Botulinum Toxin and Cosmetic Fillers (Children) Bill

James Cartlidge Excerpts

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

[Laura Trott]

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

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

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

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

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

“nowhere for these people to turn to”

when things go wrong. She continued:

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

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

[James Cartlidge (South Suffolk) (Con)]

My hon. Friend is making a brilliant speech. She is talking about the scope of the Bill, but will she clarify something? It is not clear to me whether it covers England, or England and Wales or the whole of mainland Great Britain.

[Laura Trott]

I thank my hon. Friend for his intervention. The scope of the Bill is England. It focuses specifically on the lack of protections for under-18s. The absence of a legal age limit for botox and for dermal fillers means that any 15-year-old could walk into a shop and get their lips injected by someone with no qualifications whatever. Despite the proven health risks and implications for psychological wellbeing, young people can legally access invasive cosmetic procedures on the commercial market or in their homes without any requirement for a medical or psychological assessment. Unregulated practitioners are not required to hold insurance and may not have the medical knowledge to manage complications. That cannot be allowed to continue.

The case for change is absolute. It is unacceptable that we allow children to be exposed to life-changing risky procedures with little to no regulation. My Bill would criminalise the administering in England of botox injections and cosmetic fillers to people under the age of 18. There are cases where medical conditions may require such treatment, such as migraines. These treatments could continue if carried out in accordance with the directions of a doctor. However, we must take action to bring fillers and botox procedures in line with other body modifications that carry similar health risks, such as tattoos. The Bill would impose a duty on businesses to ensure that they do not arrange or perform these procedures on under-18s unless approved by a doctor. We can no longer allow the unscrupulous actions of some people to impact on our children’s lives, and those administering the procedures must be held accountable. The most frequent reaction I have received in response to my Bill is, “Surely, that is illegal already.” I join in that disbelief, and this House must now put it right.

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[James Cartlidge (South Suffolk) (Con)]

I am slightly surprised to be called so early when my hon. Friend the Member for Christchurch (Sir Christopher Chope) was ahead of me on the call list.

[Mr Speaker]

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

[James Cartlidge]

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

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

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

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

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

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

[Anthony Mangnall (Totnes) (Con)]

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

[James Cartlidge]

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

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

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

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

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

[Duncan Baker (North Norfolk) (Con)]

My hon. Friend is talking about social media. I am a father to two young, good-looking, blonde-haired, blue-eyed girls—their looks come entirely from their mother. During lockdown, as I think every parent here would agree, our children probably watched far too much social media and YouTube content. My children watch hairdressing videos from America—something my hon. Friend would appreciate given his fine locks during lockdown. The serious point is that the content they are fed about what they should look like and what their body image should be should worry all parents. I warmly welcome the Bill brought forward by my hon. Friend the Member for Sevenoaks (Laura Trott), because it is so important that young people get to understand that they should have confidence whatever they look like. I warmly welcome what has been put forward today.

[James Cartlidge]

My hon. Friend is absolutely right. On my hairdressing expertise, all I will say is that I really am from Barnet. In fact, I used to live in New Barnet, and for some reason the hairdressers’ I used to go to in New Barnet was not called New Barnet Hairdressers. I never quite understood that one. He makes a very good extremely point. By the way, I think he is looking extremely dashing today, and he should not put himself down. I am sure his input into the beauty of his children was fair and proportionate—[Interruption]—yes, for Norfolk genes! [Hon. Members: “Move on!”] I will sit down now—but I am just going to say that there is a serious point here about social media and how on earth we regulate it, but here is the key: what we are talking about today is something that occurs in the physical world. These treatments are out there and are tangible, and we can and should regulate them for children.

I will finish with one important point. I asked my hon. Friend the Member for Sevenoaks about the issue of territorial application. This Bill covers England, as far as I am aware, although it does refer in the detailed clauses to the other parts of the United Kingdom. That obviously raises a question about people who, if it is illegal in England, might cross the border into Wales or Scotland, especially if they live nearby, and still receive these treatments. It would be interesting to hear from the Minister what expectation he has of these regulations being matched in the devolved Assemblies, because that could be an issue. Whether it would happen illegally anyway, even if we banned it, is another question, but if it is legitimate in other parts of United Kingdom but not in England, there is a potential issue we should think about. I am happy to wind up there, because I think this is a very good Bill and I will be supporting it today.

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[Claire Coutinho]

That exactly underlines why this industry needs more regulation. We need to be worried not just about the potential for physical scarring but about the financial risk. A couple of Members have touched on the practitioners’ lack of insurance, which I hope can be considered when we introduce regulations. Their lack of public liability insurance means that the consumer often bears the financial risk of anything that goes wrong.

[James Cartlidge]

To go back to the point that my hon. Friend the Member for Bosworth (Dr Evans) made, having insurance in place might remove some of the cost that is falling on the NHS and therefore on the Exchequer.

[Claire Coutinho]

That is an excellent point.

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

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

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

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