Botulinum Toxin and Cosmetic Fillers (Children) Bill

Lord Beamish Excerpts

Committee stage & Committee Debate: House of Commons
Wednesday 25th November 2020 Public Bill Committees

[The Chair]

With this it will be convenient to discuss amendment 2, in clause 1, page 1, line 21, after “practitioner” insert “who deemed the procedure to be medically necessary”.

[Mr Kevan Jones (North Durham) (Lab)]

It is a pleasure to serve under your chairmanship, Ms Rees. I broadly support the amendments, which I understand are of a probing nature. When we have the stand part debate, I will raise other concerns with clause 1, but I should start by congratulating the hon. Member for Sevenoaks for bringing the Bill forward.

The amendment tabled by my hon. Friend the Member for Swansea East is really about medical practitioners. We all want to think that medical practitioners are of the highest quality and abide by the law, but in this area that is not always the case—even in cases that are medically necessary. For a number of years, I have been involved in highlighting the lack of regulation when it comes to botox and fillers and the cosmetic surgery industry more broadly. The good thing about this Bill, although it is quite small in terms of changing the law, is that it is a welcome first step. There is cause for a lot more regulation in the area generally.

At the moment, the prescription of botox for cosmetic procedures is controlled, but there is clear evidence that medical practitioners are prescribing it in a way that leads to queries over the medical supervision. I would like to put my trust in the General Medical Council, but I have to say that my experience is that it is woefully inadequate in protecting the patient. A number of Members have met my constituent Dawn Knight, whose medical negligence case against her doctor took nearly five years to conclude.

I accept that there are situations where the prescription of botox, even for under-18s, is medically needed, but that needs to be explicitly in the Bill—that would then provide protection. I accept that there is then going to be an argument about the courts having one description and the GMC another. The problem is, however, that the GMC is failing. We need the law to be very clear that medical practitioners need a medical reason for prescribing botox for under-18s. Without having the wording in the Bill, people might somehow argue that because they are a medical practitioner, they can prescribe it whatever. The idea being advanced through these amendments, arguing about the medical necessity, would make the Bill stronger.

I accept that my hon. Friend the Member for Swansea East has tabled probing amendments, but we need to look at the issue as the Bill progresses. I will raise some of the broader issues, including my concerns about medical practitioners, in the clause stand part debate.

[The Chair]

Do any Front Benchers wish to speak at this stage? No? In that case, I bring in Carolyn Harris.

--- Later in debate ---

[Mr Kevan Jones]

I welcome the Bill, but there are issues with it and those need to be improved.

Clause 1 goes to the heart of trying to stop the wild west that we have in this sector, but my concern is with the get-out-of-jail card for medical practitioners. Again, while most will follow the rules, there is clear evidence that we have medical practitioners signing prescriptions for botox and then selling them on. If we had a robust GMC or regulator that was clamping down on this, that would solve some of these problems, but I have seen no evidence of that at all.

The Bill will make a start on improving this situation, as the hon. Member for Sevenoaks said. There are existing regulations, but they are toothless. Do they provide the powers to intervene? Yes, I think so, but that is not happening. Certainly, the situation with prescription botox needs to be tightened up.

The problem I have, as I said in my earlier contribution, is the allowing of medical practitioners to administer these products to under-18s. I understand that there are perfectly good medical reasons that they are needed, and it would be wrong for the Bill to block those altogether, but I believe that regulation on this could be strengthened, and I know the hon. Lady and the Minister said that they will look at that.

I do not know whether this is something that the Minister could talk to the GMC about or whether we could get it into the Bill, or indeed if it is in the regulations that go alongside the Bill, but before an under-18 is prescribed these treatments, there should be a written prognosis giving the reason that they are needed. There should also be a clinical treatment plan outlining how and why those will be administered over a certain period, as well as a written statement relating to the supporting evidence, the consent of the patient and their guardians, and an agreement with the patient in advance on the expected outcomes. That would strengthen the rules.

Most practitioners will abide by the rules, but I have been looking at the sector for five or six years, and frankly, my experience is that there are medical professionals out there who are just out to make money.

[Carolyn Harris]

Does my right hon. Friend agree that the practice of remote prescription serves only to further damage the reputation of the industry? During a recent evidence session, a GP stated that they were offering a lifetime botox prescription for £50. That is a dangerous practice and it needs to be considered very deeply before we move forward on the issue.

