Organ Donation and Transplantation Strategy

Anthony Mangnall Excerpts

Wednesday 23rd February 2022 Westminster Hall

[Esther McVey (in the Chair)]

I will call Anthony Mangnall to move the motion. I will then call the Minister to respond. As is the convention for 30-minute debates, there will not be an opportunity for the Member in charge to wind up.

[Anthony Mangnall (Totnes) (Con)]

I beg to move,

That this House has considered the organ donation and transplantation strategy.

It is a pleasure to serve under your chairmanship, Ms McVey. I thank the Backbench Business Committee for granting the opportunity to debate the important topic of the organ donation and transplantation strategy. I also thank the Minister and her departmental team for their responses to my inquiries about organ donation on behalf of my constituents. Their answers have been detailed, helpful and reassuring.

In the time I have been in this place, I have learned that Westminster Hall debates are not always used to be helpful to the Government and are often used to point out their flaws and failings. I may be guilty of having done that once or twice myself, but I want to use this debate to do three things. First, I want to congratulate the Government on the steps they have taken thus far, most notably with the Organ Donation (Deemed Consent) Act 2019. Secondly, I want to encourage further education and awareness around organ donation. Thirdly, I want to explore future steps that the Government can take in relation to organ donation and transplantation strategy.

In May 2020, the law around organ donation in England was changed to allow more people to save more lives. The Organ Donation (Deemed Consent) Act, which many hon. Members present supported, changed the law to mean that an individual agrees to become an organ donor when they die if they are over 18, have not opted out and are not in an excluded group. The Government’s legislation brought us more into line with other countries but, more importantly, the number of available organ donors increased dramatically, while the number of people opting out of the opting-in initiative only slightly increased. Pre opt-out—before 5 May 2020—the UK had 26,037,200 registrations, whereas the total UK opt-in registration was 27,594,279 on 13 February 2020. By comparison, fewer than 1.5 million people opted out before 5 May 2020, with the total number now standing at 2.3 million. These numbers show that in less than two years, we have had a sizeable increase in the number of potential organ donors, while only a small percentage of the population have chosen to opt out of the initiative.

NHS Blood and Transplant launched a public awareness campaign in April 2019 to inform the public about the prospective law change and the choices available to them. An evaluation of that campaign found that over 75% of adults in England were aware of the new system of consent. The third year of the campaign, which I believe comes to an end in March 2022, looks to encourage people to talk to their families and loved ones about organ donation and their organ donation decisions. With consent rates currently at 68% across the UK and 78.8% in the south-west, it is particularly welcome to see the Government state their ambition to increase consent levels to 80%. A 12% increase is likely to result in approximately 700 more transplants per year and countless lives saved.

[Jim Shannon (Strangford) (DUP)]

I commend the hon. Gentleman for securing the debate. The hon. Member for Barnsley Central (Dan Jarvis), who is present, the former MP Geoffrey Robinson and I were part of the team that worked to get the organ transplant legislation changed. As a member of the Democratic Unionist party, I was always in favour of the opt-out. I am very pleased to say that my party saw the light and supported that line of thought. With Northern Ireland and other countries in the UK having passed legislation to adopt the choice to opt out of organ donations, does the hon. Gentleman agree that now is the time for a UK-wide strategy to ensure that no organ is lost because the system does not efficiently make the most of the connectivity between each region of the United Kingdom of Great Britain and Northern Ireland?

[Anthony Mangnall]

I am always delighted to take questions from the hon. Gentleman. I absolutely agree that if there is parity in all four corners of the United Kingdom, there is an opportunity to ensure that all citizens can get the organs they need; that they can get on to the register where possible; and that there is a developed and comprehensive transplantation strategy across the country. I understand that the hon. Gentleman went further than his party and was by far one of the earliest supporters of the opt-out initiative. I know to my heart that he was a pioneer in leading his party and getting them to where they needed to be to see the changes in Northern Ireland. I am grateful for his question.

As I was saying, the Government and the NHS should be proud of the campaign that they have run to date, and the undeniable progress that it has delivered. That brings me to my second point: the organ donor register. I am sure that all colleagues here today will agree that it is essential that we encourage as many people as possible to sign up to the organ donor register. As of 31 March 2021, 38% of the population had joined the register, while 3% had opted out. Initiatives are already in place to increase registration, with a number of routes available, whether through the Driver and Vehicle Licensing Agency, the NHS app, applying for a Boots advantage card, or even through the NHS Blood and Transplant organ donation website, which, just for clarity, is at www.organdonation.nhs.uk.

It is vital that we continue to keep as many avenues open as possible, and that the campaign continues to be fully supported and championed by the Government. With that in mind, I ask the Minister what plans are in place to continue to raise awareness of the organ donor register and to encourage continued conversation and education around organ donation. Secondly, would the Minister consider extending the scheme to include other official forms? That might include, but not be limited to, those signing up to the electoral roll or giving blood.

The organ donor register moves an individual’s organ donation from a passive decision to an active one. For every individual that decides to sign up to the organ donation website, they are providing a record of their consent to help save lives should the unimaginable happen to them. Importantly, by signing that register, individuals are providing an affirmation of their desire to be an organ donor, which I hope that their family members and loved ones will honour—I will touch on that again shortly.

As of 13 February 2022, there are 6,157 people waiting for an organ transplant in the UK. Even the large numbers that I have buried the House in thus far hide the fact that there is a shortage of donors in the UK. Between April 2020 and March 2021, in the UK, there were a total of 1,180 deceased donors and 444 living donors, which resulted in 3,391 lives being either saved or dramatically improved by an organ transplant. However, 474 people died while on the active waiting list and a further 693 were removed, primarily because of deteriorating health. Of course, I accept the varied reasons why people come off the list, but the numbers provide an indication that while the situation is improving, there is still work to be done.

The NHS Blood and Transplant strategy, “Organ Donation and Transplantation 2030: Meeting the Need”, published on 1 June, calls for a highly public campaign broadening the settings in which people might find information around organ donation. It also includes six key points: making living and deceased donation an expected part of care; developing and pioneering new technologies and techniques; ensuring recipient outcomes are the best in the world; ensuring that people of all backgrounds and circumstances have timely access to the organs they need; maintaining a sustainable service across the UK; and building a pioneering culture of research and innovation in donation and transplantation in the UK. I ask the Minister how those six action points are being monitored, and how often they will be reviewed. Furthermore, does she feel that anything should be added to those points since the introduction of the 2019 Act?

Although I promised to be positive and congratulatory about the Government’s action on this matter, I am aware of a few areas relating to organ donation that are causing some concern. As mentioned already, under the 2019 Act, and specifically the opt-out system, all over-18s—albeit with a few caveats—are considered to become organ donors when they die unless they opt out. An individual can also actively register, as I have mentioned already, through the organ donor register. However, a family member or loved one can—and often does—overrule the donation of an organ in both instances. As mentioned already, the consent rate for eligible donors was 68% between April 2020 and March 2021, meaning that loved ones, for various reasons, refused to support 32% of potential donations. That equates to 695 donors.

