Botulinum Toxin and Cosmetic Fillers (Children) Bill

Luke Evans Excerpts

2nd reading & 2nd reading: House of Commons
Friday 16th October 2020 Commons Chamber

[Laura Trott (Sevenoaks) (Con)]

I beg to move, That the Bill be now read a Second time.

Let us be clear, no child needs cosmetic fillers or botox. However, this is not, unfortunately, how many of our young people feel. Social media exerts a huge pressure on young people to conform to aesthetic ideals, which are simply not attainable without cosmetic surgery or interventions, and this, combined with their increasing availability on the high street and in people’s homes, means that we have an increasing normalisation of cosmetic interventions among the young. These procedures risk ruining young people’s lives.

Alarmingly, this is an unregulated area, so the data that we have on prevalence is very thin, but a survey in 2018 showed that 100,000 under-16s had undergone cosmetic enhancements, the most common of which were fillers. This is worrying not just for the mental health of our young people, but for their physical health, too. We do not expect something that we can easily and very legally get done in the comfort of our own home to be something that can blind us, but, shockingly, that is the case.

For those who are not familiar with fillers and with botox, let me explain: fillers are gel-like substances that can be injected into the lips or the face to add volume and plump the skin. Temporary fillers last eight to 16 months, and there are permanent fillers as well, which have an increased risk of complication. There are currently no restrictions on who can inject fillers into the face. Botulinum toxin, more commonly known as botox, is injected into the skin to smooth lines and wrinkles, and it is not hard to understand the attraction of that. It is a prescription-only medicine, but doctors can delegate responsibility for injecting the botox to anyone at all with no qualifications.

Botox and fillers can be incredibly dangerous. Complications can include, but are not limited to, blindness, breathing difficulties—if it is injected into the neck—infection and the filler moving away from the intended treatment area into other areas of the face. Many people, mainly women, have been left with rotting tissue, lip amputations and lumps. I remind the House that, if any of these complications occurs, the practitioner injecting the substance needs to have no medical training whatsoever, so neither will they be able to deal with the potential complications, nor are they required to have insurance, so they do not have to pay for the very expensive cosmetic surgery that may be required to fix the problem.

[Dr Luke Evans (Bosworth) (Con)]

Does my hon. Friend therefore feel that, when people do run into these problems, the NHS will have to pick up the tab?

[Laura Trott]

My hon. Friend makes an excellent point. It is the NHS that has to pick up the bill for these problems, but it is not the NHS that will always pay for cosmetic surgery to fix them, so young people can be left with lifelong scars as a result of their surgeries, so he raises an excellent point.

The worst of it is that these risks are not theoretical or rare. I stress that this is an unregulated area, so instances of severe complications are not formally documented. However, thanks to brilliant campaigns by many Members of this House, the campaigning organisation, Save Face, and investigations carried out in the media, horrific stories have come to light. There were more than 1,600 complaints to Save Face last year, and it is estimated that 200 people have gone blind following these treatments, but it is the cases of the under-18s that have really stuck with me.

It is worth dwelling on a specific case study, which is representative of the countless stories I have heard. An under-18 female, who I will not name, booked a lip filler treatment after seeing a social media post promoting a discount. When she arrived at the clinic, she applied numbing cream herself to her lips. She was not asked her name. She was not asked details of her medical history. She was not even told what product was being used. She was not told of any possible side-effects. She was not consulted.

The treatment itself took less than 10 minutes. On completion, she was hurried out to pay the final balance. A few days later, she was experiencing significant pain and loss of sensation on the left side of her face. She contacted the person who treated her. She was ignored. Her symptoms became worse. She contacted her GP. She was told she should go and see another practitioner. When she eventually found a reputable local aesthetic healthcare professional, she reviewed her lips and concluded that the filler was compromising the blood flow to the tissue. She nearly lost her lips. This is an under-18 girl who nearly lost her lips through a procedure freely advertised and legally administered with no warnings or regulation whatever. Sadly, that example is not rare enough.

At the opening session of the all-party parliamentary group on beauty, aesthetics and wellbeing’s inquiry into the sector, Rachel Knappier appeared. She suffered from a botched filler, injected by a practitioner without any medical training, which resulted in her needing critical care. She told the APPG that there is

“nowhere for these people to turn to”

when things go wrong. She continued:

“Cheap adverts on social platforms are encouraging young impressionable people to seek an instant change to their appearance…to seek what is portrayed as the image of perfection.”

I could expound at length on the historical lack of oversight on women’s health issues. From PIP breast implants to vaginal mesh, we have simply not seen enough focus on these important issues by Governments over decades. This is a private Member’s Bill, however, and is necessarily limited in scope. I am pleased that the current Minister for Patient Safety, Mental Health and Suicide Prevention and her predecessor, my hon. Friend the Member for Thurrock (Jackie Doyle-Price), have started to change the trend.

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[Jane Stevenson (Wolverhampton North East) (Con)]

It is a pleasure to follow my hon. Friend the Member for South Suffolk (James Cartlidge), who spoke so passionately about children’s mental health, which is at the core of the Bill. I thank my hon. Friend the Member for Sevenoaks (Laura Trott) and congratulate her on bringing this really important Bill to the House.

The use of botulinum toxin and dermal fillers has become big business over recent years. These non-surgical procedures are now a £2.75 billion industry in the UK. They started out as a subtle way to knock a few years off and to look a bit younger, but in recent years they have been used to a much greater extent and to achieve a much more obvious cosmetic effect. They can be used to change the shape of facial features—to disguise a bump on someone’s nose, to redefine their jawline, or to plump up their cheeks or their lips. They are becoming incredibly popular.

We live in an age when everyone has a video camera in their pocket and our daily lives are shared on social media and broadcast on such a wide range of social media channels. Magazines bombard us with airbrushed images of celebrities. I know that my hon. Friend the Member for Bosworth (Dr Evans) seeks to require doctored images to be clearly labelled on social media, but sadly, at the moment, our young people look at very unrealistic images.

[Dr Luke Evans]

Does my hon. Friend agree that the problem with images online, especially if they are doctored in their proportions, is that they create an unrealistic aesthetic that is unachievable in real life? That is the problem with social media versus aesthetics in the real world.

