money to be made in this sector. Some of those issues will come out in the private Member’s Bill of the hon. Member for Bosworth on body image, but if we do not tackle them, this Bill could be enacted and the Facebooks of this world could still make money on the back of this sector.
The purpose of new clause 1 is to ensure some oversight over the effectiveness of the Bill. It calls for a report when it is under way so that we can assess whether it is effective. It also relates to advertising and promotion. By raising this issue with the Minister, I want to put on the record that there is an issue. I accept that advertising is not directly within her remit as Public Health Minister, but I want to see what more can we do not just on the targeting of under-18s, but on the broader issue of the way in which big business is trying to circumvent the law—advertising botox is supposed to be illegal.
There are two ways of doing that. The first is to stop the supply of botox from prescribers, and the second is to crack down on it very heavily. The Mental Health Foundation’s report on body image shows that, in this age of the internet and the internet of things, young people are in a terrible situation and are suffering due to their body image. That is reinforced by advertising. Botox is seen as a quick fix, but it is potentially dangerous. We need to try to stop this danger to our young people.
Ms Dorries
The right hon. Gentleman has made wide-ranging and important comments. I am not sure it was any easier to speak to the former right hon. Member for Sheffield, Hallam when he was in this place than it is now—there is not much change there—but I thank the right hon. Member for North Durham on all our behalf for his efforts to do so. Outside of the Committee and official channels, he still keeps batting away and trying to get results. We thank him for that.
I believe everyone has the right to make informed decisions about their bodies and our role in Government is to support young people in making safe, informed choices and, where necessary, to protect them from the potential harm that cosmetic procedures can do to their health. This Bill is a really important step on that path and in that process.
On indemnity, the Government passed legislation in July 2014 requiring all practising regulated healthcare professionals to have appropriate indemnity arrangements in place as a condition of registration with the regulatory body and, therefore, their ability to practise. For doctors, those regulations came into force in August 2015. Failure to comply may mean that they are dealt with under fitness-to-practise procedures. That means that all practising surgeons are affected by the legislation, including overseas surgeons practising in the UK. I hope that information helps.
Mr Kevan Jones
I am not against the cosmetics industry. I agree with what the Minister just said—it is about informed choice—but it has to be done safely. I welcome her comments on professionals. The big grey area, which this Bill cannot cover but which needs covering, is those who administer botox and fillers. Most of those people are not medical professionals. They have done “a course” in injections, which in some cases I have seen is just a tick-box exercise. That is the area we need to move on to next—not only who can prescribe, but who can inject these fillers and botox.
Ms Dorries
As the right hon. Gentleman notes, those matters are not within the scope of the Bill and the Bill will not seek to achieve the points he has made. As I have said before, I will take the comments away and will continue to work on them and review them.
Laura Trott
I thank the right hon. Member for North Durham for all his work in this area. On amendment 4, the pressure that young people are put under by social media is undoubtedly a motivating factor behind many of them seeking out these cosmetic treatments. That was discussed at length on Second Reading by the hon. Member for Clwyd South, among others. In many case studies that we have heard, discounts were one of the reasons that a young person went to have one of these treatments.
I note that there is a lot more work going on this area, which is welcome. In January, the Committee of Advertising Practice and the Medicines and Healthcare Products Regulatory Authority issued an enforcement notice to the beauty and cosmetics industry and have started to use monitoring tools to take down posts on social media, which is a welcome development, although obviously we need more.
I completely agree that further work is needed in this area. However, as the right hon. Gentleman rightly notes, it is outside the scope of the Bill. I will be making those points in the debates on forthcoming online harms regulations. I imagine he will be doing the same.
Mr Kevan Jones
These were probing amendments. I took the opportunity to get them on the record, as it is important to ensure that we tackle this area. I welcome the Minister’s comments on this being an area that we need to look at further. I know the Department of Health and Social Care does not like to bring legislation forward because it is still suffering from the Care Act 2014—
Mr Jones
Well, I was told that by a Minister in her Department. One simple thing we could do is to regulate those who administer these fillers and botox. That would be a huge step forward. I beg to ask leave to withdraw the amendment.
Amendment, by leave, withdrawn.
Question proposed, That the clause stand part of the Bill.
Laura Trott
Clause 2 sets out a duty on business owners to ensure that substances are not administered to a person under 18. This does not apply to administration by a doctor or regulated healthcare professional. Subsection (1)(b) sets out that a business owner commits an offence if they or someone acting on their behalf makes arrangements for botox or filler to be administered by injection for cosmetic reasons to a person under the age of 18. This will cover, for example, making an appointment, or agreeing to make an appointment by social media. By making it an offence to make arrangements to administer the products covered by the legislation, prosecutions can be brought even when the person aged under 18 does not go on to have the procedure administered because, for example, they changed their mind or there was an intervention by an enforcement body.
Ms Dorries
My hon. Friend the Member for Sevenoaks has said everything that needs to be said about these clauses.
Mr Kevan Jones
Are we now debating whether the rest of the clauses stand part of the Bill?
Mr Jones
Right. I again put on the record my thanks to the hon. Member for Sevenoaks for bringing the Bill forward. Will the Bill solve all our problems in this sector? No, it will not, but as I say, it is a welcome first step. It also gives us an opportunity to put on the record other concerns, which I know the hon. Lady shares.
This industry—because it is a multibillion-pound industry—is very lightly regulated. When these fillers and botox procedures go wrong, they can cause damage to individuals and costs for the NHS. There are cases of people having to go through expensive procedures on the NHS to put things right before we even mention the cosmetic surgery industry, which costs this country an absolute fortune when operations go wrong and the cost of people’s life-changing conditions have to be met by the taxpayer.
Going right back to when I was chair of public health in Newcastle upon Tyne in the early ’90s, I am reminded a little bit of the same lack of regulation that there was around tattoo parlours. The Government changed that and gave local authorities clear powers. Now, largely, the rules on administering tattoos, for example, are clear. They are enforced by local authorities and the standards are high. To go back to what the Minister said, I agree: I do not want to close the industry down. It has to be about personal choice. If people want some type of what they consider necessary enhancements, that is entirely up to them; but it must be done in a safe and regulated way. I referred to the wild west, and it is like that: there is little control over what is happening.
I think it is five years since the Keogh review recommended increased regulation, and it is now time, with the Bill, which will be a first step forward, to try to get those recommendations put into law. I think that if that proposal came forward there would be no problems about getting cross-party support. I would be a huge champion of such regulations. The issue is not just with fillers and botox, but the broader cosmetic surgery industry. It is about people making informed choices and ensuring that work is done in a safe and effective way. At the moment, the system is in many ways completely unregulated, and regulations that exist are being ignored.
I congratulate the hon. Member for Sevenoaks on bringing the Bill forward, and thank the Minister for how she has responded and taken the issues on board. I think that, although on occasions we have our disagreements, she believes at heart that in the sector in question things should change, and patient safety should come first and foremost for everyone.
Laura Trott
Many good points have been made today about the wider work that we need to do in this, but when the Bill goes through it will be the next step towards protecting children, in an area where at the moment they are open to physical and mental scarring for life. I thank everyone who is here today for their work in supporting the Bill, and I thank you, Ms Rees.
Question put and agreed to.
Clause 2 accordingly ordered to stand part of the Bill.
Clauses 3 to 6 ordered to stand part of the Bill.
Bill to be reported, without amendment.
10.23 am
Committee rose.
Botulinum Toxin and Cosmetic Fillers (Children) Bill
Friday 12th March 2021
(3 years, 8 months ago)
Commons ChamberRead Full debate Botulinum Toxin and Cosmetic Fillers (Children) Act 2021 Read Hansard Text Read Debate Ministerial Extracts Amendment Paper: Consideration of Bill Amendments as at 12 March 2021 - (12 Mar 2021)
Sir Christopher Chope (Christchurch) (Con)
I beg to move amendment 1, page 3, line 29, leave out clause 5.