There are myriad reasons why consent for deceased donors might not be given: the patient expressing a desire not to donate, but not opting out; a lack of desire for further surgery on a body; a feeling that the patient had suffered enough; the fact that the process takes too long; or the fact that the donation was against religious beliefs. Of course we must respect the decisions and views of family members and loved ones; staggeringly, however, 10.2% of those 32% of organ donations were refused because family members were unsure about whether the patient would have wanted to donate. Surely that clearly shows the continuing need to have a conversation and actively encourage greater sign-up to the organ donation register. In actual numbers, that 10.2% equates to 71 individuals whose organs might have helped to save a great number of lives. Of course, I make no judgment about those families and the decisions that they take in incredibly difficult circumstances, but there is an opportunity for us to go that little bit further and help save those extra few lives.

With that in mind, what progress has been made with the Leave Them Certain campaign mentioned in the NHS Blood and Transplant strategic plan, which I referenced earlier? I understand that the Human Tissue Authority guidance specifically states that families will always be consulted and that scrutiny is needed in the process. However, where possible we should be trying to eliminate the second-guessing and possibility of going against the deceased’s final wishes.

I asked for this debate because among the regular correspondence that I have had with constituents on the matter of organ donation, I have had the incredible good fortune of having been introduced to Sarah Meredith and her family. Sarah is a 29-year-old constituent who lives with cystic fibrosis. Thanks to the approval of the drug Kaftrio, Sarah and thousands of others living with cystic fibrosis can look ahead with an improved degree of certainty and a greater quality of life. However, that wonder drug does not solve all the difficulties of living with that disease; Sarah needs a liver transplant.

Over the course of the last two years, I have met Sarah’s mother Cathy and sister Jessica to hear first hand about the ailments from which Sarah suffers and some of the problems that they have identified within our transplant system and the wider regional disparity when it comes to healthcare services. I have already highlighted some of the concerns around organ donation, but I would like to add a few words about healthcare infrastructure. The organ utilisation group, chaired by Professor Stephen Powis, was established by the then Health Secretary, my right hon. Friend the Member for West Suffolk (Matt Hancock), to provide recommendations that would deliver improvements in the number of organs accepted and successfully transplanted; to optimise the use of existing skilled workforce investment in infrastructure; to support innovation in the field of organ transplantation; to standardise practices across the country—a point made by the hon. Member for Strangford (Jim Shannon); and to provide equity of access and patient outcomes. I look forward to seeing the recommendations, the report when it is published—in March, I believe—and the Government’s response.

Will the Minister come before the House when the report is published to take questions from Members interested in this topic? Although the south-west can boast a high consent rate—it is only slightly off the Government’s 80% target—we are at something of a disadvantage when it comes to liver transplant units across the region. There are just eight such units in the UK, including one in a children’s hospital. The liver transplant centres nearest my constituency of Totnes in south Devon are in either London or Birmingham.

I have heard anecdotal and first-hand accounts about ill patients who have been asked to make the journey to London from south Devon for a transplant, only to arrive and discover that the organ they were expecting has deteriorated and is no longer suitable for transplantation. One can only imagine how awful that journey is in both directions in that situation. I understand that there is a new national programme to expand the number of living transplant centres across the UK and that the north-west and south-west are two priority areas due to a lack of existing transplant infrastructure. Will the Minister reassure me and all those across the south-west who are hoping for an improved service that this new programme will be rolled out at pace? It is clear that many cannot wait.

[Dan Jarvis (Barnsley Central) (Lab)]

I hesitate to intervene on the hon. Gentleman because he is making an excellent speech, but I wanted to take the opportunity to warmly congratulate him on securing this debate and bringing this important matter to the House’s attention. I should declare an interest as part of the team of people who took the legislation through the House—that was a genuinely outstanding cross-party effort and I am really delighted that we are proceeding now in that same vein.

The hon. Gentleman rightly raised concerns about the number of people currently on the waiting list; we are now at a five-year high and the pandemic and lockdowns have not been helpful. Does he agree that although legislation was, of course, very important, it is not enough in itself? What we need is continued public education and additional capacity within the NHS so that we can continue the important process of saving lives. I congratulate him again on securing this important debate.

[Anthony Mangnall]

I thank the hon. and gallant—and mayoral—Member for his intervention. He has been an extraordinary champion on this matter; a significant amount of my research has been on the back of his words in this place to help to get that legislation to where it needs to be. On his point about education, I think he is absolutely correct. We need a combination of education and funding across all our hospitals, GP surgeries and other available forums to promote this issue so that we can bring down that five-year high and help to get as many people as possible off the transplant list, as quickly as possible.

[Jim Shannon]

I want to say for the record that my nephew—my brother’s son—had a kidney transplant; he was born as a wee child with a kidney the size of my thumbnail. He had to wait until he was almost 16 before he got a transplant, but he got it, and today that young man has a full life because of that. If anyone ever needs evidence—I know we all have some—of what a transplant can do, I can speak personally to that.

[Anthony Mangnall]

As ever, I thank the hon. Gentleman for his powerful intervention. He uses personal experience to lend great weight to a very serious topic, and that has certainly been registered by me and by the House. As we develop more and more strategies, as I hope we will, to encourage more and more to sign up on the organ donor register, people will hear his words, among those of others.

We are often quick to say that other countries have it better than us. While I am not suggesting that that is the case—especially thanks to the remarkable improvements that have been made over a short period of time—I will ask the Minister a final two questions. First, what engagement and consideration has the Department of Health and Social Care given to other countries’ organ donation and transplant strategies? Spain is often mentioned, and I would be interested to hear whether there is any consideration of that model and whether we can learn anything from it.

Secondly, the transplant benefit score also determines the position in which a patient might sit in relation to receiving an organ. How is that position altered when a new drug is used on a patient, presumably—one hopes—improving their situation? It would be interesting to understand whether the transplant benefit score is quick enough to determine where they are on that list.

The Meredith family are a fantastic group of campaigners for organ donation, and they are the reason why this debate is happening. I hope that their efforts in pushing me and others will result in renewed campaigns to make people aware of the organ donation register and to improve access to transplant facilities in the south-west. I very much look forward to hearing the Minister’s response.

Public Health

Anthony Mangnall Excerpts

Tuesday 14th December 2021 Commons Chamber

[Wes Streeting]

If the hon. Gentleman just lets me make this point, I will certainly give way.

Those are broadly the arguments, but I would ask Members on both sides of the House to think about those NHS staff who go to work every day feeling unsafe because their colleagues are not vaccinated. If that is not persuasive enough, I ask them to think about how they would feel if a loved one were treated in a clinical setting or care home by an unvaccinated member of staff through whom they contracted covid and, with it, serious illness or worse. If I lost a loved one through serious illness in those circumstances, I am not sure that I would be very forgiving about the decisions made by Members of this House.

[Anthony Mangnall (Totnes) (Con)]

I appreciate the point that the hon. Gentleman is making, but that is not what the results of the survey of NHS staff in the healthcare and social care workforce found, which was that 55% of people in the NHS were against this proposal. How does he respond to that?