[Jane Stevenson]

I absolutely agree, and I commend my hon. Friend for his work in this area.

I am thankful that in my early teenage years, I did not have to face the kinds of pressures that young people today have to face. I have concern for my two goddaughters, Lily and Eve, who are in their early teens, growing up with these constant pressures to look a certain way that is unrealistic to achieve. Thankfully, my awful 1980s hairstyles in an attempt to look like Bananarama or the latest pop group, and my appalling dress sense of my early teens, are now a dim and distant memory—a very distant memory—but young people today know that images taken of them every day will live online for their whole lives.

Our teenage years are challenging enough as we grow up, and many young people are now turning to these treatments as a way to feel better about themselves or to copy the look of someone they admire. In my work in schools over a decade, I noticed that sixth-form girls were increasingly having eyelash treatments to lengthen their eyelashes, or fillers to make their lips plumper. It is incredibly sad. As my hon. Friend the Member for Sevenoaks said, no child needs botox or fillers. It is completely unrealistic.

Sadly, consumer protections have not kept up with the industry, and we hear some horror stories; my hon. Friend shared one a moment ago. When they are injected by people without medical training, these treatments are extremely dangerous. Many people seeking beauty treatment do not realise that botox is a prescription-only medicine that should be prescribed only after a face-to-face consultation and by a licensed prescriber.

[Jane Stevenson]

Yes, I absolutely agree. People have to go into these treatments with full information so that they are giving informed consent, which, of course, under-18s cannot realistically give on such a serious matter.

The cost of these treatments is certainly not insignificant. A reputable, qualified, experienced practitioner can charge between £300 to £1,000 for botox treatments. Dermal fillers have a similar cost. The effects last about 12 months before they will need to be repeated. For most adults, those are significant amounts of money. For young people, the high cost leaves them seeking cheaper alternatives. They use non-healthcare professionals, sometimes hairdressers or beauticians, many of whom have trained for mere hours rather than several years.

In the wrong hands, these treatments frequently go wrong. The number of cases of botched jobs has doubled in the last year, from 616 cases in 2017-18 to 1,300 last year. There are, as we have heard, potential health risks, including blindness, tissue necrosis, infection and scarring. There can also be a significant psychological impact when a treatment does not give the desired effect, or when it does not deliver the desired boost in self-confidence. I think that that is at the root of the mental health point.

[Dr Luke Evans]

Does my hon. Friend agree that when complications happen, particularly when someone does not feel their aspirations have been achieved, that creates a vicious cycle, because the temptation to go back and have yet another procedure means that they are entwined in associating the procedure with their body image and the negative effect that can have?

[Jane Stevenson]

Absolutely. I completely concur. We see that in the treatments becoming more obvious and lip fillers becoming bigger. We see girls with very unrealistic lip sizes these days, which is worrying.

I agree with my hon. Friend the Member for Sevenoaks that the industry needs more regulation. Certainly, we want the security that one can go to somebody who knows what they are doing, and has the insurance and the skill to correct a procedure that does not go to plan. The NHS should not be picking up cases where an obvious failure of skill has occurred.

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[Simon Baynes]

I thank my hon. Friend, and I could not agree more. As she rightly anticipates, that is a point that I am going to make and I think that it is extremely important, speaking as a Member for a border constituency, Clwyd South. The border between England and Wales is a major issue of discussion at the moment, but the borders are porous and it is vital that this exists on a similar basis on both sides of the border.

We have discussed in detail the potential health risks, and this was put extremely well by my hon. Friend the Member for Wolverhampton North East when she described this as potentially expensive botched jobs. The issue of expense is extremely important. The Bill is right to seek to prevent under-18s from accessing botox or dermal filler procedures for aesthetic reasons, and that goes to the heart of many of the problems that have been discussed by Save Face, and particularly by my hon. Friend the Member for Bosworth (Dr Evans)—I commend him for his campaign. Save Face manages a national register of accredited practitioners who provide non-surgical cosmetic treatments, and it is extremely important that we back up its campaign. It campaigns for high standards of practice, knowledge and training to ensure that patients do not have to compromise on safety or aesthetic outcomes. Its director, Ashton Collins, said on BBC News:

“Some of these girls have been…hours away from having parts of their face surgically removed, which is not only physically traumatic, but”

has a

“mental health aspect…as well”.

I think that this is a very important point.

[Dr Luke Evans]

My hon. Friend mentions the impact on girls, but would he also consider the impact for many men? The cosmetic industry for men is growing, as is the use of steroids to try to bulk up for the gym. That fits in with botox being one of the choices that young men are looking to as well. Does he agree that there is a danger in the debate that if we concentrate so much on women, we forget about men?

[Simon Baynes]

I could not agree more with my hon. Friend. That is an extremely important point. As he rightly says, the body image consciousness of young men is also an area that leads to great vulnerability. Of course, it is an area where people would expect there not to be the same degree of vulnerability, because they are young men and strong and everything else, but it is an area of great importance. It goes back to my original point, which was about setting discussion of the Bill within a broader context of cosmetic interventions and other aspects that I think are dangerous for people.

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[Dr Luke Evans]

That is a really important point about accountability. Does my hon. Friend feel it is right that the NHS becomes the carer of last resort?

[Simon Baynes]

I agree with the point that my hon. Friend is making. The NHS is of course, in a sense, the carer of last resort, and I do not want to say the wrong thing within that context, but it is not right that the NHS should have to pick up the pieces from dangerous procedures that take place within an unregulated environment for young people. If that is the point that he is making, I fully agree with it.

It is also important that these procedures will remain available where there is an assessed medical need, and when provided by a registered health professional. The regulation of businesses will be enforced by local authorities, as I understand it, which will help to keep children safe in these procedures. Often local authorities have a very close understanding of what is going on within their community. We have touched on the fact that the growth in non-surgical treatments increases the need for consumer protection. It is important to work with stakeholders to strengthen the regulation of cosmetic procedures in general. We have touched on that point, but it is important. As has been said, it is also vital that we do everything we can to protect the mental health of children and young people, including through promoting body positivity. We have discussed that at some length, but I cannot stress enough, from my own personal experience of that young age group, how promoting body positivity is desperately important.