Madam Deputy Speaker (Dame Eleanor Laing)
With this it will be convenient to discuss amendment 2, in clause 6, page 3, line 38, leave out from “force” to end of subsection and insert “on 1 October 2021”.
This amendment will incorporate into the Bill the guidance for policy makers issued in August 2010 that there should be two common commencement dates each year, one of which is 1st October, for the introduction of changes to regulations affecting businesses.
Sir Christopher Chope
Amendment 1 stands in my name and the names of my hon. Friends the Members for Wellingborough (Mr Bone) and for Shipley (Philip Davies).
The purpose of amendments 1 and 2 is to try to address the quality of the legislation that we produce in this House. Using clauses as a means of giving the power to change a whole mass of other legislation has long been a bugbear of mine and is exactly what clause 5 does, which is why the Bill would be better without it. I know that, inevitably, the response from the Government on these issues is always, “Oh, well, this is belt and braces and it will save time in the future because we won’t have to bring forward fresh legislation or statutory instruments in order to cover scenarios that we have not yet thought about.” It seems to me that the case has not been made, which is why I have moved amendment 1.
Amendment 2 is a similar provision to the one on which I was briefly trying to engage the Under-Secretary of State for Education, my hon. Friend the Member for Chichester (Gillian Keegan), when we were discussing the Education and Training (Welfare of Children) Bill. The Minister would not engage with me because she felt that that Bill was a deregulatory Bill—she was probably right—and that, therefore, this provision did not really apply. None the less, the purpose of this is to try to ensure that there should be two common commencement dates each year for regulations that impact on businesses, and that one of those should be 1 October, because that seems to be closest to the time when this Bill will be implemented, so that is the date that I have chosen. Perhaps the Minister will be able to give me an assurance that it is indeed the Government’s policy to deregulate and reduce the regulatory burden on businesses and individuals, and to reassert that the Government accept the virtue of having two days each year that might be described as regulatory days, because that will not only facilitate the effectiveness of our legislative process, but make it much easier for those who are impacted on by our legislation to respond and prepare for it. That is why I moved amendment 1 and have spoken to amendment 2.
Laura Trott (Sevenoaks) (Con) [V]
I am very grateful to have reached this point today. This is an important Bill that will protect young people. We are short on time, so I will cover the substance of the amendments quickly. On amendment 1, consequential provisions are essential to ensure consistency with other legislation. On amendment 2, six months will enable the necessary changes to be made to the human medicines regulations under the consequential provisions that were just discussed.
Alex Norris (Nottingham North) (Lab/Co-op) [V]
I have been reassured by the answers given to the promoter of the Bill, the hon. Member for Sevenoaks (Laura Trott), so I do not intend to support either amendment or delay proceedings any further.
The Minister for Patient Safety, Suicide Prevention and Mental Health (Ms Nadine Dorries) [V]
I congratulate my hon. Friend the Member for Sevenoaks (Laura Trott) on the outstanding work that she has done in introducing the Bill, and I reiterate the Government’s support for the legislation. I believe that everyone has the right to make informed decisions about their bodies, but our role in Government is to support young people in making safe, informed choices where necessary to protect them from the potential harm that cosmetic procedures can do to their health. The increasing popularity of cosmetic procedures and the pressures on our young people to achieve this aesthetic ideal are well documented, and I believe that the Bill is an important step in putting those necessary safeguards in place.
I acknowledge the intentions behind the amendment tabled in the Public Bill Committee by the hon. Members for Swansea East (Carolyn Harris) and for Bradford South (Judith Cummins) to introduce a medical necessity test on the face of the Bill, and I hope that they have taken assurances from the explanation by my hon. Friend the Member for Sevenoaks of the work that she has done to explore this. The standards set by the General Medical Council already require doctors to consider the best interests of the patient to cover the ethical treatment of under-18s.
It has been an absolute pleasure to work with my hon. Friend to take this step towards greater regulation of the cosmetic procedure industry. I look forward to the Bill’s successful passage through the Lords.
Sir Christopher Chope
Because time is running short, I thank those who have contributed to this short debate, and so that we can move on to Third Reading, I beg to ask leave to withdraw the amendment.
Amendment, by leave, withdrawn.
Third Reading
Laura Trott [V]
As discussed, time is short, so I will keep my remarks to a minimum. I thank everyone who has been involved in this Bill. I pay tribute to my hon. Friend the Member for South Leicestershire (Alberto Costa), the hon. Members for Swansea East (Carolyn Harris) and for Bradford South (Judith Cummins), and the right hon. Member for North Durham (Mr Jones), all of whom have raised the profile of this very important issue over a number of years. I also pay tribute to the work of Save Face, a campaigning organisation that has done brilliant work to safeguard many, many young people over many years. Lastly, I also thank the Minister, whose support throughout this has been absolute, and I am very grateful.
Ms Dorries [V]
I have nothing further to say due to the shortage of time. I just reiterate that it has been an absolute pleasure to work with my hon. Friend the Member for Sevenoaks (Laura Trott) to take these steps forward to the conclusion of the Bill, and I commend it to the House.
Alex Norris [V]
I add my congratulations to the hon. Member for Sevenoaks (Laura Trott). I know that this has been no mean feat, especially during the current challenging times, and there has had to be a lot of patience, but it has been rewarded today. It is important that we act to protect our young people, especially with the pressures that they face. This is one of those great bits of legislation where I think if we stopped our constituents in the street and asked them about it, they would think it was already like this. This is a common-sense, practical and proportionate way to protect our young people, and we give it our full support.
Sir Christopher Chope
I, too, support this Bill. I notice that it was first canvassed as a possibility in the 2017 Conservative manifesto, which contained a commitment to ensure the
“effective registration and regulation of those performing cosmetic interventions.”
I had not realised the extent to which children had been able to access botulinum toxin and cosmetic filler procedures without a medical or psychological assessment; nor had I realised that practitioners did not need to be medically qualified to perform the procedures and that there are no mandatory competency or qualification frameworks related to their administration. Obviously, this Bill will help to avoid the potential health risks of such procedures, which include blindness, tissue necrosis, infection, scarring and psychological impacts.
It seems to me that my hon. Friend the Member for Sevenoaks (Laura Trott), so early on in her obviously very promising political career, has been able to identify an issue on which there is a lot of enthusiastic support. I congratulate and thank her for bringing the Bill forward, and I hope that it makes successful progress in the other place after its passage here.
Laura Trott [V]
I am grateful to my hon. Friend the Member for Christchurch (Sir Christopher Chope) for his remarks, and to the Opposition and the Government for their support.
Question put and agreed to.
Bill accordingly read the Third time and passed.
Botulinum Toxin and Cosmetic Filters (Children) Bill
Friday 12th March 2021
(3 years, 8 months ago)
Lords ChamberRead Full debate Botulinum Toxin and Cosmetic Fillers (Children) Act 2021 Read Hansard Text Amendment Paper: Consideration of Bill Amendments as at 12 March 2021 - (12 Mar 2021)
Botulinum Toxin and Cosmetic Fillers (Children) Bill
Friday 16th April 2021
(3 years, 7 months ago)
Lords ChamberRead Full debate Botulinum Toxin and Cosmetic Fillers (Children) Act 2021 Read Hansard Text Read Debate Ministerial Extracts Amendment Paper: Consideration of Bill Amendments as at 12 March 2021 - (12 Mar 2021)
Baroness Wyld (Con)
My Lords, I first congratulate Laura Trott MP on her success in skilfully navigating her Bill through the other place, and in particular on its arrival in this House unamended. I am afraid the beginning of my speech may be a bit of an Oscars speech, because so many people have campaigned on this issue to date. I want to mention Alberto Costa MP, who has campaigned for so many years following the high-profile case of one of his constituents who suffered a terrible injury following a botched lip filler administered by an unregulated and unqualified beautician, and Carolyn Harris MP and Judith Cummins MP, who are co-chairs of the All-Party Group on Beauty, Aesthetics and Wellbeing. I also pay tribute to the fantastic work of Save Face, which is a national register of accredited practitioners who provide non-surgical cosmetic treatments.