[Wes Streeting]

I have no doubt whatsoever that opinion in the workforce is divided. I do not dispute that, and it is divided partly because people resent the mandate. Ultimately, however, it comes down to this. It is not just about the broad arguments I have outlined or the specific cases we might be confronted with without this protection; we have to ask whether we as a House think it is acceptable for people working in health and social care, who have a duty of care to their patients, to say, “I am making a choice to put them at greater risk. I am working against the very principles that encouraged me to sign up to my vocation in the first place.” That is why, on balance, I think it is the right measure, but I will come on to talk about the way in which we need to take the workforce with us and what we need to do ahead of April.

--- Later in debate ---

[Anthony Mangnall (Totnes) (Con)]

It is a pleasure to follow my hon. Friend the Member for Don Valley (Nick Fletcher) and I thank him for his reassurance that the Whips have not pushed him in that direction.

The Government have done an extraordinary job over the last two years. Rolling out the vaccine so quickly has been an extraordinary achievement as is producing a booster programme in the way we have. There is a remarkable book by Adam Grant called “Think Again”—the title is perhaps apposite for the Government right now—which talks about how we persuade people to take vaccinations and it gives the two case studies of Canada and Germany, where people are not mandatorily required to get vaccinated or pushed in that direction but ways are found to persuade them. We would do well to follow the guidance to be found in that book.

I will vote against the masks measure in SI No. 1400 and support the self-isolation measure in SI No. 1415. In relation to the masks, the legislation is shoddy; it seems ill thought through if, as I said the other day, we can sing, eat or drink with a colleague but not have to go to work with them, and yet masks are introduced in the certain settings. A Government and their legislation have a responsibility to be good and comprehensive; that is not what this is doing.

When it comes to vaccine passports, I will not support them. As countless colleagues have said, there is little evidence to show that they work. I am sorry that no SNP Members are here, because the 70-page report produced by Nicola Sturgeon adds to that point. A very important point was made earlier about the lack of enforceability now that we have the lateral flow tests, because of this slightly dodgy deal that has been done with the Opposition to get their support. The scope for abuse and obfuscation on that is far too great.

When it comes to mandatory vaccinations, I cannot and will not support them. The problem I have with this is that the Government have yet to release the data on how many people have left care homes since we introduced that policy. We need to have the data to be able to review that, because if 60,000, 20,000 or 30,000 people in the NHS decide to walk out, how on earth will we have the capacity to support those who get infected? We need more information before we make those decisions.

Over the last two weeks, the ghost of Christmas past has appeared, and he brings with him fear and uncertainty. We cannot continue to flip-flop and change tack, nor should we be cherry-picking information from South Africa to support the Government’s agenda. I appreciate that the evidence coming out this morning shows that two Pfizer vaccinations do well and that the virus is milder, but we cannot continue to terrify people. I am staggered by the Government’s approach over the last two weeks, during which we have used fear to persuade people. I believe that no Government should ever use fear as a tool to try to persuade their citizens, and that it is what has happened. We must build up our resilience and reduce our restrictions.

[Madam Deputy Speaker (Dame Rosie Winterton)]

Order. We must move quickly on.

Covid-19 Update

Anthony Mangnall Excerpts

Wednesday 8th December 2021 Commons Chamber

[Sajid Javid]

I can confirm that the Chancellor, and indeed every member of the Cabinet, is fully behind these decisions.

[Anthony Mangnall (Totnes) (Con)]

A few weeks ago, Nicola Sturgeon produced a 70-page report that outlined whether or not coronavirus vaccine certificates actually worked. That report presented absolutely evidence, so where is the Secretary of State getting his evidence? The Office for National Statistics published a report saying that the fact that 95% of English and Welsh adults have antibodies should also be a consideration, far above what is going on in South Africa. If there is a severity document published in the next few weeks that shows that transmission is lower than expected, will we see an end to these measures? If I can sing in a club, drink in a pub and not have to go to work with colleagues, why are the Government pursuing a completely illogical process?

[Sajid Javid]

During the next few days, when we have the debate in Parliament and a vote next week, we will set out more of the data. In terms of one of my hon. Friend’s key questions about what happens should the data change or we get more evidence that suggests that omicron is less severe or its impact on the vaccines is not what it seems at this point, we will not hesitate to act and remove these restrictions.

Oral Answers to Questions

Anthony Mangnall Excerpts

Tuesday 8th June 2021 Commons Chamber

[Helen Whately]

What I will say, after the enormously difficult year that social care has had through the pandemic, is that that has indeed strengthened the already strong case for reform of social care. I will say to the hon. Member that I want us to have a better social care system, whether it is for our grans and grandads, mums and dads, brothers and sisters, children and grandchildren, or, indeed, as and when we need it ourselves. We have a once-in-a-generation opportunity to reform social care. Now is the time, now is the moment and we will seize this opportunity. We will be bringing forward proposals for reform of social care later this year.

[Anthony Mangnall (Totnes) (Con)]

What recent (a) discussions and (b) meetings he has had with the Food Standards Agency.

[The Parliamentary Under-Secretary of State for Health and Social Care (Jo Churchill)]

My ministerial colleagues and I are in regular contact with the Food Standards Agency on matters of common concern.

[Anthony Mangnall]

Next week the Food Standards Agency will produce its annual report and hold its annual general meeting. That report is likely to recommend significant changes regarding live bivalve molluscs, which have a huge impact on my constituency and on the health of the nation for those who eat seafood. Will the Minister commit that any changes recommended in the report next week will be brought forward in record time, so that they may be implemented quickly and we can secure the future of the seafood industry in the United Kingdom?

[Jo Churchill]

It is a change to be talking about a different sort of mussel in this place during Health questions. The Under-Secretary of State for Environment, Food and Rural Affairs, my hon. Friend the Member for Banbury (Victoria Prentis) and I are well aware of the challenges that currently face the shellfish industry, and I thank my hon. Friend the Member for Totnes (Anthony Mangnall) for his dogged determination, especially on behalf of those businesses that rely on exports. We will continue to work closely with the FSA, which I know has been working hard to resolve these issues and make progress. I have been advised that there is potential for change to ensure that classifications are awarded in a proportionate and pragmatic way, while continuing to ensure high levels of public health protection. I assure my hon. Friend that I will continue to work closely with the FSA and with my colleagues in DEFRA.

Covid-19

Anthony Mangnall Excerpts

Monday 22nd February 2021 Commons Chamber

[Dr Liam Fox (North Somerset) (Con)]

It was great to hear the Prime Minister say today that the Government’s policy will continue to be based on data, not dates. It would have been wrong to give in to those who wanted a premature lifting of restrictions on the basis of the calendar rather than the available scientific data, but it would also be wrong to continue unnecessarily with restrictions if the data said that it was safe to lift them. If data is right in one direction, it has to be right in the other. I hope that there will be sufficient flexibility in the mechanism that the Government have set out today to respond more quickly should the data continue to improve.

The strategy has always been clear. It has not been to drive covid deaths down to zero, because that would be ridiculous and out of step with everything we know about medical science and historical experience; it has been to stop the medical services becoming overwhelmed. As we see greater levels of immunisation, with a reduced risk of that happening, I suggest to my right hon. Friend the Paymaster General that that is the No. 1 basis on which we should make decisions.