Finally, these regulations will help to raise awareness of the impact of botox and dermal filler procedures among all age groups. That is important because if parents and grandparents understand better the dangers of these procedures, they will be able to give meaningful advice to their children or grandchildren. In conclusion, I again congratulate my hon. Friend the Member for Sevenoaks on bringing this Bill to the House. It has my full and heartfelt support.

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[Claire Coutinho]

That is a really important point, because when people undergo these medical procedures sometimes the look that they are trying to achieve is a lie, because they are using filters and other social media applications. When someone has filler in their face they do not look like the filter shows them they might look.

[Dr Luke Evans]

On the subject of social media filters, is my hon. Friend aware of evidence from Girlguiding that three quarters of young girls will not consider posting an image without it being doctored? What impact does she think that has on perpetuating the cycle of bad body image?

[Claire Coutinho]

I was not aware of that fact, but it is a truly horrific statistic. We should all consider carefully what it might mean for our young people if they feel that lack of confidence in their own personal image. It is incredibly sad, and very much feeds into this debate.

It is commendable that the Bill tackles the risks that could affect people if they are given fillers by a medical practitioner who is unregulated. We heard from my hon. Friend the Member for Sevenoaks about a young lady who might have lost her lips. The risk of scarring, nerve damage and, in some cases, blindness has not been conveyed to people who are trying to access these procedures. I would therefore welcome a regulated sector.

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[Dr Luke Evans (Bosworth) (Con)]

This Friday is a day of joy for me for so many reasons. First, I had my point of order corrected—that is a learning point. Secondly, I am following my hon. Friend the Member for East Surrey (Claire Coutinho), who spoke eloquently. Thirdly, this is the first time since being elected that I am able to speak in this House with no time limit, and I am thoroughly looking forward to it. Fourthly, and through gritted teeth, I have to give credit to my hon. Friend the Member for Sevenoaks (Laura Trott), because I would have brought forward this private Member’s Bill should I have been lucky enough to have been selected in the ballot.

Since entering the House, I have seen, through my work on the Health and Social Care Committee and through many conversations with my hon. Friend, that she is dedicated, thoughtful and absolutely tenacious in getting this Bill through, and rightly so. The Bill is really important and has my full support.

We need to be careful in this debate not to demonise botox and fillers, because they are not the problem. We must remember that they have a use in medicine. As has already been hinted at, botox can be used for migraines, for excessive sweating and to relieve pain by numbing the nerve and stopping the nerve from working. That is why it stops wrinkles, because if it is used in a nerve, that part of the face cannot be innervated, so not so many wrinkles are created.

Fillers have a place as well. My hon. Friend the Member for East Surrey hinted at scarring, but they can also be used for acne. Hyaluronic acid, in the right place at the right time, is really important. We should also make distinctions when we talk about these products. Botox is time-limited and wears off, but with fillers it is a mixture depending on what is used and how it is used. Part of the problem is that often people do not know what kind of filler is going into their face.

My hon. Friend the Member for South Suffolk (James Cartlidge) talked about aspiration and I agree with him. There is a place for these products where people want to improve their body. Countless studies show that plastic surgery or interventions on an aesthetic basis can indeed give long-lasting happiness. Take the example of someone who has their nose corrected or a bump taken out: that can have a devastating effect if it is not dealt with and a really positive one if it is. We must therefore be very careful in this debate to ensure that people can get support when they want it and it is appropriate. A big part of the problem is that we get into this vicious cycle of people thinking incorrectly that having a correction will somehow deal with a flaw that is actually deeper in themselves, be it misplaced anxiety or depression.

[Suzanne Webb]

Does my hon. Friend think that we need to talk about body positivity, starting in schools and colleges, to ensure that people do not feel the need for treatments such as botox? People are trying to go for an unattainable image, and that is of great concern. They can never ever be that person, because the image is doctored by photoshopping or by an injection that paralyses the face and takes away all its natural features. I very much feel that the debate should start with body positivity, and that starts with a family in their house and in schools.

[Dr Evans]

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]

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 Evans]

rose—

[Madam Deputy Speaker (Dame Eleanor Laing)]

Order. Just before the hon. Gentleman answers that point, let me explain something. I am using this morning as a sort of tutorial on how the Chamber ought to be run. As the hon. Gentleman said, this is the first time he has been able to speak without a time limit, and I try not to interrupt when we are under pressure with time limits. The hon. Member for Hastings and Rye (Sally-Ann Hart) cannot say “yourself” to the hon. Gentleman, because in that she is addressing not the hon. Gentleman but the Chair—not even the person in the Chair but the Chair. That is a really important principle, and we do not want it to be lost in these unusual times.

[Dr Evans]

Thank you, Madam Deputy Speaker.

I absolutely agree with my hon. Friend. The differentiation between medical and aesthetic is really important. This is all about accountability, which is the key part of the Bill. There are the good uses that we have talked about, but there are complications as well. Unfortunately, in my practice I have seen those complications. I have had patients come to me who have had botox, and it has created an asymmetry in the face. Fortunately, it lasts only for six months, but that is a long time to sit with a face that a person is not happy with. More concerningly, I have seen patients who have come in with lip fillers that have gone wrong. The lesser side is the bruising and swelling, which will usually go after the first two weeks, but fillers can also become clumpy, with uneven lumps and bumps within the lips. Worse still, I have seen necrosis, which is dying of the tissue, where the lip filler starts to come out. That is absolutely devastating for the person suffering, and there is no accountability or anything to allow them to find out how to get that corrected.

[Jane Stevenson]

Does my hon. Friend agree that any cosmetic treatment, whether non-surgical or simple beauty treatments such as eyelashes being permanently bonded to the face, carries a medical risk? Does he agree that any procedure with medical risks should involve a detailed consultation and a form of consent?

[Dr Evans]

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 (Meriden) (Con)]

I understand that my hon. Friend has an extensive background in the medical field. From his experience, does he think that there are enough tools in place in education and in the home to help children feel the confidence they need to deal with the challenges of social media and such pressures?

