Botulinum Toxin and Cosmetic Fillers (Children) Bill

(2nd reading: House of Commons)
Friday 16th October 2020

(1 week ago)

Commons Chamber
Read Hansard Text Bill Main Page
Department of Health and Social Care

Second Reading

Laura Trott Portrait Laura Trott (Sevenoaks) (Con) - Hansard
16 Oct 2020, 12:05 a.m.

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 Portrait Dr Luke Evans (Bosworth) (Con) - Hansard

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 Portrait Laura Trott - Hansard
16 Oct 2020, 12:08 a.m.

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 Portrait James Cartlidge (South Suffolk) (Con) - Hansard

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 Portrait Laura Trott - Hansard

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.

Sir Lindsay Hoyle Portrait Mr Speaker - Hansard

Sir Christopher Chope is missing, so I call James Cartlidge.

James Cartlidge Portrait James Cartlidge (South Suffolk) (Con) - Hansard

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.

Sir Lindsay Hoyle Portrait Mr Speaker - Hansard

He may have been ahead, but if he is not here, you are certainly the winner!

James Cartlidge Portrait James Cartlidge - Hansard

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 Portrait Anthony Mangnall (Totnes) (Con) - Hansard

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 Portrait James Cartlidge - Hansard

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 Portrait Duncan Baker (North Norfolk) (Con) - Hansard

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 Portrait James Cartlidge - Hansard

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 Portrait Jane Stevenson (Wolverhampton North East) (Con) - Hansard

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 Portrait Dr Luke Evans - Hansard

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 Portrait Jane Stevenson - Hansard

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 Portrait Anthony Mangnall - Hansard

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 Portrait Jane Stevenson - Hansard
16 Oct 2020, 9:30 a.m.

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 Portrait Dr Luke Evans - Hansard

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 Portrait Jane Stevenson - Parliament Live - Hansard
16 Oct 2020, 10:01 a.m.

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 Portrait Anthony Mangnall - Hansard
16 Oct 2020, 10:02 a.m.

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 Portrait Jane Stevenson - Hansard
16 Oct 2020, 10:02 a.m.

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 Portrait Fay Jones (Brecon and Radnorshire) (Con) - Hansard
16 Oct 2020, 10:02 a.m.

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 Portrait Jane Stevenson - Hansard
16 Oct 2020, 10:03 a.m.

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.

Sir Lindsay Hoyle Portrait Mr Speaker - Hansard
16 Oct 2020, 10:04 a.m.

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 Portrait Simon Baynes (Clwyd South) (Con) - Parliament Live - Hansard
16 Oct 2020, midnight

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 Portrait Fay Jones - Hansard
16 Oct 2020, 12:02 a.m.

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 Portrait Simon Baynes - Hansard

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 Portrait Dr Luke Evans - Hansard
16 Oct 2020, 12:04 a.m.

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 Portrait Simon Baynes - Hansard
16 Oct 2020, 12:01 a.m.

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 Portrait Anthony Mangnall - Hansard

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 Portrait Simon Baynes - Hansard
16 Oct 2020, 12:02 a.m.

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 Portrait Suzanne Webb (Stourbridge) (Con) - Hansard
16 Oct 2020, 12:02 a.m.

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 Portrait Simon Baynes - Hansard
16 Oct 2020, 12:04 a.m.

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 Portrait Dr Luke Evans - Hansard
16 Oct 2020, 12:04 a.m.

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 Portrait Simon Baynes - Hansard

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 Portrait Claire Coutinho (East Surrey) (Con) - Parliament Live - Hansard

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.

Fay Jones Portrait Fay Jones - Hansard

My hon. Friend is making an excellent speech. She is also a dear friend of mine, as is my hon. Friend the Member for Sevenoaks (Laura Trott). I have seen the photos she is talking about and if I were her, I would be happy to share them—she was a very cute child.

Claire Coutinho Portrait Claire Coutinho - Parliament Live - Hansard

That is most generous.

Sally-Ann Hart Portrait Sally-Ann Hart (Hastings and Rye) (Con) - Hansard

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 Portrait Claire Coutinho - Hansard

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 Portrait Anthony Mangnall - Hansard

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 Portrait Claire Coutinho - Hansard

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.

Anthony Mangnall Portrait Anthony Mangnall - Hansard

Where would my hon. Friend go?

Claire Coutinho Portrait Claire Coutinho - Hansard

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 Portrait Jane Stevenson - Hansard

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 Portrait Claire Coutinho - Hansard

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 Portrait Simon Baynes - Hansard

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 Portrait Claire Coutinho - Hansard

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 Portrait Dr Luke Evans - Hansard

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 Portrait Claire Coutinho - Hansard

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 Portrait David Johnston (Wantage) (Con) - Hansard

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) - Hansard

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 Portrait David Johnston - Hansard

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 Portrait Claire Coutinho - Hansard
15 Oct 2020, 12:21 p.m.

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 Portrait James Cartlidge - Hansard
15 Oct 2020, 12:21 p.m.

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 Portrait Claire Coutinho - Hansard
15 Oct 2020, 12:21 p.m.

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 Portrait Anthony Mangnall - Hansard

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 Portrait Claire Coutinho - Hansard

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 Portrait Dr Luke Evans (Bosworth) (Con) - Hansard
15 Oct 2020, 12:21 p.m.

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 Portrait Suzanne Webb - Hansard

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.

Dr Luke Evans Portrait Dr Evans - Hansard

Absolutely, I could not endorse that message of body positivity more strongly. Each of us has a natural way for our body to be, and there is no problem with wanting to improve that. That is part of a healthy message on both eating and exercise.