Our vaccine results continue to be terrific. It is one of the best cases we can make for the Union of the United Kingdom that we have been able to buy and distribute vaccine across the whole country in a way that would not have been possible otherwise. There must be a lot of egg on a lot of Euro faces tonight, given the information we have about the AstraZeneca vaccine. It would perhaps be a source of some amusement even in this House, were it not so serious, that the idle chatter and uninformed comments from senior European politicians will undoubtedly have cost lives. We should be trying to get a vaccine dividend for the British people, given the success of our vaccine programme, to get back as quickly as we can to normal.

The NHS will face staffing issues, as we have to deal with not only the new vaccines but the second doses of vaccine at the same time, and I would like to hear from the Minister how we will deal with that. It is right for us to share vaccine with the developing world. It is not a case of altruism. In a world that is interconnected and interdependent, the longer the pandemic goes on, the more variants we will see, and therefore it is in our mutual self-interest to deal with it.

Finally, it is time to get Parliament back. The mechanisms we have had are better than no Parliament, and Mr Speaker and his staff deserve credit for that, but if it is good enough to get the schools as institutions back, it is good enough to get Parliament back. Three-minute monologues that are uninterruptible are not the same as the robust debate that we need.

[Anthony Mangnall (Totnes) (Con)]

Will my right hon. Friend give way?

[Dr Fox]

I will give way, almost reluctantly, to my hon. Friend.

[Anthony Mangnall]

Being in Parliament gives the opportunity for individuals to intervene in debates and have a more rigorous debate on these issues. Is that not a benefit to being here?

[Dr Fox]

Proving the point that show is always better than tell, my hon. Friend is exactly right. We have to not just hold the Government to account on the issues of the day but have genuine debate in Parliament about the whole range of issues that will become live once we start to get complete control over the covid pandemic.

It is time that we set out a programme for immunisation in Parliament for Members, Members’ staff, our security staff, the catering staff and even the Lobby. On that subject, I am more than happy to volunteer my services, if for no other reason than I have always believed it is fine to mix business with pleasure.

--- Later in debate ---

[John Spellar (Warley) (Lab)]

With all the delays that are built into the various stages of the statement, I think it is very unfortunate that the Prime Minister has not learned from the magnificent work undertaken by Kate Bingham and the vaccine taskforce about how to move safely and at pace.

The right hon. Member for Maidenhead (Mrs May) rightly drew our attention to the plight of the aviation industry and, quite frankly, got a fairly limp response in reply. Our economy needs that traffic moving again, and a key enabler would be a vaccine certificate—a vaccine passport, if you like. The Government response in the paper shows no sense of urgency. We will not even get an answer until some time in June. It is not just for aviation; a vaccine passport could assist with the safe reopening of hospitality, sporting and leisure venues. Many of these are on the brink, and they need every help in getting back on their feet, while their workers want their jobs back. It also matters for their customers. The Government’s own survey in the document shows that half of adults are reporting boredom, loneliness, anxiety or stress. Unemployment kills; loneliness kills as well.

Why not have a vaccine passport? Huge advances in technology over the past decades mean that it should be a relatively straightforward process. The NHS keeps records of everyone who has had the jab—I have my own card here—and this information could be stored on a plastic card produced in a secure environment or possibly on a mobile phone app, and carried around in a pocket ready to be presented on entry at any commercial venue. Let us be clear that the NHS already issues yellow fever cards as the proof of vaccination that some countries require before people can visit.

[Anthony Mangnall]

Does the right hon. Member not realise the damage having a vaccination certificate would do for anyone under the age of 35, who will not be at the frontline of getting a vaccination and will have to remain behind locked doors, with their freedoms curbed, for not having the vaccine? It is a terrible idea.

[John Spellar]

I fail to follow the logic of the hon. Gentleman that says he would rather the places stayed closed. I think it would be a rather good idea if venues were actually open, and people could then visit. Perhaps we ought also to be speeding up the vaccine. We are already down to the over-50s, and moving it further down should be part of the Government’s ambition.

I have to say that the omens are not encouraging. Last year, we saw that while many venues had spent considerable sums on making their premises covid-safe, that was just ignored and disregarded, and they were closed down just the same in the face of precious little evidence that they had played any significant role in spreading the disease. Sometimes one does wonder whether this is driven by the Victorian hangover in the British Government psyche that distrusts the public actually enjoying themselves, but at stake are businesses and jobs, and our economy and society, because leave this too long and, as I was just saying, there will be no venues to go back to. That would be a human and economic disaster, and it would also change our country.

One of the attractions of visiting, living and working here is our rich cultural life. Music and theatre, pubs and clubs, sporting events, hotels and restaurants make life worth living here, but they also make us stand out in the world. The Government are putting this outstanding ecosystem at risk, so I urge the Prime Minister, and the Paymaster General here, to shift back from risk avoidance to risk management, to ramp up vaccination to the maximum, to bring forward the great reopening—and, incidentally, then to help the rest of the world with vaccines—and to get Britain back to work and play.

--- Later in debate ---

[Anthony Mangnall (Totnes) (Con)]

It is always good to remind ourselves that hindsight makes people sound wiser than they actually are, following that speech.

I welcome the Prime Minister’s statement today. For many, though, it will be a painful and drawn-out process and too long before we can sit down together with friends and family. I share the views that were expressed by my hon. Friends the Members for Broxbourne (Sir Charles Walker), for Hazel Grove (Mr Wragg), and for East Surrey (Claire Coutinho) about the need to be able to look our constituents in the eye and to be able to reopen in a safe and orderly manner. We must also understand that the costs that will come in the coming weeks and months are likely to be very severe.

I want to talk about the hospitality sector. By the end of this process, when it is able to open up, it will have had more than 200 days out of action. The sector is a pillar of the UK economy. If we are to have an economic recovery and if we are able to build back better, then it will be on the back of the hospitality sector. We must do all we can to support its regrowth, its rebirth, and its reopening when the time comes. With that in mind, I hope that the Government will look carefully at extending the VAT extension to the end of this year and the business rates extension to next year. This is not simply a case of asking for more. It is about giving those businesses the breathing space to be able to recover. It is about giving them certainty to be able to create the business and the opportunity for new generations to go out and find employment to benefit our local economies.

My hon. Friend the Member for Bolsover (Mark Fletcher) wisely and accurately spoke for the younger generation, who have often been overlooked throughout this pandemic. People under the age of 45 have suffered dramatically over the course of this crisis. They have been asked to do the most. They have been unfairly portrayed by the media as snowflakes, as woke or whatever it is, but I have seen young people across this country stand up and volunteer and do everything that has been asked of them. We must return the favour to them now. We must create a landscape of opportunity, so that someone entering a job for the first time is given the support that they need, whether that be lower income tax, or an opportunity through the kickstart scheme. We must help university students who have seen their courses curtailed through virtual systems that do not work and do not give them the experience that they so richly deserve. We can provide that opportunity for them, so that they can have the opportunity they expect in this country, in this economy, and for the benefit that goes with all that.

I would like to finish with the fact that we are asking teachers on 8 March to return to their places of work and to teach children. We could serve as a very good example by doing the same. I am one of the handful of MPs who has not used the virtual system in any way. I have not used a proxy vote and I have not used the virtual system. If I may serve as an example of that, we need rigorous debate in this place. We need to hold the Government to account on all manner of things. It will do us justice if we can actually decide to have proper debate.