[Dr Evans]

I am grateful to my hon. Friend for pointing that out. He is absolutely right. The Bill and the medical profession cannot deal with this alone; it is a wider, societal problem. As Members have already hinted at, we are aware of that and it is incumbent on us as parents and in whatever other role we come into contact with young people to try to nurture them and take them through. They can aspire to a healthy image of themselves through eating well, exercising and interacting with other humans. That is what humans do, and we should aspire to do that through education, both in educational settings in the home and through contact with the medical profession.

I see the Bill as a step-wise piece of legislation. Both my hon. Friend the Member for South Suffolk and my hon. Friend the Member for Totnes (Anthony Mangnall)—I am pleased to see that he has remained in his seat, as I half expected him to pop up on the other side of the House or further down the Bench. It seems a little harsh to say “Where’s Wally?” at this stage, so I will not. Both my hon. Friends hinted at a really important point, which is the crux of the matter. Indeed, my hon. Friend the Member for Sevenoaks mentioned it in her speech and it needs to be highlighted. This is about accountability. That is the crucial part of any decision.

I want to break that point down into three areas: practitioners, businesses and patients. When someone goes to see a practitioner, they need to know that they are qualified in what they do, that they can deliver it to a high standard and that, if something goes wrong, they can be held to account. At the moment, the industry is unregulated, and that is a real problem which means that the NHS becomes the carer of last resort.

Businesses have a responsibility as regards promotion. They should be held accountable when they put undue pressure on people who are unsure or exploring what they want to find out about the industry. That goes for adults as well as for young people under the age of 18. When businesses are set up, there should be some form of redress should they not perform to the expected standards. After all, let us think what would happen if we had unregulated operations. If someone needs to have a cyst removed, we do not allow them to walk in off the street and have it taken out by someone with no accountability or training. The principle is the same. The only difference is that rather than something being taken out, something is being put in. It is a big concern for me.

[Anthony Mangnall]

My hon. Friend is making an important point. I wonder how he envisages the practicality of creating a register of all the businesses that currently practise in this area. Given his medical insight, I would be interested to hear how that might work.

[Dr Evans]

I thank my hon. Friend for raising that point. I believe the industry has put in place a voluntary sign-up for standards. The point was made earlier—I am sorry, but I forget who by—that the industry itself is asking for regulation to be put in place, because it understands that good practitioners are very good at doing these procedures safely and wisely. We want to encourage businesses to take responsibility for putting standards in place.

[Jane Stevenson]

Does my hon. Friend agree that another serious concern is that less scrupulous practitioners will not use a light touch and seek a cosmetic improvement, but will seek to upsell and invite people to have more and more procedures in the name of making more money?

[Dr Evans]

Absolutely. My hon. Friend points out something worrying: if someone is vulnerable in the first place when they go for a procedure, unsure about why they are there, and is coerced into taking some further measure, that is a concern. It leads into a vicious cycle of returning again and again for an update on something that may never be achieved.

All that leads on to the idea of consent, which is really important for both patients and practitioners. We need to make sure that when someone goes for a procedure it is fully explained to them what the procedure is, why they are having it and what the consequences are, including the short-term and long-term complications. If someone goes to theatre to have an operation, it is spelled out to them. They have to sign a declaration to say that they understand it, and they and the person carrying out the operation are held accountable to that standard. That is really important. Sadly, that accountability is lacking, particularly in respect of fillers. That is the concern, because it leads to a variation in standards, an unregulated industry and the horrific cases that my hon. Friend the Member for Sevenoaks highlighted.

All that I have described applies to adults, but of course we are talking about under-18s. It is really important to make the point that this is about drawing these procedures into line. We already have statutory regulations that say that a person cannot have a tattoo until they are 18. The Bill would simply bring into line an industry that is burgeoning and blooming. That is the important point.

This is about protection, accountability and, most importantly, choice. We should encourage those who want to go ahead for the right reasons to have the right procedure done in the right way, and held to account in the right way. We need to protect, nurture and educate those under the age of 18 and allow them to make the decision when they become 18.

[Anthony Mangnall (Totnes) (Con)]

It is a pleasure to speak in this debate. I congratulate my hon. Friend the Member for Sevenoaks (Laura Trott). She is a fantastic champion on this issue and her constituents should feel incredibly proud of what she is doing today. I should add that this Bill complements the ten-minute rule Bill introduced by my hon. Friend the Member for Bosworth (Dr Evans) not so long ago.

I hope to address a whole host of things in the course of this debate, but I shall start by reflecting on some of the words that Members have already spoken. My hon. Friend the Member for South Suffolk (James Cartlidge) spoke incredibly powerfully about the need not to over-regulate, and to encourage education throughout schools, through the media and, perhaps more importantly, through social media. We cannot make that point too strongly. It is a necessity in this modern day and age, when social media is at the fingertips of every schoolchild and, indeed, every adult. We need to be able to engage the industry and the sector to inform and help the debate along, to make sure that people’s view of their body image is a positive one, not one that constantly and continually needs change.

[Dr Luke Evans]

My hon. Friend talks about education. Indeed, should a person be curious about going ahead with these procedures, is it not right that the extent of what may well happen to them should be fully explained so that, when they go into that consultation, they can make that decision with the full unfettered knowledge of what may proceed?

[Anthony Mangnall]

Absolutely. I hope that that can be done from a professional point of view. I also hope that Members of Parliament, who have learned from this debate, can go into schools to discuss this issue and the outcomes of the Bill, which I hope very much will pass its Second Reading later today. As the hon. Member for Strangford (Jim Shannon) is not in his place, I will try to make many interventions on this point as well, because it is such an important issue.

My hon. Friend the Member for Wolverhampton North East (Jane Stevenson) also talked about the need for regulation and for comprehensive documentation on those practitioners, which is really important. We know that a huge number of practices that currently perform this procedure are not regulated and are not on the books. People can too easily get access to these practices, so that needs to change. Perhaps a register should be brought forward to ensure that there is firm documentation and that we understand who is doing what and where.

