Botulinum Toxin and Cosmetic Fillers (Children) Bill
Friday 16th April 2021
(3 years, 8 months ago)
Lords ChamberBotulinum Toxin and Cosmetic Fillers (Children) Act 2021 View all Botulinum Toxin and Cosmetic Fillers (Children) Act 2021 Debates 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.