I was delighted when Laura Trott approached me to sponsor this Bill in this House and I hope, with the help of noble Lords, to steer it on to the statute book in the remaining weeks of this Session. I am sure we will have a very wide-ranging discussion about children and young people; for good order, I declare my interests as a non-executive member of the boards of Ofsted and DCMS.
The purpose of the Botulinum Toxin and Cosmetic Fillers (Children) Bill—which is very hard to say—is to prohibit specific cosmetic procedures being performed on people under the age of 18 in England, except under the direction of a doctor, thus safeguarding children from the potential health risks of Botox and cosmetic fillers. The Bill has cross-party and government support; we are very grateful for the collaboration from both Opposition Benches and the time that noble Lords have given me. I hope that will help its progress.
I still find it quite shocking that this Bill is needed at all. To be clear, I have no problem whatever with an individual’s right to alter their appearance, should they so wish. However, children are still developing, physically and emotionally, and without this legislation we are leaving them exposed to completely unacceptable risk. Laura Trott commented in the other place:
“The most frequent reaction I have received in response to my Bill is, ‘Surely, that is illegal already.’”—[Official Report, Commons, 16/10/20; col. 652.]
Today we have the chance to ensure we put this right.
In recent years we have seen a growing prevalence and normalisation of non-surgical cosmetic procedures; they are increasingly accessible and affordable on the high street because technologies and products in this field have advanced. Cosmetic fillers and botulinum toxin—which I will refer to as Botox, which is actually a brand name—have been identified as the two procedures most appropriate to be brought under the scope of the Bill, as they are two of the most accessible and invasive procedures available on the high street.
For those who do not know, I will quickly say what Botox and cosmetic fillers are. Fillers are gel-like substances commonly injected into the lips or face to add volume and plump the injected area; they may also be used in the hands and feet, or for non-surgical nose jobs. There are temporary fillers and less common permanent fillers, which have an increased risk of serious complications. Although some filler products are regulated as medicines, they are usually classified as general products. As a result, there is a vast range of products available for purchase, and the specification and assurance of the product is limited.
Botulinum toxin is a medicine injected into the skin to smooth lines and wrinkles—I considered making a joke about Botox in your Lordships’ House, but I thought we ought to play it safe today. As prescription-only medicines, they are regulated by the MHRA in the UK. Regulated healthcare professionals with prescribing responsibilities, such as doctors, may delegate responsibility for the administration of the medicine to a secondary practitioner who does not have to be medically qualified.
I will now explain why children are at risk. In England, cosmetic surgery can be performed only by doctors registered with the GMC, and providers of cosmetic surgery are required to register with the Care Quality Commission. As non-surgical procedures, the administration of botulinum toxin and cosmetic fillers is not a regulated activity. The procedures can be performed by clinicians, beauty therapists or lay people in both clinical and high street venues.
Although these procedures are offered on the high street, there are risks and complications. Risks from Botox include blurred or double vision, breathing difficulties, if the neck area is injected, and infections. For fillers, complications include the substance moving away from the intended treatment area, infection, scarring and blocked blood vessels in the face, which can cause tissue death and permanent blindness. People—mainly women—have been left with rotting tissues, lip amputations and lumps.
Currently, children, in the same way as adults, may access Botox and cosmetic filler procedures on the commercial market without a medical or psychological assessment. A 2018 survey showed that 100,000 under-16s had undergone cosmetic enhancements, the most common of which were fillers.
This Bill’s focus is intentionally narrow. It will create a new offence in England of administering botulinum toxin and cosmetic fillers to persons under 18, except where their use has been approved by a medical practitioner. The procedures will still be available to under-18s from doctors and a limited range of registered health professionals—dentists, pharmacists and nurses who are acting under the direction of a doctor—as there are cases where medical conditions would require such a treatment, for example with migraines. It also places a duty on businesses to ensure that they do not arrange or perform the procedure on under-18s unless it is administered by an approved person—a doctor, nurse, pharmacist or dentist.
The Bill creates no new enforcement mechanisms. Local authorities will be able to use the powers already accorded to them under the Consumer Rights Act 2015. As they would be criminal offences, the police can use their existing powers in relation to the powers in the Bill. The legislation would bring these specific invasive cosmetic procedures in line with age restrictions on tattoos, teeth-whitening and sunbed use.
The Bill is both short and straightforward—in many ways that is its strength—but its effect in introducing an important protection for young people is crucial. It is not about attacking the cosmetic treatment industry; indeed, the industry supports the purpose of the Bill. It is about ensuring that young people cannot access cosmetic procedures until they are able to make a genuine, informed choice.
Like many others speaking today, I speak a fair bit in this House and in my other work outside it about policy affecting children and young people. I spend most of the rest of my life, when not at work, worrying about my three young daughters and whether I am being overprotective or not protective enough, given that, after all, life is full of risk and we should prepare children for that. But there are situations when we have an absolute responsibility to step in and remove danger. I strongly believe that this is one of them. I beg to move.
Baroness Massey of Darwen (Lab) [V]
My Lords, I thank the noble Baroness, Lady Wyld, and the original mover of this Bill, Laura Trott, MP for Sevenoaks, for bringing this important issue to our attention. In particular, I thank the noble Baroness for setting out the issues so clearly today. I know that Nadine Dorries, Minister for Mental Health, Suicide Prevention and Patient Safety, has already indicated government support for the Bill, which is welcome. The noble Baroness laid out the main concerns set out in the Bill. I will simply emphasise the importance of this legislation and some of the possibilities and dilemmas involved.
The United Nations Convention on the Rights of the Child, along with other domestic legislation, sets out the need to protect children—under-18s—from all kinds of dangers. But children take risks, and hopefully learn from any mistakes. They must also be empowered by parents, schools and society to resist dangerous actions and say no to pressure—and there is a good deal of pressure on young people in relation to their appearance, particularly girls.
Social media exerts huge influence. As Laura Trott said at Second Reading in another place, girls see the attainment of physical desirability as unachievable without cosmetic surgery. This is increasingly available, no questions asked, through DIY efforts at home, despite Botox being a prescription-only medicine which should be administered by medical professionals who have taken account of the person’s age and believe them to be over 18.
It is clear from the evidence that procedures are inadequately regulated and may result in horrific injuries—physical, mental and emotional. Some 100,000 treatments of under-16s have been recorded, and the actual number is probably higher. Reparation of injury is expensive and difficult.
The Bill is very timely. Legislation is clearly needed, but so is a public health approach that informs and persuades people to change their behaviour. Young people may grow out of dangerous behaviour, but that may be too late and much regretted. Will any public health messages about botulinum toxin be directed at young people and parents? Are schools being warned to look out for symptoms? Is counselling available? How will perpetrators of illegal treatments be dealt with?
I see that there are signs that the Bill could result in increased funding for local authorities to carry out enforcement of the law and that the regulations consequential on the Bill could be made by statutory instruments. All that is welcome, but I hope that careful watch will be kept on the impact of the Bill and progress monitored, not only on the number of cases but on interventions to help children keep well away from these dangerous practices.
Baroness Walmsley (LD) [V]
My Lords, I thank the noble Baroness, Lady Wyld, for bringing us the Bill, and I support it as far as it goes. However, I would like assurances that, using the powers to make regulations in Clause 5, the Government will ensure that, for the most part, botulinum toxin procedures on under-18s do not take place at all, even by a clinician.