My hon. Friend the Member for Clwyd South (Simon Baynes) talked about body image, and he talked about his two daughters. Although I am not a parent, or at least not that I know of, there is an important issue here: if parents can step in and educate their children on that role and join up with schools in making sure that there is a comprehensive, joined-up approach to tackling social media and tackling what newspapers and magazines are doing, that will be key to solving the issue. He very aptly talked about the idea of double trouble, and that is the point. As my hon. Friend the Member for East Surrey (Claire Coutinho) said, we are the last generation to experience a world without social media. Any generation that comes after us will have to put up with the constant impact of social media, and that is a significant problem.

[Dr Luke Evans]

One problem that has been hinted at, and it has been ever thus, is fashion and trends. A big complication that we have with cosmetic surgery, particularly with regard to the longer-term use of lip fillers, is that this may well be permanent. Therefore, a person may be featuring a fashionable trend that lasts, perhaps, six months, but, yet, 10 months down the line, they may be seen as somewhat unfashionable.

[Anthony Mangnall]

That is indeed the case. Importantly, we must not let this be a fad of the time. It has to be something that is thought out. If there is a medical reason for someone undergoing an operational procedure, that is absolutely correct, but we cannot let the whims of social media or the fad or the style of the day dictate how someone might end up living for the rest of their life.

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[Dr Luke Evans]

Through my work on body image, I have had meetings with Instagram and Facebook, and they are keen to point out that they want to promote positive images and are working hard to achieve that. One of the issues often talked about in terms of policing the digital sphere is how we identify this, particularly around social influencers. Social influencers have a really important role in this, and they are keen to point out that they already differentiate between organic content and content for commercial purposes. Does my hon. Friend agree that it is not pie in the sky to police honest advertising on social media when it comes to body image?

[Anthony Mangnall]

This goes back to the intervention that I made earlier about the datasets used by cosmetic companies on adverts. It is extraordinary to read that “80% of all women think this product works” when the dataset is only 105 people. That is not an acceptable way to market a product. It aims to change someone’s perception, using incredibly persuasive advertising techniques, with incredibly beautiful people and saying, “This works.” That is a misnomer, and it is very damaging. Many of us have spent a great deal of time watching television in lockdown, and it is a real problem for parents to see their children influenced in that way.

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[Laura Farris]

I am grateful to my hon. Friend for her point, which I agree with. I have focused my comments more on young women, but I think the read-across to men should not be disregarded.

[Dr Luke Evans]

We must not forget that celebrities are people, too. They feel the anxiety and pressure to conform, too. That creates a vicious cycle. Spencer Matthews, very honourably, has spoken about the need to use steroids to bulk up and Laura Anderson has spoken about the need to manipulate her images put into the media so that they conform to a standard. Does my hon. Friend agree that that is part of the problem? There is a vicious cycle of trying to achieve something unobtainable.

[Laura Farris]

I agree with my hon. Friend. This is not a case of trying to pinpoint individuals and say that they are responsible; it is an overall culture.

I have reflected on what this says to young women. It does not say that it is a good idea to look that way. It says that it is a necessary idea to look that way if you want to be happy and successful, and to have a partner, to have a full social life and to be of value in this world. And actually it says that the opposite, not conforming to those kinds of standards, is equivalent to failure. That is a pernicious message that deserves to be aired by Members of the House this morning.

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[Dr Luke Evans]

I am glad to have my hon. Friend’s support. I think it is important to realise that fashion, trends and the air of beauty have always been there. The difference is the intensification and the unrealistic aspect of it these days, as opposed to the days of hexamethonium, when women would take drugs that ended up killing them, or indeed of corsets, for example. That is a really important point. It is the intensification and the unreal achievability.

[Suzanne Webb]

I thank my hon. Friend for his comments. That is an important point. People put pressure on us to make us feel that there is a way that we are supposed to look. I am afraid that gentleman often make us feel that way as well. We feel that we need to look a certain way to be attractive. We are attractive for who we actually are. We should just be ourselves. That is the most attractive quality in a person that I can think of.

I have seen written work where botox was debated around a “Should they or shouldn’t they?” argument. My simple question is: why would you? Why would you feel the need to do that?

I had not realised when researching this topic that non-surgical cosmetic treatments, such as botox and dermal fillers, generate over £2.75 billion in the UK and account for 75% of all cosmetic enhancements carried out each year. That is great news on the one hand because it is generating income—fantastic—but when we look at it another way, it is a lot of money focused on cosmetic enhancements. It is the word “enhancements” that starts to ring alarm bells, as does the fact that young adults partake of this practice. I thank my hon. Friend the Member for Sevenoaks for taking time to raise awareness of the impact of botox and dermal filler procedures among all age groups, but particularly those under the age of 18.

When I dug a little deeper, I found that, unlike their surgical counterparts, such as breast enlargement and facelift operations, which have clear and defined laws as to who can undertake the procedures, non-surgical cosmetic injections can be administered by anyone. What struck me most was that it is a largely unregulated industry. I support the wish to see the regulation of this practice enforced by a local authority, which will help to keep children safe from these procedures. It will help to ensure that children grow up to be the person they actually are and, as I said before, to age gracefully.

I thank my hon. Friend for raising awareness of the potential health risks of the procedures, including blindness, infection, scarring and psychological impacts. I also want to say again that we do not know the mental health impact of this and what has brought somebody there in the first place. There must be some damage to one’s self-esteem to think that you need to change your appearance. For me, as I mentioned at the start, that is one of my greatest concerns on this and the growing mental health issue within young adults.

Local Contact Tracing

Luke Evans Excerpts

Wednesday 14th October 2020 Commons Chamber

[Catherine McKinnell (Newcastle upon Tyne North) (Lab)]

I agree with everything my hon. Friend the Member for Wirral South (Alison McGovern) said.

NHS Test and Trace is not working. Billions of pounds have been poured into a system that has sidelined existing local expertise in primary care, public health and science. The resulting system is labelled NHS Test and Trace, but it has hardly anything to do with the NHS. Stop denigrating the NHS by associating it with this failing system.