Medicines and Medical Devices Bill

Anthony Mangnall Excerpts

Consideration of Lords amendments & Ping Pong & Ping Pong: House of Commons
Wednesday 27th January 2021 Commons Chamber

In conclusion, the Bill deals with patient safety and making sure that the British people have access to the best medicines and medical devices. We have fought hard to make it the best Bill that we can, and I am really proud and pleased with the progress that we have made.

[Anthony Mangnall (Totnes) (Con)]

It is a pleasure to follow the hon. Member for Nottingham North (Alex Norris), and to have followed the Bill from afar. It is a shining example of cross-party support, and to see it emerge from a skeleton Bill into a framework Bill is a credit to everyone who participated in Committee and in the House of Lords, and to Members across the House.

It is, in short, a pleasure to be able to speak in this debate, and I support Lords amendments 1 and 54. The creation of a commissioner for patient safety has long been sought, and it will not only enhance the fact that the NHS is viewed as one of the safest healthcare systems in the world but will reinforce the view that it is an organisation that can learn from its mistakes. One such mistake is the unconsented and experimental use of TVT mesh. The intent was for the best of purposes, but in fact it caused utter devastation, both physically and emotionally, to those who suffered adverse side effects. Those effects went unreported and were misdiagnosed for a great length of time, and change was down to people such as Janet Peck and Susan Morgan—two of my constituents and victims themselves—who fought hard for action to be taken. Their determination and hard work have resulted in the excellent report by Baroness Cumberlege, which calls for the appointment of a Patient Safety Commissioner, which the Bill seeks to put in place, to ensure that scenarios such as those surrounding TVT mesh become never events.

The Minister for Patient Safety, Suicide Prevention and Mental Health gave a heart-felt and meaningful apology to those who have been failed by medical treatments as outlined by the Cumberlege report last year. The new position will be welcomed by patients and practitioners alike, and I hope that the Minister responding to the debate will go further and explain the commissioner’s remit and the parameters of their work, and how recruitment will find a suitable person to report back. I welcome the fact that the Government will respond further to the independent medicines and medical devices safety review. Finally—much of what I wanted to say has already been said—I pay tribute to Susan and Janet. Their fortitude and determination have helped to shape the Cumberlege report and shape this Bill and, as we have already heard, their repeated efforts to ensure that patient safety is put first have allowed the Bill to be created in such a way that it will have a long and meaningful impact on those who seek the best service possible from the NHS. As has already been said, the cross-party support is a credit to this House. I congratulate all Members who have taken a significant step in helping to shape the Bill.

[Ms Marie Rimmer (St Helens South and Whiston) (Lab) [V]]

In 2018, the imported bodies of political prisoners and human rights abuse victims in China were on display in Birmingham. It was supposed to be a Real Bodies exhibition, to inform the public about biology, yet in reality it was a barbaric travelling circus. The British public unknowingly paid £15 each to view the remains of these poor souls.

Since I learned of that horrific display, I have become determined to work on behalf of these human rights abuse victims to end forced tissue and organ harvesting. Our nation and the people who live here must not be complicit in the brutal acts of the Chinese communist regime. The first step is to put a stop to the importing of tissue and organs of human rights abuse victims. Currently, neither the human tissue regulations nor the Human Tissue Act 2004 requires appropriate consent for imported human tissues to be used in medicines. After several attempts to bring forward an amendment to achieve this, both here and in the other place, the Government have finally included a negotiated amendment in this Bill, which I welcome.

That amendment provides the opportunity to prevent complicity in this crime within the UK medicine industry, and gives Ministers the powers to do the right thing. It is important to stress that the amendment has not dealt with the issue of organ transplant tourism, or the issue of plastinated unclaimed bodies being imported and commercially displayed, as we saw in Birmingham. The amendment is a welcome start, but it is only the beginning; there is much more to do.

I hope the House will forgive me if I place my thanks on record, as securing that amendment has been a long, drawn-out battle across both Chambers. First, I congratulate Lord Hunt of King’s Heath for persevering so tenaciously, along with his co-signatories Lady Finlay, Lady Northover and Lord Ribeiro. I also thank Lord Alton and Lord Collins for their tireless efforts on this issue. Finally, I thank my hon. Friend the Member for Nottingham North (Alex Norris) for his support and advice.

One of my predecessors as MP for my home town, St Helens, was Sir Hartley Shawcross, the chief British prosecutor at the Nuremberg trials. Just like the Nazis he prosecuted for, among many reasons, using human beings for medical experiments, I hope and pray that one day, those responsible for these despicable, heinous acts will be prosecuted for their crimes against humanity, for that is what forced organ harvesting is. Last year, the China tribunal, led by Sir Geoffrey Nice QC, a former lead prosecutor at The Hague, concluded that

“Forced organ harvesting has been committed for years throughout China on a significant scale and that Falun Gong practitioners have been one—and probably the main—source of organ supply”,

and that

“In regard to the Uyghurs the Tribunal had evidence of medical testing on a scale that could allow them, amongst other uses, to become an ‘organ bank’.”

The amendment sends a very clear message that we will not tolerate such appalling acts against humanity and that we will deliver for the people of China, not for the Communist party of China. Let the amendment truly mark the beginning of a new relationship with China—a relationship that is not naive. Today, Holocaust Memorial Day, is the day when the world says “Never again” to genocide. Let this be the start of the Government putting those words into practice.

Covid-19: Dental Services

Anthony Mangnall Excerpts

Thursday 14th January 2021 Commons Chamber

[Anthony Mangnall (Totnes) (Con)]

I congratulate the hon. Member for Putney (Fleur Anderson) on securing this debate.

The impact of covid on the dental sector has been profound, from the sector’s closure in March to the 20 million lost appointments, the 15 million-appointment backlog and the year-on-year decrease in those who visit the dentist. In previous years, being able to avoid the dentist may have seemed an art form, but it is rapidly becoming a significant and desperately serious problem, with mouth cancer diagnoses significantly down and major operations being put on hold or just avoided due to lack of access.

It is right that we have to clear the significant backlog. While I do not oppose the concept of a UDA target, I do oppose the mechanism that penalises dentists who do not meet that target. I respectfully ask the Minister to consider whether the target could be rejigged so that people have the security and understanding that if they are unable to meet it, they will not see a loss of salary or any penalisation from the Government. Of course, we have already heard that 50% of dental practices are meeting that target, so we have seen an ability to deliver.

The intent is right, but the mechanism is wrong and only adds to the extra stress that those who work in dental practices are already suffering. I do not deny that dental practices in my constituency are safe, but the individual set-up of each is very different; things such as the air purification systems that they implement will mean that they have different fallow times and will therefore also impact the UDA issue. There is a result here whereby different circumstances will mean that the overall target is unable to be met.

I ask the Government to consider taking away the penalisation mechanism of UDAs, reimbursing the VAT costs faced by dentists on PPE, and ensuring that our dentists are treated as part of the primary healthcare network. We hope to encourage people to stay in this sector. We want them to do so—we do not want them to go towards private alone—so I hope that the Minister will be able to reassure me and many of the dental practices in my constituency.