We live in a world where young people, particularly girls, are under great peer pressure about their appearance and their weight. Undertaking a dangerous procedure such as this is not necessarily the answer. If the matter affects the mental health of the young person, it should be treated as a mental health issue, not with Botox.
The charity Changing Faces has provided us with the voices of young girls affected by “visible difference”. One said, “Everywhere I looked, clear-skinned models told me the same thing. I never saw a public figure that looked like me and I felt totally alone. I spent hours researching various scar removal surgeries and extreme treatments and started saving for them.” These young people require support, information, the attention of professionals and the protection of the law.
When the Bill was debated in another place, amendments were tabled to ensure that medical practitioners could provide non-surgical cosmetic procedures to a person under 18 only if it was medically necessary. I agree with this. There may be situations where facial disfigurement from whatever cause is causing physical or mental distress to the patient and for which botulinum toxin is considered by a doctor to be the appropriate treatment, rather than more intrusive cosmetic surgery. In such cases, regulations could be used to lay down those matters which should be considered before a clinical decision is reached.
Laura Trott MP, the sponsor of the Bill, argued that it already had safeguards to ensure that under-18s would receive these procedures only where medically necessary. The Minister, Nadine Dorries, agreed that there would be a review of the regulations to assess any unintended consequences. I would like an assurance that this review will consider regulations to restrict the use of this procedure except in certain clearly defined conditions of medical need.
I am aware that GMC guidance says that doctors performing cosmetic interventions can provide treatment to children only when it is deemed to be medically in the best interests of the patient. However, I would like to see the Government making their intentions clear in regulations that under-18s should not receive this treatment except where strictly medically necessary. I would also like the Minister’s assurance that mental health support will be provided to patients in this situation where appropriate.
Lord Lansley (Con)
My Lords, I congratulate my noble friend on bringing this Bill forward and on her excellent presentation, which set out very clearly its purposes and justification. I very much support it.
My noble friend will know, and the House may well recall, that the Bill is in line with one of the recommendations from the Review of the Regulation of Cosmetic Interventions led by Sir Bruce Keogh and published in April 2013. Of course, as Secretary of State, I asked him to lead that review back in January 2012, following the PIP breast implant scandal disclosed the previous month. It is fixed in the memory of Health Ministers across the globe—the problems were disclosed by the French Government the day before Christmas Eve, so we all lost our Christmas in 2011. One of the consequences was that the many issues and problems associated with cosmetic interventions and medical devices were exposed. Indeed, the Keogh review did a great deal to help to bring that forward. I think this Bill will be extremely welcome.
While I have this moment, I would mention the Cosmetic Surgery (Standards) Bill in my name, which is way down in the Lords list of Private Members’ Bills. It is not going to have the benefit of the House’s attention in this parliamentary Session; I hope it may in a future one, perhaps even with the benefit of support from the Government at some point. It also follows up one of Bruce Keogh’s recommendations. It was very good that our honourable friend the Member for Sevenoaks was able skilfully to bring this Bill through. I know how difficult it is in another place to get a Private Member’s Bill through, even if one is fortunate to get a place in the ballot.
I briefly mention two other things. First, Kevan Jones, who also supports my Bill, spoke in the other place about the issues associated with advertising cosmetic interventions, increasingly on social media these days, and he was right to do so. That is an issue raised in the review that needs to be followed up. I also hope that, in line with my Bill, the Government will encourage the General Medical Council, regardless of legislation or otherwise, to use the Royal College of Surgeons interspecialty committee’s work on certification for cosmetic surgery to try to ensure that it is indicated on the medical register, so that people can identify who is properly certified and qualified to provide cosmetic interventions.
Bruce Keogh’s review said—I think I quote correctly—that, in
“our view … dermal fillers are a crisis waiting to happen.”
It is not a crisis in respect of which young people should be the victims. I am very glad that my noble friend has brought the Bill forward, and I hope that we will be able to pass it into law before the end of this Session.
Baroness Bull (CB)
My Lords, I too congratulate the noble Baroness, Lady Wyld, on bringing the Bill to the House and on her excellent introduction.
Restricting the use of Botox and cosmetic fillers in young people seems to me such an unarguable proposition that I could resume my seat at this point. However, I would like to take a moment to set this legislation in the wider context of body image and, in particular, the causes and impact of body image negativity in children.
The term “body image” describes our relationship with our body—how we think and feel about it and how much other people’s opinions affect that view. The recent report from the Women and Equalities Committee in the other place reveals that 66% of children feel negative about their body image, with body dissatisfaction identified in children as young as five.
Poor body image matters because of where it leads: low self-esteem, depression, anxiety, body dysmorphic disorder and eating disorders. Poor body image prevents young people from taking exercise, joining clubs, visiting their GP or even speaking up in the classroom. It increases risky behaviours, reduces quality of life and, at the extreme, can lead to self-harm and suicide ideation. It does not go away: poor body image lasts a lifetime. It is not surprising that Professor Chambers of the Nuffield Council on Bioethics describes body image as nothing short of a public health issue.
The factors acting on our sense of our bodies are manifold and unrelenting. From early childhood, we are bombarded with images of unrealistic bodies on screen, in print and online—ideals that young people internalise and then pursue, with social media the perfect platform to idealise and compare. The Commons inquiry highlights the damaging impact of digitally altered or filtered images in advertising across social media, with image editing apps readily available to change our shape or our appearance—apps regularly used by 45% of 11 to 16 year-olds.
I stress all this today because body image dissatisfaction is understood to be a motivator for the pursuit of cosmetic medical interventions. Preventing these procedures for young people who do not have the maturity to give informed consent at least addresses the supply side of the equation, but can the Minister say what we can do to address the demand side? What steps will government take to reduce the image editing, ban altered images and encourage use of a greater diversity of body types in advertising? Will the Government ensure that the forthcoming online harms Bill covers harms related to body image, and will they reconsider the potential harms inherent in the obesity strategy, particularly those relating to calorie labelling, which the Minister has been good enough to discuss with me?
The Bill is important, I support it and its provisions are welcome, but it addresses only part of the problem. Unless we create an environment in which children are supported to accept and enjoy their bodies as they are, they are likely to carry on chasing the fairy tale dream of a skin-deep perfection that does not in reality exist.
Baroness Sugg (Con) [V]
My Lords, I speak in full support of this Bill. I congratulate my noble friend Lady Wyld for sponsoring it and thank Laura Trott MP for her work on it in the other place.
The non-surgical cosmetic treatment industry is worth over £2.75 billion and accounts for over 75% of all cosmetic enhancements carried out each year. However, it remains almost entirely unregulated, meaning that legally, cosmetic injections can be administered by pretty much anyone.
A number of reports over the years have highlighted and flagged this problem. The review by Sir Bruce Keogh, commissioned by my noble friend Lord Lansley, found that, among other things, non-surgical cosmetic procedures were almost entirely unregulated. In 2017, a report by the Nuffield Council on Bioethics highlighted several concerns, including “inadequate” controls on the safety of some of the products and the absence of any statutory requirements for practitioners who perform such procedures to have particular qualifications or experience.
I am pleased that the Government have been considering ways that training and qualifications could strengthen sector standards and that they have been exploring the regulation of premises, practitioners, products and consumer safeguards. I welcome moves from practitioners to make these procedures safer, and I commend the work of bodies such as Save Face, an organisation that provides a national register of accredited practitioners.
This Bill is needed, and needed now. We know this is a problem that needs resolving. There are clear complications that can occur through such treatments, which other noble Lords have highlighted. The number of cases of botched jobs has at least doubled in the last year and, given the unregulated nature of the industry, that is probably just the tip of the iceberg.