We are stuck in this world of uncertainty, with a rising infection rate and the virus out of control, and we are without the ability to properly track it, as my hon. Friend has just described. It is like “Groundhog Day”. Until we have a vaccine, we will not get out of this without a functioning track and trace system.

We are the fifth richest economy in the world, and we have one of the best healthcare systems. We have leading science research universities, yet we have spent all this money contracting out the system to Serco. Now, on top of that, we are spending millions of pounds bringing in private contractors to try to sort out the mess. It costs more in one week than we pay an experienced nurse in a year. It is a disgrace, and it feels like a wasted opportunity to build on the existing expertise and experience to strengthen the local systems in primary care and local authorities. Doing that now is the only way out of this nightmare scenario.

The outbreaks we have seen in the universities in Newcastle, for example, were not identified by the national system—it seems incapable of doing that at present. The outbreaks were identified based on local intelligence and local knowledge, and by piecing the pieces together. We know that co-operation between local health services and authorities is the way to control infectious diseases. GPs, NHS and public health laboratories, and local public health officers all play a key role. Winter is approaching and GPs will be the people who can see the overlap in covid symptoms such as fever and a dry cough, and the classic flu symptoms of fatigue, sore throat and headaches. We need that integrated public health expertise to truly make this testing and tracking system work. We have 1,200 primary care networks in England. They will be best placed not only to run test, track and trace, but to deliver the vaccine when we finally have it—we will be ready for it.

[Dr Luke Evans (Bosworth) (Con)]

I hear time and again from this side of the House people talking about giving more to the primary care networks. As a GP, I worry that this could be a concern for my public health colleagues as well because they already serve a function—of non-covid health service. I would be interested to hear the thoughts of others on this concern: what happens if we keep putting more pressure on public health and GPs, who are already dealing with non-covid stuff? How do we deal with this? It makes a lot of sense to bring in a national service to try to do that; we did that with the Army to help with test, track and trace. What does the hon. Lady think about the possibility of extra pressure there?

[Catherine McKinnell]

Absolutely, spend the billions of pounds that we have wasted—spend it on bumping up the capacity and ability of our local GPs and health services, which can do a better job.

I wish to say a word about asymptomatic carriers. Research published by University College London last week found that 86% of those sampled who had tested positive for covid-19 between April and July had had no symptoms—that includes cough, fever or loss of taste and smell. So many people who are asymptomatic test positive, as we have seen at Northumbria University, and that is hugely concerning. It shows that we need a much more robust and expanded testing strategy to control the virus.

What are the Government doing to ensure that we can capture these silent spreaders? Is the system anywhere close to having the capacity to address this, given that we cannot even test those who have symptoms and have been instructed to take a test? The Government wasted the time we spent in national lockdown and failed to get the apparatus of proper track and trace system in place once those restrictions were finally relaxed. We are now living with the consequences of that decision. As we now appear to be entering another era of harsher restrictions across much of the country, the Government owe it to the people who continue to endure hardship, uncertainty, loneliness and bereavement not to waste this time again.

Public Health: Coronavirus Regulations

Luke Evans Excerpts

Tuesday 13th October 2020 Commons Chamber

[Matt Hancock]

Yes, absolutely, and I will go further than that: we look at this at sub-district level, if that is appropriate. In High Peak we put four wards into level 2 and the rest of the wards stayed in level 1. So we are prepared to look at the sub-district level if that is appropriate. Some districts within North Yorkshire have individual outbreaks in individual institutions that we are managing, and we should not mistake that for general community transmission and therefore put those areas into a higher level than is necessary. I am happy to go through the local epidemiology from near Thirsk that affects my hon. Friend’s constituency.

In a sense, that brings us to the point of these local covid alert levels. These are the first statutory instruments to be debated under our commitment to consult Parliament on significant national measures that have effect in the whole of England or are UK-wide and, wherever possible, to hold votes before the regulations come into force. That is what we are doing today.

Local action has proved to be one of our most important lines of defence. Where firm action has been taken—for instance in Leicester, or in Bolton, where we flattened the curve—our local approach has inevitably produced different sets of rules in different parts of the country, as my right hon. Friend the Member for Sutton Coldfield (Mr Mitchell) set out. We have already moved towards simpler national rules that are centred on the rule of six, and we are now acting to simplify and standardise the rules at a local level.

The regulations set out three levels of alert: medium, high and very high. The medium alert level, which will cover most of the country, will consist of the current national measures. This includes the rule of six and the closure of hospitality at 10 pm. The high alert level reflects the interventions in many local areas at the moment and that aims to reduce household-to-household transmission by preventing social mixing between different households indoors, with the rule of six outdoors. That is super-simple: no household mixing socially indoors and the rule of six outdoors.

The very high alert level will apply where transmission rates are rising most rapidly and where the NHS will soon be under unbearable pressure without further restrictions. In those areas the Government will set a baseline of prohibiting social mixing, while allowing households to mix in public outdoor spaces, because that is where the risk of transmission is lowest, as long as the rule of six is followed. That baseline is set out in the very high alert level regulations being considered today. Pubs and bars will be closed, and we will advise against travel into and out of very high-risk areas.

We also offer a package of support for individuals, businesses and councils. That includes more support for local test and trace, which many have asked for, more funding for local enforcement and the offer of help from the armed services, as well as the job support scheme announced by the Chancellor. That is best done as a team effort and, wherever possible, we want to build local support on the ground before we introduce these measures. So in each area we will work with local government leaders on the extra measures that need to be taken. We do not rule out further restrictions in the hospitality, leisure, entertainment, or personal care sectors, but retail, schools and universities will remain open.

[Dr Luke Evans (Bosworth) (Con)]

On buying-in the local community, would the Secretary of State consider having a Government postcode checker so that people know exactly where they should be, in having the three tiers?

[Justin Madders (Ellesmere Port and Neston) (Lab)]

That was my idea.

--- Later in debate ---

[Dr Luke Evans (Bosworth) (Con)]

I take this opportunity to thank all those in my constituency who followed the rules when Leicestershire was being threatened with a lockdown. Through their dedication and their following of the rules, we have managed to avoid it for now.