Sally-Ann Hart Portrait Sally-Ann Hart - Hansard

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?

Dr Luke Evans Portrait Dr Evans - Hansard

rose—

Madam Deputy Speaker (Dame Eleanor Laing) - Hansard

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 Luke Evans Portrait Dr Evans - Hansard
16 Oct 2020, 12:01 a.m.

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 Portrait Jane Stevenson - Hansard
16 Oct 2020, 12:02 a.m.

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?

Dr Luke Evans Portrait Dr Evans - Hansard
16 Oct 2020, 12:02 a.m.

Absolutely. Yet again, I wholeheartedly agree with my hon. Friend. That is the crux of what we are discussing, and I will get on to that point.

Complications happen. Fortunately, I have seen them only in adults; I have yet to see them in a child.

Saqib Bhatti Portrait Saqib Bhatti (Meriden) (Con) - Hansard
16 Oct 2020, 12:02 a.m.

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 Luke Evans Portrait Dr Evans - Hansard
16 Oct 2020, 12:03 a.m.

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 Portrait Anthony Mangnall - Hansard

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 Luke Evans Portrait Dr Evans - Hansard

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 Portrait Jane Stevenson - Hansard

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 Luke Evans Portrait Dr Evans - Hansard
16 Oct 2020, 12:02 a.m.

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 Portrait Anthony Mangnall (Totnes) (Con) - Hansard
16 Oct 2020, 12:04 a.m.

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 Portrait Dr Luke Evans - Hansard

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 Portrait Anthony Mangnall - Hansard
16 Oct 2020, 12:05 a.m.

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 Portrait Dr Luke Evans - Hansard

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 Portrait Anthony Mangnall - Hansard

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 Portrait Suzanne Webb - Hansard

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 Portrait Anthony Mangnall - Hansard

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) - Hansard

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 Portrait Anthony Mangnall - Hansard

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 Portrait Simon Baynes - Hansard

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 Portrait Anthony Mangnall - Hansard

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 Portrait Dr Luke Evans - Hansard

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 Portrait Anthony Mangnall - Hansard

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 Portrait Claire Coutinho - Hansard

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 Portrait Anthony Mangnall - Hansard

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 Portrait Rob Butler (Aylesbury) (Con) - Hansard

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 Portrait Anthony Mangnall - Hansard

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 Portrait Sara Britcliffe (Hyndburn) (Con) - Hansard

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 Portrait Anthony Mangnall - Hansard

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 Portrait Laura Farris (Newbury) (Con) - Parliament Live - Hansard

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 Portrait Anthony Mangnall - Hansard

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 Portrait Laura Farris - Hansard

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 Portrait Bob Stewart (Beckenham) (Con) - Hansard

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 Portrait Laura Farris - Hansard

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.

Suzanne Webb Portrait Suzanne Webb - Parliament Live - Hansard

Will my hon. Friend give way?

Laura Farris Portrait Laura Farris - Hansard
16 Oct 2020, 11:04 a.m.

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 Portrait Andrew Bowie (West Aberdeenshire and Kincardine) (Con) - Hansard
16 Oct 2020, 11:04 a.m.

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 Portrait Laura Farris - Hansard
16 Oct 2020, 11:05 a.m.

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 Portrait Sally-Ann Hart - Hansard

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 Portrait Laura Farris - Hansard
16 Oct 2020, 11:05 a.m.

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 Portrait Dr Luke Evans - Hansard
16 Oct 2020, 11:06 a.m.

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 Portrait Laura Farris - Hansard
16 Oct 2020, 11:06 a.m.

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.

Simon Baynes Portrait Simon Baynes - Hansard
16 Oct 2020, 11:07 a.m.

Will my hon. Friend give way?

Laura Farris Portrait Laura Farris - Hansard
16 Oct 2020, 11:07 a.m.

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 Portrait Simon Baynes - Hansard
16 Oct 2020, 11:09 a.m.

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 Portrait Laura Farris - Hansard
16 Oct 2020, 12:04 a.m.

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 Portrait Suzanne Webb (Stourbridge) (Con) - Hansard
16 Oct 2020, 12:04 a.m.

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 Portrait Andrew Bowie - Hansard

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 Portrait Suzanne Webb - Hansard

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 Portrait Dr Luke Evans - Hansard

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 Portrait Suzanne Webb - Hansard

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 Portrait Jane Stevenson - Hansard

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 Portrait Suzanne Webb - Hansard

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 Portrait David Johnston (Wantage) (Con) - Parliament Live - Hansard

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. There is a clinic in Southmoor that 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 Portrait Saqib Bhatti (Meriden) (Con) - Parliament Live - Hansard
16 Oct 2020, 12:01 a.m.

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 Portrait Sally-Ann Hart (Hastings and Rye) (Con) - Parliament Live - Hansard
16 Oct 2020, 12:05 a.m.

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 Portrait Virginia Crosbie (Ynys Môn) (Con) - Hansard
16 Oct 2020, 12:05 a.m.

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 Portrait Sally-Ann Hart - Hansard
16 Oct 2020, 12:05 a.m.

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 Portrait Shaun Bailey (West Bromwich West) (Con) - Parliament Live - Hansard

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 Portrait Mike Wood (Dudley South) (Con) - Parliament Live - Hansard
16 Oct 2020, 12:02 a.m.

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 Portrait Bob Stewart - Hansard

Will my hon. Friend give way?

Mike Wood Portrait Mike Wood - Hansard

Very briefly, and then I must move on.

Bob Stewart Portrait Bob Stewart - Hansard

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 Portrait Mike Wood - Hansard
16 Oct 2020, 12:04 a.m.

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 Portrait Sara Britcliffe (Hyndburn) (Con) -