As the demand for treatment has continued to increase, so have the number of unscrupulous treatment providers. We know that tens of thousands of under-18s undergo cosmetic enhancements every year, with cosmetic fillers being the most common procedure. Children should not be able to access these procedures from unregulated and unqualified providers, let alone with no prior medical or psychological assessment required.
It has been nearly a decade since Sir Bruce Keogh’s original and concerning report. In the intervening years, as my noble friend Lady Wyld highlighted in her opening speech, there has been a growing prevalence and normalisation of non-surgical cosmetic procedures. These services are more accessible and more affordable. For young people, as the noble Baronesses, Lady Massey and Lady Bull, highlighted, there are huge pressures to conform to the unrealistic and unattainable ideals that young people, particularly girls, see on social media.
This Bill will stop the dangerous and unnecessary non-medical procedures that can ruin children’s lives. It is narrowly focused and includes exceptions and protections where appropriate. It has been widely welcomed as a positive step forward by the industry and patient safety campaigners and across the political spectrum, and I hope that it moves forward unamended. My particular questions to the Minister have already been asked by other noble Lords today. I am pleased that the Government fully supported the Bill in the other place, and I look forward to hearing the Minister’s response.
Baroness Meyer (Con)
My Lords, I too fully support this Bill and thank my noble friend Lady Wyld for introducing it to this House.
If you need to be 18 to get a tattoo or a sunbed session, it stands to reason that Botox and fillers should also be illegal, to protect children under 18 from themselves and from unscrupulous practitioners. It is normal for teenagers to worry about their appearance. However, as we heard earlier, the pressure put on them by social media has led to the increasing normalisation of cosmetic interventions among the young. Children who are still growing should not be considered candidates for cosmetic treatments, particularly with products such as Botox, which paralyses muscle and is used to lessen the appearance of wrinkles. Of course, there may be instances where the prescription of Botox is medically needed, even for under-18s, as we heard, but Botox is at least classified as a medicine, so it must be prescribed by a medically qualified practitioner. The problem is that it can be injected by somebody with no qualifications at all.
Fillers, on the other hand, are classified as devices as opposed to medicines, which means that they are wholly unregulated. Children can, for instance, walk into a shop and get their lips injected by someone with no qualifications at all. Botox and filler parties are quite common among the young, where they inject each other. As with Botox, complications with fillers are not uncommon. They can include the filler moving away from the treated area into other parts of the face. As we heard, some individuals were left with rotting tissue and lumps on their faces, and required lip amputations.
The medical profession itself has tried for many years to get fillers classified as medicines and not devices and to close loopholes such as online purchase, whereby unscrupulous doctors prescribe a product and have it delivered for a fee to someone with no qualification whatever. The young and vulnerable should be protected from unscrupulous exploitation. In other countries, legislation prohibits cosmetic procedures under a certain age. In Germany, for example, no procedure can be done on someone under 18, whether aesthetic or otherwise, without parental consent. In Spain it is the same, and in France the law is even stricter.
Clearly, the Bill must be approved, and I fully support it, but as this business is lucrative, it will be difficult to curb illegal trade. I also look forward to hearing the Minister’s responses to some of the questions that were raised about supply.
Lord Addington (LD)
My Lords, this is one of those debates where it is very difficult to find somebody who disagrees with the central thrust of what is proposed. The main thing we can say is, why on earth was this not done earlier? I hope that the noble Baroness, Lady Wyld, will accept my congratulations and pass them on to everybody who worked on this Bill in the other place, and to all those who did the prior spadework. This should have happened already. We are patching up a hole here, not dealing with some new problem. The noble Baroness, Lady Bull, described very well—much better than I could—the pressure of social media.
This is not new. When I first came here all those years ago, we were talking about photoshopping images in magazines. However, it is more intense now. It is also not an exclusively female problem. The body image issue generally affects both sexes, but due to fashion, it affects girls predominantly. Can we please make sure that we keep this under review? The Government should be doing more of this—but they should be doing more of many things. I therefore hope that the House and indeed Parliament as a whole will keep an eye on what is going on here.
I had one or two other points to make but my noble friend Lady Walmsley—I am very glad to be on the same team as her—did an excellent job of saying everything I was going to say, and more succinctly.
I conclude by asking the Minister to make sure when he sums up that we get an idea of the Government’s overview of this subject. Can he confirm that where these procedures are needed for a medical problem, whether physical or psychological, they will still be available? Their unavailability is the only conceivable objection I can see to this measure being adopted.
I hope that we will all give this Bill a great round of applause—a metaphorical one—so that it gets through quickly, because it will make life a little bit safer and better for people. Even if such a botched procedure is only temporary, that still involves more trauma, which will add to any problems that made the person go there in the first place.
Baroness Neville-Rolfe (Con)
My Lords, like the previous speaker the noble Lord, Lord Addington, I very much support this Bill.
The idea of cosmetic Botox and fillers for under-18s fills me with absolute horror; that horror has been magnified by the debate so far. I speak as a grandparent of five beautiful granddaughters who are adventurous and will grow up to experiment. These kinds of procedures used to be the preserve of those of us who are care-worn and ageing but, with social media, everything has changed. There is a very strong case for early action. I congratulate my noble friend Lady Wyld on her first Bill and her clear introduction. I also congratulate Laura Trott MP in the other place—another emerging talent. They have done really well to secure government support, as my noble friend Lord Lansley said. I look forward to his Bill.
Noble Lords will know that I am always concerned about enforcement. I am glad to see that the Bill uses the powers in the Consumer Rights Act 2015, which I had the pleasure of putting on the statute book when I was a Minister. There are parallels with tattoos and sunbeds. I have faith in local authorities as enforcers of such regulations and in stopping bad practice as such practices go underground, although I always fear that their funding is inadequate.
I am disappointed that no impact assessment is available, but then this is not a government Bill. I have heard that one has been made; perhaps I could have a copy. I would, however, ask my noble friend the Minister or my noble friend Lady Wyld where the new costs are likely to fall and on whom. I assume that operators will lose some of their ill-gotten gains and that there will be a cost in understanding the new requirements, in training and in identifying under-18s accurately.
I know that there was also some concern in the other place that the Bill did not respect the common commencement dates for regulations of 1 April and 1 October. I valued these conventions as a former operator across many regulatory areas when I was in retail—though not in Botox, I hasten to add. They allow for proper preparation and training. However, it is for the Government to set the commencement date under Clause 6, so they may be willing to support that policy.
I wish the Bill a speedy passage so that it is not lost in the forthcoming Prorogation of Parliament before the new Queen’s Speech.
Baroness Mobarik (Con)
My Lords, I thank my noble friend Lady Wyld for introducing the Bill. I want to take this opportunity to congratulate my honourable friend Laura Trott MP on championing this important cause.
Like many in your Lordships’ House and the other place, I was alarmed to learn that there are currently no statutory provisions in place to restrict access to botulinum toxin and cosmetic filler procedures for children and young people aged under 18. The Bill is therefore a welcome step towards the protection of children from aesthetic interventions, particularly from non-medically qualified practitioners.
It is a chilling thought that children today feel the need—or pressure, more likely—to alter their appearance. The innocence of children is being lost. It was harrowing to learn that, back in 2018, some 100,000 children under the age of 16 had undergone cosmetic procedures, mostly consisting of fillers. It is a sad reflection on our failure to stand up to this global trend of so-called body perfection, which is why I am passionately behind the common-sense, practical measures that the Bill will provide.
We know that the pressures faced by young people today are more extreme than they have ever been. Although much good has come from the near-universal access to the internet that we are privileged to have in this country, we cannot ignore the fact that the social media giants preside over a grave situation in which the youth of today are constantly bombarded with images, videos and filters that present unrealistic aesthetic ideals. It is no wonder that so many children feel the need for cosmetic alterations. I call on big tech to do what is morally right and protect our children from the unrealistic ideals being forced on them.