During that threat of lockdown, one of the key messages I brought to this House was the importance of making sure that two key messages get through: where the affected area is and the measures that come into place. I am therefore pleased to hear today that we have a simplification and a tier-based system that will allow our constituents to understand the measures in place. With a postcode checker as well, it is even better. That was built, and I fed into the review led by Dame Mary Ney. She has produced a document on good practice for areas going into lockdown. I suggest that Members have a look at that document, because they can hold the Government to account by the very nature of what is written in it.

I was pleased to hear yesterday—it was repeated again today—that the Government acknowledge the difficulties of balancing health and the economy. It is a simple temptation to say, “Let’s just do it by generations and protect the shielded”, but the evidence shows that we cannot do that. Generational spread does happen, and that is when the threat comes to our elderly and our shielded.

What has happened this time is that we have a more nuanced response from the Government, and I welcome that. It is good medicine to change as things progress, but I want to focus on the future. I have some short-term suggestions for the Government, such as making sure we are clear with our signage about indicative dates, changes and accountability. We need to be clear about the principles behind the decisions we take, so that when someone asks, “Why can’t I sing?”, they can be told, “Well, singing transmits the virus four times further.” When those principles are clear, it becomes obvious how to interpret the guidelines.

We want certainty for sectors, whether that is the wedding industry, events, the aerospace industry or the travel industry. They need certainty on exactly what will happen for them with guided points. They welcome timetables and they understand if things move, but a clear direction at least is important.

I welcome the aim for a vaccine, but until we get there I agree that a plan B would be useful. We have talked about near patient testing, and I have raised those questions in this House. Could it be that, in the future, before we come to speak in the Chamber, we have 20-minute saliva test—it is bound to be negative—and then come in and carry on with our day-to-day life? Until we get there, I urge the Government to read the Health and Social Care Committee’s recommendations on dealing with non-covid sites. At the end of the day, experience teaches us to help those who cannot and to empower those who can. That should be the message that the Government take forward.

Covid-19 Update

Luke Evans Excerpts

Monday 5th October 2020 Commons Chamber

[Matt Hancock]

That is exactly what we are doing—absolutely. For instance, this morning I also spoke to Sadiq Khan, the Mayor of London, about how we continue to strengthen the join-up between the national and local approaches. I entirely agree with the hon. Lady that that is incredibly important.

[Dr Luke Evans (Bosworth) (Con)]

Until we get a vaccine, the House knows that it is about following the rules of hands, face, space and get a test, but my right hon. Friend will also know that there are different types of test out there. Can he comment on the plans for future testing and on what updates there might be? We have heard talk of saliva testing, finger-prick testing or, possibly, that we may be able to allow individuals to deal with covid themselves.

[Matt Hancock]

We are doing a huge amount of work to trial these next-generation tests at the same time as expanding the current testing capability. For instance, if we have to have a test, would it not be easier if we just needed some of our saliva rather than to having to put the swab all the way up our nose and down the back of our throat? These sorts of improvements in technology are in the pipeline and we are working incredibly hard to bring them to bear as soon as possible.

Covid-19

Luke Evans Excerpts

Tuesday 1st September 2020 Commons Chamber

[Matt Hancock]

We are working very closely with the Department for Education to have a successful and safe return of universities, just as, from today onwards, we are seeing a successful and safe return of schools.

[Dr Luke Evans (Bosworth) (Con)]

I am really pleased to hear my right hon. Friend talk about the largest flu vaccine programme ever being put in place, particularly for those over the age of 50. In normal times that would be a challenge and it is going to be even more difficult in the light of covid. I would be grateful if he would talk about the practical steps he is taking to make sure that things are simple and secure enough to deliver it, but not too prescriptive for those delivering the vaccine; whether or not adequate funding is in place to support the flu vaccine; and any other steps he has taken to make sure we have a successful flu vaccine campaign over the winter, given the covid situation.

[Matt Hancock]

We are putting enormous sums into the flu vaccine programme and have released extra funds to buy more vaccine. We are deregulating and making sure that we have a wider group of people—who will all be clinically qualified—who can administer the flu vaccine; those regulations will come before the House shortly. My hon. Friend is right to say how important it is to get the communications out that everybody should get a flu jab. We will start with the free jabs for the over-65s, the frontline healthcare workers and those who are clinically vulnerable, and we will then move on to the 50 to 64-year-olds. But everybody, of every age, can get one—it is just not free to others. I encourage everybody to get one. We must tackle these online rumours that spread the pernicious anti-vax lies.

Coronavirus Response

Luke Evans Excerpts

Monday 20th July 2020 Commons Chamber

[Matt Hancock]

I am pleased to congratulate all those working in Buckinghamshire—the council, the CCG and the other parts of the NHS—on their work to keep Buckinghamshire safe. The number of infections across Buckinghamshire is very low now, and we want to keep it that way.

I also take this opportunity to answer part of the question from my hon. Friend the Member for South Derbyshire (Mrs Wheeler) that I did not answer. More powers, as well more data, will be available to local areas to take more local action themselves, without having to refer up to the Secretary of State to use my powers. Of course, national Government hold further powers for significant action, which we have had to use just the once, but we will give local areas more powers, as well as more data, to be able to grip this issue locally.

[Dr Luke Evans (Bosworth) (Con)[V]]

I am grateful to my right hon. Friend for his announcement today and congratulate the scientists looking into the research that will hopefully solve this covid problem. On Friday, he announced a review into Public Health England deaths data, which is incredibly important. Does he have any indication of how inaccurate that data may be? If so, how is that impacting future planning for the covid response?

[Matt Hancock]

I do not have anything further to add yet. The problem was that anybody who had had covid at any point and then subsequently died, whether or not from covid, was being counted in this data. Right at the start of the crisis, that was a perfectly reasonable approach to take, but clearly it needs to be reviewed. It is likely that the number of deaths has been overestimated on this measure, hence the urgent review, and I hope to have more information this week.

Covid-19 Update

Luke Evans Excerpts

Thursday 16th July 2020 Commons Chamber

[Matt Hancock]

The report was incredibly important in making sure that we cast ahead and look at all the challenges facing us, but it took the assumption that there would be no action from the Government should the R go to 1.7 and it is our stated policy not to allow that to happen. So although the report showed a worse-case scenario based on a set of assumptions, we are constantly vigilant.