Dentists are not asking for any more than anyone else, but they have received significantly less than many of those out there. All that we ask the Government today is to treat our dental sector with the respect that it deserves and to help it deliver for those who most need it across the whole United Kingdom.

Botulinum Toxin and Cosmetic Fillers (Children) Bill

Anthony Mangnall Excerpts

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

[James Cartlidge]

The Bill is about fillers, and we could have had a filibuster—you never know.

I congratulate my hon. Friend the Member for Sevenoaks (Laura Trott) on her brilliant speech. This Bill is clearly well justified. She set out the scope of it and the key powers in it, and she has done herself immense credit.

I need to declare an interest. For many years, I have benefited from an artificial enhancement to my appearance. It may not be obvious to most people in the room, and before the speculation starts, it is not botox. It is made of something called hydrogels. I am, of course, referring to my contact lenses.

The point is a serious one. It is a good feature of the Bill that it will still be legal for children to have botox treatments where it is necessary for medical surgery. We talk about “enhanced appearance”. In my case, if I did not wear my lenses, whatever it did to my appearance, it would certainly affect everyone else’s, because my prescription is minus 7.5 in the left eye and minus 9 in the right eye, and I have a strong astigmatism. Without my lenses or glasses, I would not be able to see anything. I had glasses in secondary school that were so thick, it was like someone had attached two pint glasses to my head. When I got contact lenses, it helped with sport and many other things, and it gave a huge boost to my self-confidence and self-esteem. I will not comment on whatever it did to my appearance, because that is not the point. I understand and empathise with those who want to invest in procedures or enhancements that give them greater self-confidence about their appearance. It is an entirely reasonable thing to do, and millions of people do it up and down the country. I am not necessarily aware of the cases involving children, but many people use botox perfectly reasonably and are very happy with the results. It is a booming industry, and I suspect most procedures are successful.

As much as I welcome the Bill and believe that my hon. Friend the Member for Sevenoaks made a good case, we on the Government Benches in particular—there are not many on the Opposition Benches—should, by default, take the devil’s advocate position with respect to any regulation that will restrict what people can do, no matter how worthy. I feel I have to do that, given that my hon. Friend the Member for Christchurch, who was supposed to speak before me, probably would have examined that position in some detail.

These are heavily regulated times. I have a table booked in a restaurant in my constituency on Sunday for the six members of my family. Because Essex has gone into tier 2, I got a phone call to ask whether any of us are from Essex. At a time when we are regulating every aspect of daily life—which, of course, is for reasons beyond our control, because of covid—we must be extra careful in examining the case for all new regulations, even if it is morally very strong.

[Anthony Mangnall (Totnes) (Con)]

I thank my hon. Friend for the point he is making, because I agree that too much regulation could be a problem. This ties in with the ten-minute rule Bill presented a few weeks ago by my hon. Friend the Member for Bosworth (Dr Evans) about the impact of social media on people’s image. Does he agree that we must educate people about their image, how it is perceived and what social media companies are doing around that, so that we do not necessarily have to implement regulation all the time?

[James Cartlidge]

My hon. Friend makes an extremely good point, and that is, in many ways, what I am driving at. There is always a balance between whether we regulate and restrict or trust people’s judgment. There will even be people aged 16 or 17 who consider surgical enhancement procedures and are very rational and do not suffer from any form of mental health issues or self-confidence issues, for whom this sort of procedure would result in a satisfactory outcome. We have to remember that. The question in regulating is the traditional one of whether the benefit in protection of the vulnerable minority—we assume it is a minority; statistics are hard to come by—is worth while, given the impact it may have on a greater number who may not need that regulation but will now have a freedom stifled. That is the old chestnut.

I have heard what my hon. Friend the Member for Sevenoaks said—I thought it was a very good speech—and I have read all the notes and a lot of the research on the internet, and I am of the view that, definitively, this is a very necessary and justified Bill. It is necessary for the state to intervene and restrict the availability of these services, products and interventions for young people, because what outweighs the downside of regulating is the fact that we are protecting vulnerable people from an outcome that—in some cases, if not many cases—can be terrible or disfiguring, and they can go on to regret it for years to come, potentially at great expense. On that basis, it is certainly justified.

It is particularly justified in the context of children’s mental health, which I feel very strongly about. I have the Adjournment debate today on a very tragic suicide in my constituency. It reminds me that one of the very first traumatic constituency cases I had to deal with related to a young lady’s self-awareness issues—basically, an eating disorder—and although it was not fatal, there was an attempted suicide. It was a terrible case, and it really opened my eyes as a new MP to the issue of eating disorders.

Since then, I have had the pleasure to engage with the charity Beat. Its local spokesperson in my constituency is Laura Shah, an absolutely wonderful lady, who has explained the issues to me. In fact, given that my hon. Friend the Minister will be speaking later, I should put on record—he may not want to say this because of his naturally humble outlook—that he was once the parliamentary champion for the Beat charity, and he got its parliamentarian of the year award. I say that because I know he would not volunteer it himself. That is a noble achievement because it is a very good charity, and it underlines the fact that there are wider issues.

The other point—my hon. Friend the Member for Totnes (Anthony Mangnall) intervened on me about this—is about social media. I am profoundly worried about social media, its impact on young people and our inability to regulate it. It is not a failing; it is very difficult to regulate the sharing of media and the enhancement of media. Of course, we can imagine young people going to a practitioner to receive such surgery based on an image they have seen where the person has not actually had it, but has simply been artificially enhanced digitally.

--- Later in debate ---

[Jane Stevenson]

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

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

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

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

[Anthony Mangnall]

My hon. Friend is making a very good point. She raises the issue that people treat botox as something trivial, and that there needs to be greater sincerity about people going through that procedure, putting aside whether it is necessary or for cosmetic reasons. Does she think that further steps need to be taken to make people more aware? This goes back to the point about education that I made in my intervention on my hon. Friend the Member for South Suffolk (James Cartlidge).

[Jane Stevenson]

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

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

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

[Jane Stevenson]

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

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

[Anthony Mangnall]

My hon. Friend is again making an important point about ensuring that registered practitioners undertake these practices. Could she just add a few more points on whether she thinks a national register needs to be created, so that this cannot be practised by people who do not have the correct skills to be able to perform it?

[Jane Stevenson]

It certainly needs a lot more regulation. The Bill does not seek to impose that, but minimum training levels to inject someone’s face with a filler or with botox is certainly desirable. On insurance, that could be regulated, too. I am sure further legislation will appear.

--- Later in debate ---

[Simon Baynes]

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

[Anthony Mangnall]

It has always struck me as particularly worrying when adverts say that 50% or 80% of people say that something is successful, but with only a very small dataset. That is happening across adverts on daytime television and in a whole load of other situations. I know that it is also happening in this sector. I am interested in whether my hon. Friend has any further thoughts on how we might be able to combat that. If datasets are to be used in persuading people to take up a product or to have a surgical procedure, those datasets must be comprehensive.