At a young and impressionable age, one is heavily influenced by what one hears or sees. The media has become ever more powerful and pervasive in recent decades, with social media platforms enticing young minds to look at images that are unattainable, rather than giving them confidence about their own individuality. I reflect on my own youth: as perhaps the only child from my ethnic background throughout my schooling, having large dark eyebrows and full lips was not very commonplace. Had I had the chance to eradicate them, I probably would have done—but then I would not have been on trend later. What might seem like a good idea to someone at 14 may not be the case when that person reaches the age of 24, not to mention the untold harm and disfigurement that these procedures potentially cause.
While the matter of filters in advertising being shown to young people via social media is not in the scope of the Bill, I believe that the Bill is an important milestone to that end. By prohibiting specific cosmetic procedures being performed on young people for purely aesthetic purposes, we will be putting the necessary safeguards in place—and not before time.
I hope that, if the Bill is passed, the social media giants will consider this legislation a warning shot and so adapt their practices before we are obliged to legislate further. The Bill is long overdue. It is a first step towards providing a proportionate way of protecting our children while not interfering with the mandate of personal choice. To that end, it has my full and unwavering support.
Baroness Bennett of Manor Castle (GP) [V]
My Lords, I thank the noble Baroness, Lady Wyld, for bringing us the Bill, and offer my group’s full support. We have heard many important contributions already. I associate myself with the comments of the noble Baronesses, Lady Walmsley, Lady Bull and Lady Sugg—particularly the last, on the urgent need for more regulations.
This is a long, obvious and necessary measure. Although it is disappointing that it took so long for it to reach us, at least we are here now. However, it is important to consider why we need this legislation at all. There is little doubt that, while we will soon have this measure on our own soil, once travel restrictions are lifted, at least some who might have sought these practices here will do so overseas where restrictions are, in some cases, less strict or non-existent. There is also the problem of enforcement, of course, as outlined by the noble Baroness, Lady Meyer.
To protect the young people—indeed, all people—of Britain, it is worth thinking about why there should be such demand for these medically unnecessary, expensive and dangerous procedures; indeed, the noble Baroness, Lady Wyld, rightfully and graphically outlined the dangers. Surely this is evidence of the need for much further action. There has been much talk about, and focus on, the technologically new social media, but it is important that we do not underestimate our children’s ability to think critically and clearly about what happens to them and the world they live in—particularly if we provide the educational framework of critical thinking to do so.
It is also important that we do not ignore other, possibly greater, pressures. Your Lordships know about the push that comes from advertising. This includes not just direct advertising for procedures, although we should be looking at considerably tighter controls on that, but broader advertising that depicts airbrushed, perfect features and flawless complexions achieved through art, not life. Look at the sheer level of bombardment with such images to which we are all subjected, whether by choice or not. Less advertising in our public spaces, with more art, poetry and nature instead—there’s a radical idea for your Lordships’ House.
There is also the pull of insecurity, fear and competition in the workplace. There is the gig economy, with management practices that regularly cull the so-called lowest performers in workplaces. There is the weight of student debt and the fear of economic difficulty. All combine with the assumption that, for a wide range of jobs—practically any job—individuals need to market themselves, present themselves well and compete to get to the top of the pile.
The noble Baroness, Lady Wyld, in introducing this Bill, identified her interest in Ofsted. I hope that she will think about how Ofsted, and all those involved in education, can inoculate our young people against the economic, social and commercial pressures, with strong support for their mental health and well-being, and how we can transform our society and our economy to greatly reduce—even end—these workplace pressures. As the noble Baroness, Lady Massey, said, we need a public health approach— a systems-thinking approach.
Lord Hannan of Kingsclere (Con)
My Lords, it is a great pleasure to follow the noble Baroness, Lady Bennett, my noble friends, and noble Lords opposite. In fact, I would like to associate myself with all the informed concern and expertise brought by so many more qualified than myself. I do not want to add anything to what has already been said, other than to associate myself with the congratulations for my noble friend Lady Wyld, and for Laura Trott for bringing the Bill before us.
Instead, allow me to invite your Lordships to ponder the somewhat anomalous legal position in which a 16 or 17 year-old British subject finds himself or herself. At that age, you are allowed to pay tax but not to quit full-time education; you are allowed to have sex but not to watch it on the screen; you are allowed to smoke cigarettes but not to buy them. Anomalies are intrinsic in any legal system in our imperfect, Aristotelian, sublunary world. An anomaly is not intrinsically a reason not to do something. None the less, there has been something of a harmonisation around the age of 18 as the moment at which we recognise legal adulthood and informed consent. You have to wait until your 18th birthday to buy a bottle of wine, a knife or a mortgage—though probably not in that order. You have to wait until you are 18 before you can serve on a jury or indeed be confined in an adult prison.
In a way, all that this legislation is doing is bringing this procedure into line with what we are increasingly recognising as the age at which adulthood begins. This has been, by the way, a move carried out under Governments of all parties—it was the previous Government, I think, who raised the age for buying fireworks, using sunbeds, buying knives and so on.
I leave your Lordships with the thought that it would be extraordinary to ban people under the age of 18 from making all these decisions about their own bodies while enfranchising them, and thereby allowing them, through the ballot box, to play a part in deploying the full coercive power of the law on the decisions that other people are allowed to make. If 18 is the age of adulthood, it would be extraordinary, whether in elections or referendums, to lower it. If you cannot get fillers then you should not have the franchise.
Baroness Gardner of Parkes (Con) [V]
My Lords, I welcome this legislation. The growth in social media, instant likes and dislikes as regards body image, and peer pressure to improve a false perception of not being body perfect, all add up to pressure on children these days, so this has not come too soon. My concern, however, is whether the Bill goes far enough. The effect of the proposals is to ban anyone not qualified to use such fillers and toxins, the consequences of which I completely agree can be extreme. But I cannot help but wonder why, other than in medically justified cases, under-18s need this work done at all.
The noble Lord, Lord Addington, made a very good speech, and the comment on botched jobs doubling last year should give us real cause for concern. Should the legislation not provide a blanket ban, and then allow for limited exceptions, such as in cases of disfigurement after an accident, a birth defect or similar, for any such work to be carried out on a child?
Baroness Brinton (LD) [V]
My Lords, I declare my interest as a vice-president of the Local Government Association and congratulate Laura Trott MP and the noble Baroness, Lady Wyld, on promoting this long-needed Bill. It is important to say from the start that we on these Benches believe that this Bill will provide a safer environment for those children and young people who are tempted to seek treatments, including Botox, fillers and cosmetic treatments, which currently can be administered by unqualified individuals. To be frank, like some other speakers today, we would welcome stronger regulation of those administering these treatments to adults too. But we have some questions about how this Bill, as it stands, might be improved to ensure safety and regulation to make it work.
We have heard from noble Lords horror stories of staff treating individuals with complex and sometime disastrous consequences. I agree with the noble Baroness, Lady Bull, and my noble friend Lord Addington that young people, mainly girls, are encouraged to have treatments such as these. That speaks to the very dangerous body image agenda that is far too prevalent. Although not part of this Bill, we must ensure that schools and wider society reinforce the key point that we are all different, and that judging people on the way that they look is short-sighted and damaging.
As my noble friend Lady Walmsley mentioned, in the UK, Changing Faces is a charity that supports everyone with a visible difference, including people born with, and those acquiring, visible differences during life. Changing Faces makes the point that these young people may need the use of invasive or non-invasive cosmetic interventions to help them manage and control their condition, mark or scar, along with other physical treatment or mental health support that they also need to access. It is vital that any child or adult is appropriately supported with the right information. Along with Changing Faces, we hope that people—whether children or adults—would always have this advice and treatment from a healthcare professional. It is good that this Bill starts that process for those under 18. Changing Faces has a long track record of signposting its clients to their GPs and consultants to make sure that they get the correct advice. This is excellent practice.