[Dr Luke Evans (Bosworth) (Con) [V]]

I appreciate the Secretary of State’s answer to several questions about the learning he has done, because 10 days ago I asked him about information for the people of Hinckley and Bosworth, in Leicestershire. They want to know where the boundary is and what the implication is of any changes. Would he be kind enough to point out exactly where the boundary is? For the people who are now out of lockdown, will he say what that means in terms of the measures they are taking, so that they have a clear message to take home tonight?

[Matt Hancock]

I am happy to give that answer, which is very clear. For those in the city of Leicester, and in Oadby and Wigston, the position is that of the measures that I have set out: releasing, on 24 July, the closure of non-essential retail and of schools and childcare facilities, but keeping all the other measures in place. Those not in those two specific areas return to the same measures that the rest of the country is living with, except of course that we will keep the higher vigilance, the higher level of testing and the communications in those areas. The decisions on this geography were taken on the advice of local council leaders. While I have been on my feet, I have seen that the Mayor of Leicester has made some comments on this. I did ask him whether he wanted to put forward a different geography within the city of Leicester and he declined to do so, but we work very hard and as closely we can with Leicester and especially with the public health officials there, who are doing a valiant job in difficult circumstances.

Coronavirus

Luke Evans Excerpts

Tuesday 7th July 2020 Commons Chamber

[Matt Hancock]

Yes, we have a project under way on this. It is something that the Chair of the Science and Technology Committee has been working on for weeks as well. Again, I will write to the hon. Member with the full details of the plan to make this happen.

[Dr Luke Evans (Bosworth) (Con) [V]]

May I take this chance to thank the people of Leicester and Leicestershire, the police and public health services for dealing with the local lockdown that has been implemented? When it comes to a local lockdown being announced, the people of Hinckley and Bosworth need two vital pieces of information: what the measures are, and where the boundary is. The Government were quick to put up on their website what those measures were, and they rightly allowed Public Health England and the councils to draw the boundary. What lessons has the Health Secretary learned from the Leicester lockdown, including about passing on information quickly, to be used in future lockdowns , which may well happen in the rest of the country?

[Matt Hancock]

My hon. Friend is right to praise the work that has been done by Leicestershire County Council, as well as by the city council, with which we are working hand in glove. We are looking at the way that the lockdown was brought in at pace in Leicester, to ensure that, should we need to do that again, it is a yet more effective process. One of the lessons is that the boundary for the action is a critical piece of information. We managed to publish that overnight, within about 12 hours of the decision being publicised. I pay tribute to the county council, which led on that decision. Ensuring that we have both the actions and the boundary ready as soon as possible is critical, because, naturally, local people immediately want to know whether they are in the lockdown area.

Coronavirus and Care Homes

Luke Evans Excerpts

Tuesday 19th May 2020 Commons Chamber

[Matt Hancock]

I am a massive supporter of the living wage and, of course, the increase in the living wage that we have seen since its introduction in 2015 has had a very positive impact on the pay of the lowest paid people in our country right across the board, including many in care homes. I think it is an excellent policy and I am delighted that we have brought it in.

[Dr Luke Evans (Bosworth) (Con) [V]]

The £600 million presented by the Secretary of State for infection control is very welcome, and having a named clinician to help support care home staff is particularly important. That came out in the Health and Social Care Committee when Professor Lum talked about what happens in Hong Kong. One of the lessons they learned several years ago was to have a named person in a care home, but also to do yearly, effectively, virus drills, like a fire drill. Would the Secretary of State consider putting that in place to help to deal with the impact of possible second waves?

[Matt Hancock]

Yes, we are doing a huge amount of work now to ensure that there is protection in the future should there be a further increase, and in particular in advance of winter in case there is strong seasonality to this disease. As a clinician himself, my hon. Friend understands the importance of these areas and we will absolutely take the idea he put forward and run with it.

Covid-19

Luke Evans Excerpts

Tuesday 12th May 2020 Commons Chamber

[Dr Luke Evans (Bosworth) (Con) [V]]

It is nice to have the chance to put on record my thanks to constituents in Bosworth and the key workers. A couple of weeks ago, I wrote to the GPs, the pharmacies, indeed the police, the schools, the care homes, to congratulate them on the work they are doing, and continue to do. I am most grateful for all that they do.

It is fair to say that the virus reaches all areas of our lives, and in turn all areas of Government, and that brings pain—pain with the loss of businesses, pain with the loss of jobs, but, most importantly, pain with the loss of lives. However, out of crisis comes opportunity, and there are some positives. I would like the Government to take those forward. I envisage that in the form of a time-limited department called the “department of virus legacy”.

At the end of April, I wrote to the Cabinet Office and the Prime Minister, because I think it is so important, as we have heard in these debates, to encapsulate and draw on all the positive aspects that have come out of this crisis. We have had a revolution overnight, rather than the usual evolution. In my sector as a GP, literally overnight everyone has begun teleconferencing. That is something that the industry has tried to do for over a decade, and has not been able to achieve—and just like that, it has happened.

Pharmacies are now all digital, with electronic prescribing. In my role on the Health and Social Care Committee, I asked all the witnesses we have had what positive aspects had come out of this. Those in cancer care talked about how they were able to bring 10 teams into one hospital to deal with a patient, and maternity talked about the fact that they have actually had more contact because they can do remote teleconferencing. It is the same with mental health. There are positives out there, and that is just in the sector that I come from.

More widely, we have looked at remote working. We have looked at the societal benefits of now knowing your neighbour, caring for your neighbour and caring for your community. These are absolutely critical things, which we need to embed into our society. To do that, I urge the Government to consider establishing such a department.

Legacy planning, as we found in the Olympics, is absolutely critical. Now more than ever we have the time-limited opportunity to enshrine, post virus, the positive changes in the fabric of our policies and, in turn, our Government and society. To the Minister listening I say, “I hope you will take this on board when you hold discussions with the rest of Government.”