[Simon Baynes]

I strongly agree with my hon. Friend on that score. One of the aspects of this discussion that has been extremely pertinent is the need for consultation. It really seems to me extraordinary that people can undergo such procedures without proper consultation—a point made very eloquently by my hon. Friend the Member for Wolverhampton North East. If someone has proper consultation, they have to refer to the data, as my hon. Friend the Member for Totnes says, and then the procedures start to take place within a structured, controlled environment.

--- Later in debate ---

[Claire Coutinho]

I thank my hon. Friend for that point, because it is the crucial one. Growing up not having to contend with social media, I did not focus on these things—I did not think about them. I loved maths and reading, and I rarely thought about the way I looked, but that is not so for the children of the current generation.

[Anthony Mangnall]

We are, in one respect, the last generation to have lived in a time without social media. We recognise the difference between before and after social media, so we at least have a sense of depth and perspective about the impact it has on our life. Does my hon. Friend accept that there is a rapidly increasing problem of people going on to social media at such a young age and that not understanding a world without it is going to have much longer implications down the line?

[Claire Coutinho]

My hon. Friend makes an excellent point. The long-lasting implications do not just relate to the way people feel about the way they look; there is a wider sense of anxiety about their social connections and their sense of self-esteem, so that point is well made.

Last week, I was happy to visit a wonderful school in Lingfield in my constituency, where I spoke to a bunch of 10 and 11-year-olds. They asked fantastic questions, about not only my work in Parliament, but everything ranging from where I might go if I had a flying car to my favourite book characters.

[Anthony Mangnall]

Where would my hon. Friend go?

[Claire Coutinho]

Well, I thought I would quite like to go to Antarctica. I was told that it would be rather cold, so I said I would wear a very big jumper. It struck me when I was looking at those children that in a couple of years’ time, when they are 13 or 14, the questions might be slightly different. Women in the House will recognise the questioning that we have all experienced, which is sometimes very personal to our looks, our diet, our wardrobe and how we get ready in the morning. That focus on how we look, which seeps into our thinking as we grow older, is unfortunate and sad.

--- Later in debate ---

[Claire Coutinho]

That is an excellent point.

We should not be allowing our young people to face these risks—not only the medical and financial risk, but the psychological risk. It is damaging for a person to go for a cosmetic procedure that they think will fundamentally change their life and then for something to go wrong or for them to realise that that was not the thing that was going to make them happy in the first place. I am very happy that we will hopefully be able to address all those things through this Bill.

There are medical procedures that young people need, such as cosmetic procedures because they have some sort of facial disfigurement, for example, or procedures for migraines, bladder dysfunction, face and eyelid twitching or excessive sweating. They would still be allowed under this Bill, so no one should be worried that they would not be able to get the medical help they need.

Returning to the point about social media, we have all seen the deeply worrying statistics showing how the young people of our age are different from our generation, when we were young. Young people now are more anxious and depressed and have a lower sense of self-worth, and that starts in their early teens because of how social media helps them to see themselves and their standing in the world. The availability of these procedures, particularly if they are unregulated, will make people question themselves more and think, “Maybe I should go and make a change. Maybe I should change my face, my jawline, my nose, my lips.” The ability to access unregulated procedures almost forces the question in a very damaging way.

People have talked about the effect on boys and girls—both sexes undergo these procedures. The unrealistic images on social media lead to a very damaging cycle by setting up a view of beauty that boys take on and girls then want to live up to. I have seen the results of scientific experiments in which young children are presented with a range of images and are asked which are the beautiful ones. They are now starting to pick out the ones that are cosmetically enhanced. That is incredibly damaging.

[Anthony Mangnall]

Hello, Madam Deputy Speaker. My hon. Friend is making a very important point. What does she think about the industry taking the appropriate steps to ensure that it is in tune with the thinking of this House and that, if the Government are going to pass legislation, it has a role to play in preventing people from having unrealistic images put in front of them?

[Claire Coutinho]

That is an excellent point.

I will finish on this point. We in this House should be looking not just at the provision of cosmetic procedures but at the use of social media and how it affects our young people and at the teaching of body and face positivity. We should be doing that in all our schools with all our young people to tackle the issue at the root. I am very happy to support this Bill.

--- Later in debate ---

[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.

--- Later in debate ---

[Anthony Mangnall (Totnes) (Con)]

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

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

[Dr Luke Evans]

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

[Anthony Mangnall]

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

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

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

[Dr Luke Evans]

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

[Anthony Mangnall]

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

[Suzanne Webb]

Although we talk about it possibly being a fad, is it not more important to consider the fact that we do not know the impact on these young adults of having botox at such an early age? There is also the fact that we should all just embrace our natural features. We will all age, and hopefully gracefully, but if people have botox at such an early age, we do not know the impact that that will have on that ageing process. What they may need in future times is more botox perhaps because of the damage they have done to their face.

[Anthony Mangnall]

I hope that my hon. Friend will take it as a compliment when I say that she is ageing beautifully.

[Ms Lyn Brown (West Ham) (Lab)]

I have sat through this debate and been a little discomforted by some of the remarks that have been made. I say that very gently. I support the hon. Member for Stourbridge (Suzanne Webb) in her gallant attempts to get an understanding in this Chamber that young women and young men are beautiful in who they are and not in what they have done to them. That is the message that we should be sending out. I know that I have aged wonderfully, so I do not need the hon. Gentleman to tell me so. May I just emphasise the hon. Lady’s words, as I completely and utterly agree with the position that she has been enunciating over the past 20 minutes?

[Anthony Mangnall]

I thank the hon. Lady for making that very important point, and I take her guidance incredibly sincerely. That brings me to the point made by my hon. Friends the Members for East Surrey and for Hastings and Rye (Sally-Ann Hart), which is that every child is beautiful and that body positivity as we grow up is incredibly important. We are not asking anybody to change their image. I thank the hon. Lady for her point; I am always happy to take guidance on how to perform in the Chamber.

The impact of social media is long lasting, and our newspapers and media have become more and more emboldened about it.

[Simon Baynes]

We should also consider the fact that social media can be put to good use in all this. We have talked at length about the difficulties of social media, but social media is also an extremely good method of putting a message across. When the Bill hopefully becomes law, social media will be a way to communicate the benefits of this legislation.

[Anthony Mangnall]

My hon. Friend is curiously prescient in his intervention. As chair of the all-party parliamentary group on the preventing sexual violence in conflict initiative, I have discussed with all the social media companies how we might engage them in helping to collate and document crimes against women and children across the world and to ensure that that leads to prosecutions. The response from Twitter, Instagram, Facebook and many other social media platforms has been universally positive. We need to build on that, because if we can do it on that issue, we can do it on this one. I hope that this legislation will be used as an effective tool, learning from the different areas in which this has been done already.

[Dr Luke Evans]

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

[Anthony Mangnall]

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

[Claire Coutinho]

On my hon. Friend’s point about there being little evidence on whether these procedures will be successful, does he agree that, by regulating, we could ensure that practitioners have insurance, in which case they might face a financial cost if the procedure does not go to plan?

[Anthony Mangnall]

That ties in succinctly with the point about enforcement for practices that are undertaking these procedures. That will be an important part of ensuring that those who offer these services are fully aware of the implications of breaking the law, when the Bill is hopefully passed.