We also agree that adverts for these treatments should not be available to the under-18s. Advertisements have too often promoted a stereotypical perception of beauty, and offering to “fix” perceived imperfections can be damaging to a child or young person, particularly one with a visible difference. Hannah, a young client of Changing Faces, explains her experience:
“In the early days of social media, there were constantly adverts for different cosmetic procedures and I felt everywhere I looked, someone was saying I was ugly and needed to be fixed. Young people, whether they have a visible difference or not, must be protected from advertising that promotes cosmetic interventions. How can young people be expected to craft a healthy body image when the world is telling them that they can be fixed? Online spaces are tricky to make safe for young people, but it is possible to minimise the impact that unrealistic body image has on their developing minds by limiting advertising.”
Hannah is so right.
Our second concern from these Benches is on the effective policing of the proposals in this Bill. As outlined by the noble Baroness, Lady Neville-Rolfe, can the Minister confirm that the regulation proposals in this Bill match tattoo parlour and sunbed regulations? This should be an absolute minimum, because the treatments outlined in today’s Bill are less reversable than tattooing, piercing and tanning. Can the Minister explain how local authorities will be able to enforce these regulations? The Government’s repeated cuts to local government have severely impacted local weights and measures teams. Without the resources to police it, this Bill will fail, meaning that most enforcement will be retrospective, so that the offences by bodies corporate will be important.
That brings me to my final point. For any Bill to have effect, the threat of serious financial harm to organisations is the most likely deterrent. The most obvious defence is that corporates will need to be fully implicated. It is set out in Clause 3(2), which starts:
“If the offence is proved to have been committed with the consent or connivance of, or to be attributable to any neglect on the part of … any director, manager or secretary of the body corporate”
et cetera. This seems analogous to the corporate manslaughter situation, whereby virtually no CEO ever gets prosecuted and yet fewer are convicted.
We are concerned that the Bill, if passed, would not be policed due to under-resourced councils and, if dealing with a breach, only the local, low-paid operative would be prosecuted. Can the Minister say whether the Government have a plan properly to license, resource and supervise such therapies? I look forward to the Minister’s response and to supporting this Bill as it starts its passage in your Lordships’ House.
Baroness Wheeler (Lab)
My Lords, I too congratulate the noble Baroness, Lady Wyld, on sponsoring the Bill and on her excellent introductory speech, which clearly set out the overwhelming need for urgent and longer-term action to bring the regulation of botulinum cosmetic fillers for under-18s in line with other appearance-related procedures, such as tattoos and sunbed use, for which there is already a statutory minimum age of 18. This is what we know the public would expect and, as we have heard, mostly assume we already have.
Like other noble Lords I was shocked to realise that this crucial area is as unregulated as it is and that in 2018 an estimated 100,000 under-16s underwent cosmetic enhancements. It is also important to note that Sir Bruce Keogh’s 2013 review was also shocked, and that shock was reinforced by the 2017 Nuffield Council on Bioethics review, which highlighted major safety concerns. Everybody has been shocked ever since then, but now we are at last able to begin the process of remedying this deeply worrying situation,
Progress is obviously due to the tireless work and determination of Laura Trott MP in the Commons and the Bill’s many supporters, in particular the co-chairs of the All-Party Group on Beauty, Aesthetics and Wellbeing, Carolyn Harris MP and Judith Cummins MP. They have highlighted the lack of age restrictions for these procedures and concerns about advertising and social media promotion that leave young people at risk. The APPG’s inquiry is ongoing and has brought together people from across the sector to talk about the lack of robust, consistent and enforceable standards. It is a tribute to the cross-party work that has taken place across both Houses on these vital issues, and when it reports it will be a valuable tool to build on the initial measures in the Bill.
Like other noble Lords, I pay tribute to the pioneering Save Face charity for its campaigning and awareness-raising, its voluntary register and its work to build the necessary standards and safeguards through its accreditation with the Professional Standards Authority for Health and Social Care.
The Bill is an important step forward and fully supported by Labour. It is welcome because it prohibits specific procedures being performed on young people under the age of 18, except under the direction of a registered health professional, and prevents businesses arranging or performing procedures on under-18s on their premises. Most importantly, its provisions do not affect the vital medical use of Botox or fillers by appropriately qualified medical practitioners, such as Botox treatment for conditions such as Bell’s palsy, which will remain available where there is an assessed need.
During the course of the Bill and in today’s speeches we have heard about the horrific consequences for vulnerable young people when procedures go wrong, including the worst-case scenarios of infection, permanent scarring and tissue death, as well as serious psychological and mental health problems for young people whose lives have been seriously impacted by botched procedures undertaken by unqualified and improperly trained staff who bear no responsibility or accountability when malpractice occurs.
As the British College of Aesthetic Medicine stresses:
“Dermal fillers in particular are plain dangerous in the wrong hands”.
Its call for
“a wider regulatory regime, which supports controlled access to prescription medicines, and which differentiates aesthetic medicine from beauty therapists, spas and salons”
is the vital work that will need to follow from the Bill.
Noble Lords, especially the noble Baroness, Lady Bull, have spoken movingly of the pressure on young people to conform to the body images they see around them, especially on social media, which holds so much power over today’s youth and is flooded with adverts for treatments claiming to make them look younger, thinner and prettier. The Childline, Mental Health Foundation, YoungMinds and Save Face surveys all show an alarming picture of the impact of all this on young people’s sense of self-worth and their physical and mental health. The thousands of young people who view procedures such as lip fillers as easy, temporary and comparable to getting a haircut or manicure are deeply concerning when the results can have a profound and extensive impact on so many lives.
Under Clause 4, there are significant new responsibilities for local authorities to reinforce the provisions of the Bill using their powers available under Schedule 5 to the Consumer Protection Act, which we welcome as local councils are best placed to monitor local businesses and developments. The Explanatory Notes to the Bill acknowledge that it may result in an increase in revenue support under the Local Government Finance Act 1988, and the Commons has agreed a money resolution to give effect to any decision on this. Noble Lords have expressed serious concerns, which we echo, about what new money will be made available to local authorities to meet these responsibilities in the light of the huge funding cuts they have faced in the past decade. Can the Minister reassure the House that new money will be made available to implement the provisions of the Bill? Without additional funding it is hard to see what local authorities will actually be able to achieve.
I also seek clarification about the scope of the Bill. As I understand it, the Bill applies only to procedures carried out in England, reflecting the fact that public health is devolved. In so doing, it amends the Consumer Rights Act and the Human Medicines Regulations 2012, both of which have wider England and Wales or UK territorial scope. The Human Medicines Regulations also cover Northern Ireland. I would be grateful if the Minister or the noble Baroness, Lady Wyld, could confirm whether this would be solely for the purpose of making consequential amendments and what work and consultation with appropriate devolved bodies is envisaged in this respect.
As we have said, the Bill is a welcome first step to address the growing threat of unregulated cosmetic treatments to young people’s mental and physical well-being, but it is just that: a start which lays the groundwork for future change. We strongly support the Bill and look forward to the Minister’s response to noble Lords’ questions on how its provisions are to be taken forward, the timescales for implementation, the proposals for the review of regulations and guidance that has been spoken about, and the next steps that need to be taken to ensure effective future monitoring and regulation.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Bethell) (Con)
My Lords, I am enormously grateful to all those who have contributed to this lively debate today and pay particular tribute to my noble friend Lady Wyld for sponsoring the Bill, as well as to the honourable Member for Sevenoaks who navigated its passage through the other place. It would also be right to pay tribute to Professor Sir Bruce Keogh for his review of regulations on cosmetic interventions, which was mentioned by many noble Lords and has clearly paved the way for this important Bill. I reassure my noble friend Lord Lansley that his plug for his Private Member’s Bill has been well and truly heard by the Minister.
The Government are pleased to support the introduction of an age restriction for botulinum toxin and fillers. As my noble friend Lady Wyld showed so clearly, the provisions in the Bill will ensure that young people are accorded the highest protections to safeguard their physical and psychological health. There are already statutory age restrictions in place for tattooing, teeth whitening and sunbed use. It makes no sense that there are not similar protections for invasive, injectable cosmetic procedures.
Botulinum toxin, dermal fillers and laser hair removal account for nine out of 10 non-surgical treatments performed in the UK—an astonishing proportion. Analysis by my department last year estimated that as many as 41,000 botulinum toxin procedures may have been carried out on under-18s in 2020 and that more than 29,300 dermal filler procedures may have been undertaken on under-18s in 2017. I support the decision to focus on the treatments covered by the Bill, as introducing an age restriction on botulinum toxin and fillers will protect the greatest proportion of young people seeking a cosmetic procedure at this time.
To practise in the UK, doctors must be registered and hold a licence to practise with the General Medical Council, the regulator of doctors. The GMC publishes clear standards of practice and guidance for doctors, including Good Medical Practice, which covers consent, the treatment of patients aged under 18 years and safeguarding vulnerable patients. On my noble friend Lady Neville-Rolfe’s point on costs, keeping up to date with these provisions is the normal cost of doing business in this area.
The department is working with stakeholders to assess the need for strengthened safeguards around the regulation of providers who offer some of the more invasive non-surgical cosmetic procedures. I completely take on board the points made by the noble Baronesses, Lady Wheeler and Lady Brinton, on the advice given by the excellent Changing Faces charity on the need to protect the surgery that some young people with particular needs may require.
I assure the noble Lord, Lord Addington, the noble Baroness, Lady Walmsley, and others who have asked that the department is working closely with the Medicines and Healthcare products Regulatory Agency to develop our future regulatory regime for medical devices, which prioritises patient safety. As part of this, we will consider whether to bring all dermal fillers and any other relevant procedures into the scope of the device legislation.
Measures in the Bill complement other important work that we are taking forward. I assure the noble Baroness, Lady Massey, and others who asked that public health and mental health messages to our children and young people are key priorities in our long-term plan for the NHS. In addition to the existing funding as part of the long-term plan, the Government recently announced a further £79 million boost to funding for children and young people’s mental health. In addition, in July last year we launched Tackling Obesity: Empowering Adults and Children to Live Healthier Lives.
On the touching comments on body image by the noble Baroness, Lady Bull, I completely agree that we must seek better understanding of the motivations that may be driving consumer demand among young women. We have put in place the first government-led women’s health strategy for England. This will set an ambitious and positive new agenda to improve the health and well-being of women across England. I encourage the noble Baroness, Lady Bull, and all other Peers who have a valuable contribution to make to ensure they hit the end-of-May deadline for evidence.
The Government plan to make a full response to the Independent Medicines and Medical Devices Safety Review report chaired by my noble friend Lady Cumberlege later this year. To ensure that patient voices are heard as we move forward, a patient reference group has been established and is working closely with the department.
On the points made by the noble Baroness, Lady Bull, I note that the House of Commons Women and Equalities Committee recently published the findings of its inquiry into body image. The findings offer insight, and it is disturbing to note that the inquiry’s public survey found that 61% of adults and 66% of children feel negatively or very negatively about their body image most of the time. These figures are even higher for specific groups including women, people with disabilities and transgender people. It is clearly far too high.
These are very personal issues. My noble friend Lady Wyld has spoken of her three daughters and my noble friend Lady Neville-Rolfe spoke of her beautiful granddaughters. I have two daughters of my own and worry daily about the world they live in and their consumption of social media. I should be clear to noble Lords who have raised these points that the Bill before us has a tight focus, and social media is not the target of the Bill. I join my noble friend Lady Mobarik in calling for big tech to do all it can in this area. I reassure noble Lords that the online safety Bill will be ready this year. The legislation will help ensure that children can make the most of the benefits of going online while staying as safe as possible.
The noble Baroness, Lady Wheeler, asked some specific questions about the Bill’s powers. I would be glad to write to her to clarify her questions. In the meantime, I urge noble Lords to resist any temptation to try to improve the Bill through amendments and risk losing it altogether. Time is so tight before the end of the Session.
That leaves me to congratulate my noble friend Lady Wyld and, recognising the encouraging words from the noble Baronesses, Lady Brinton and Lady Wheeler, I offer the Government’s support to this important Bill.
Baroness Wyld (Con)
My Lords, I am so grateful to everybody who spoke in the debate today. I know we are tight on time; I see the Whip looking up at me. I wish I could go name by name through everyone and respond, because so many important issues came up.
As the noble Lord, Lord Addington, so rightly said, others did all the spade-work. I must pay tribute to my noble friend Lord Lansley. I am really delighted that he was able to come in to support me today. I am very grateful to the Minister for his comprehensive response and to the Opposition Benches, as I have said, for their support thus far.
It was a very moving debate. It made me think a lot about my own daughters and the world they are growing up with, as I said. As adults, when one comes to terms with our own physical imperfections, it is easy to forget the great pain that one feels as a young person or child at being different in any way. I will be glad if we can do a little today to help.
I hope that, with such breadth of support, we ensure the Bill has a speedy passage through your Lordships’ House. I echo my noble friend the Minister’s plea that the temptation to table helpful amendments is resisted. I think and hope it is. I beg to move.
The Deputy Speaker (Lord Faulkner of Worcester) (Lab)
We shall move on to the third Private Member’s Bill in a moment, but we will allow the Chamber to clear and re-form itself before we do so.
Botulinum Toxin and Cosmetic Fillers (Children) Bill
Thursday 22nd April 2021
(3 years, 7 months ago)
Lords ChamberRead Full debate Botulinum Toxin and Cosmetic Fillers (Children) Act 2021 Read Hansard Text Amendment Paper: Consideration of Bill Amendments as at 12 March 2021 - (12 Mar 2021)
Baroness Wyld (Con)
My Lords, I understand that no amendments have been set down to this Bill and that no noble Lord has indicated a wish to speak in Committee. Manuscript amendments are not possible at present. Unless, therefore, any noble Lord objects, I beg to move that the order of commitment be discharged.
Botulinum Toxin and Cosmetic Fillers (Children) Bill
Wednesday 28th April 2021
(3 years, 6 months ago)
Lords ChamberRead Full debate Botulinum Toxin and Cosmetic Fillers (Children) Act 2021 Read Hansard Text Amendment Paper: Consideration of Bill Amendments as at 12 March 2021 - (12 Mar 2021)
Baroness Wyld (Con)
My Lords, in moving this motion I briefly pay tribute to my honourable friend Laura Trott MP, who steered this Bill with such passion through the other place, aided by all the brave and persistent campaigners who have worked so hard. As we said at Second Reading, a huge amount of spadework was needed to bring the Bill to this point—not least by my noble friend Lord Lansley, who I am delighted to say is sitting beside me today. I also pay tribute to my noble friend the Minister, to the Bill team, and to noble Lords across the House on all Benches, who were incredibly supportive. It has been a real honour to bring this Bill to this stage.
Royal Assent
Thursday 29th April 2021
(3 years, 6 months ago)
Lords ChamberRead Full debate Read Hansard Text Amendment Paper: Consideration of Bill Amendments as at 12 March 2021 - (12 Mar 2021)