My hon. Friend the Member for Bosworth used his extensive experience and medical insight to explain the value of the Bill and its implications, and I do not need to go over what he said. However, I would like to make a few points about why I support the Bill and am so pleased to speak in the debate. As we have heard today, the Bill will introduce parity with the age at which someone can get a tattoo. It makes sense to regulate and level up so that we are all equal at the age of 18 in terms of the procedures that we can get, so that no one at a younger, more susceptible age might be influenced by the fads of social media. I have spoken to many of my constituents about that. They are worried about the body image messaging sent out by the fashion houses of Paris, magazines, newspapers and social media, so I welcome the inclusion of that measure in the Bill.

[Rob Butler (Aylesbury) (Con)]

Does my hon. Friend agree that that point is reinforced by the fact that someone now has to be 18 to buy a packet of cigarettes? Someone has to be 18 to inhale something that is potentially toxic, but currently they can be injected with something toxic at a much younger age.

[Anthony Mangnall]

Absolutely, and one might say exactly the same about tattoos as well. Someone is at the time perhaps going for something that looks cool and is a fad, but then maybe 20 years down the line, it does not look quite as good as they thought it did. That brings me on to my second point, which is about the business offensive. It was just raised on the idea of insurance and how we make sure that we are encouraging those businesses undertaking these practices to do so in a serious and responsible manner. That is something that the Bill ably encourages those businesses to do, and I hope the Minister will comment on what regulation and what data or dataset can be created to ensure that everyone who is doing these practices is registered. I feel that is key and will help inform the debate and move it along.

Enforcement is always one of the biggest problems. We here in this Chamber can speak on a whole host of different issues and at length try to pass legislation, but how do we end up enforcing it? I note that the Bill seeks to amend schedule 5 to the Consumer Rights Act 2015, and I hope that is enough, but a few more words and a bit more understanding from the Minister and others about how we would enforce it, what immediate steps could be taken and where it would fall in line with other sentencing issues is something that I would find incredibly helpful and interesting.

In an age of social media, we are competing against ease of access, with everything at our fingertips. Everything can be bought from our smartphones or iPad tablets. When we propose such Bills, they must be accompanied with an education programme and a platform.

[Sara Britcliffe (Hyndburn) (Con)]

On education, we have spoken about younger people, but one thing I have experienced is the rebellious years of university. Students go to university and are on their own for the first time. Does my hon. Friend agree that universities need to be doing more to highlight the risks of these surgeries and tattoos, for example?

[Anthony Mangnall]

Absolutely. Any place of education has a role to play in the Bill. Again, we will make sure we are expressing that both now and in the future.

Social media has made things very easy and accessible for people. We should seek to address those issues, but we should also seek to reaffirm the fact that every individual is beautiful and born perfect. I commend my hon. Friend the Member for Sevenoaks for bringing this Bill before the House, and I will be very much supporting it.

[Laura Farris (Newbury) (Con)]

I, too, congratulate my hon. Friend the Member for Sevenoaks (Laura Trott) on bringing this Bill to the House, and it is a delight to speak in the debate this morning, because I recall talking to her about it in the very early days after we were elected. I am glad it is now being ventilated on Second Reading in this Chamber.

I am part of the cohort of Members who was unaware that it was lawful to inject fillers and botox into the faces of children under the age of 18. When I began my research, I was struck that the first case study I found was of a young British girl whose mother was a part-time beauty therapist who entered her into pageants. She was injecting this eight-year-old with a full face of botox before every performance and every competition. If that example was extreme, it did not take very long to find much less extreme examples and to see how ubiquitous the issue was.

VICE magazine did an experiment in 2019 with a 16-year-old girl where they visited 20 beauty salons in Essex and London, and every single one was willing to make the appointment for either botox or filler. They did not ask the young girl to produce any ID. The conclusion of VICE was that it did not particularly matter whether they went to a Harley Street practitioner in an upmarket venue or a high street hair salon where the filler was administered alongside the leg waxing kit in the back room—the reaction was the same.

Of the 20 salons, only 13 bothered to take any details about next of kin or who her GP was. In a sense, they were off-the-books procedures. When the British Association of Aesthetic Plastic Surgeons—BAAPS, as it is more commonly known—was asked about that, its director was very clear, saying that treatments of this nature carry physical and psychological side effects and that most registered practitioners should not contemplate giving them to teenagers. Yet the simple truth is that the light-touch regulation means there is ample opportunity for unscrupulous practices.

[Anthony Mangnall]

My hon. Friend has just given a horrific account of what an eight-year-old girl went through in beauty pageants. May I just ask her where the research came from and how she got access to that information? It seems to me that the negative impacts out there are not prevalent, and that they will be overridden by the positive impacts that this is going to have.

[Laura Farris]

I must confess to my hon. Friend that I found that particular story in the scientific tome that is the Daily Mail. I must also confess that when the details of that particular mother came to light and her story was reported, the child was at least temporarily taken into care. That is probably not a surprise to any Member.

I would like to give three reasons for supporting the Bill. The first relates to something that my hon. Friend the Member for Sevenoaks touched on: the skyrocketing number of botched procedures. In 2018, approximately 610 botched treatments of this nature were reported; that had more than doubled by 2019.

Covid-19 Update

Anthony Mangnall Excerpts

Tuesday 8th September 2020 Commons Chamber

[Matt Hancock]

I will do everything I can to solve the problems and the challenge of having more demand than supply in testing capacity everywhere in the country, including in Hull. However, trying to split, according to their employer, the different people who are working on this, be they in local authorities, the local NHS, Public Health England or the private sector parts of this delivery, is just not going to help—in fact, it will make the problem worse. It was a pity to hear this from the shadow Secretary of State, the hon. Member for Leicester South (Jonathan Ashworth), because he is so often a very sensible person. What we have to do instead is all work together to solve these operational problems.

[Anthony Mangnall (Totnes) (Con)]

I congratulate the Secretary of State on the positive elements of his statement, but he will know all too well that rural communities have lived in fear in the past few months, especially during lockdown. He and the Chancellor have made a great deal of money accessible and available through the budget, but can he provide further funding for our rural healthcare network as we enter winter, not only to ramp up testing, but to deal with undiagnosed cases and operations not undertaken?

Coronavirus

Anthony Mangnall Excerpts

Monday 9th March 2020 Commons Chamber

[Matt Hancock]

We are working very hard right across England and I know that my Scottish and Welsh counterparts are working right across Scotland and Wales to ensure that we get that expansion of critical care beds as much as is possible.

[Anthony Mangnall (Totnes) (Con)]

I thank the Secretary of State and his team for their help for all patients who have been diagnosed with covid-19 in the south-west, but, as he knows I have a highly rural community. Can he please just elucidate as to how he will be able to provide further action and help for those in rural communities?

[Matt Hancock]

This is a very important point. One thing we will be doing during this period is encouraging people who need to see their GP or to have an out-patient appointment for something that is not to do with coronavirus to do so via Telemedicine if it is both clinically and practically possible. That is even more important in rural areas, and absolutely critical for reducing the amount of infection through GPs.