[Mr Jones]

I agree. There are adverts on Amazon in this sector, and treatments offered include fillers, although certain other terms are used. People are not allowed to advertise botox, but they get around that by advertising consultations. In response to the question, many practitioners are not qualified at all and hold no medical qualifications, so how do they get access to botox? They do so because people are signing prescriptions. I fear that a situation may arise in which that practice continues, although it needs to stop.

Another issue is that under the definition the botox can be bought because this is basically a free market, as I see it. A practitioner could then administer the botox to a young person with no regard to that individual’s medical history. A medical practitioner, under the definition, could even be defined as a dentist. That needs tightening up. I do not think that would be onerous for doctors, who are quite rightly prescribing botox injections and other things for perfectly legitimate medical use. Doctors and patients are protected when those uses are laid out.

If I had more faith in the GMC to clamp down, I would be content to leave the situation as it is. I am sorry, but having seen the way the GMC operates, I see that the organisation is not friendly to the complainant or to the patient organisation. It protects the doctor. We took self-regulation away from solicitors, and I have concluded that self-regulation should be taken away from doctors. I did not start with that position, but have come to it.

The Minister promised a Bill on GMC reform in the last Parliament, and one is certainly needed, because frankly, the patient is at a disadvantage in a host of areas, not just this one. It cannot be right that it took my constituent’s case five years to reach the GMC, with huge hurdles to overcome to get there. I hear what the hon. Member for Sevenoaks says, but we should try to tighten things up a bit. The Bill will certainly be improved if we can.

[Ms Dorries]

Again, I thank my hon. Friend the Member for Sevenoaks. Many points have been made today and throughout the passage of the Bill that will give us plenty to consider and review.

The GMC publishes guidelines on the ethical obligations of doctors undertaking cosmetic procedures, including guidance on responsible advertising. There is no question as to the GMC’s performance and it being fit for purpose as an organisation. The GMC maintained its track record of meeting regulation standards last year, and it met those standards amid a surge in demand for registration.

The performance review of the GMC for 2018-19 by the Professional Standards Authority, the body that oversees the healthcare regulators, found that good practice was upheld in all 24 standards of good regulation across education, registration standards and fitness to practise. The review confirmed an effective approach to managing a rise in registration applications, progress with the credentialing framework and work to promote fairness in fitness to practise processes.

[Mr Kevan Jones]

I hear all that, but I think what needs to happen—I offer this to the Minister—is for her to meet my constituent, Dawn Knight, so she can explain to the Minister the agony that she went through to get justice. The GMC is not user-friendly to patients. The fact of the matter is that, in her case, a doctor was allowed to remain on the register for five years, even though there was clear evidence from multiple women that he had undertaken operations that were, in some cases, life-threatening. Frankly, that is appalling.

[Ms Dorries]

The right hon. Gentleman does Dawn great credit by raising that case again, and his words have been noted. He is a tireless advocate. The GMC publishes guidance on ethical obligations for doctors undertaking cosmetic procedures, as it does with all procedures that doctors undertake, which includes guidance on responsible advertising, as I have said. There is another opportunity to continue to raise this matter: I will take his comments away and, as I have a patient safety meeting later today, I will raise them in that forum as well, since this is ultimately a patient safety issue.

[Ms Dorries]

The most I can say at this point—Dawn is a case in point—is that I will take away the comments made by the right hon. Member for North Durham, and I know my hon. Friend the Member for Sevenoaks has also heard them. We will consider those comments. It might be that this matter cannot continue within the scope of the Bill, but we will look to continue it. This does not stop here: my hon. Friend the Member for Bosworth (Dr Evans) is introducing the Digitally Altered Body Images Bill under the ten-minute rule, so there will be another opportunity to raise these points. Within the confines of patient safety, this is an issue that we need to continue reviewing.

[Mr Kevan Jones]

Will the Minister look at prescriptions for botox as well? There is clearly a market out there and there are medical professionals signing prescriptions and then selling them on, fuelling this market and leading to people who are not qualified giving that botox. Could she look at that?

[Ms Dorries]

Of course. I heard that comment in the right hon. Gentleman’s initial remarks. This is a difficult market to police—it is regulated, but it is difficult to police and to know who those practitioners are and where they are selling prescriptions on to. If he knows of any practitioners who are doing that, or is aware of any practitioner who is writing out bulk prescriptions for botulinum toxin and selling them on to other, more ruthless practitioners, or to people who are not even registered to practise, I ask him to please let us know, then we can take that forward.

[Mr Kevan Jones]

May I suggest another way of doing this? If the Minister speaks to the prescription licensing body, it will know exactly who is signing huge amounts of botox prescriptions, and one possible way to investigate large numbers of botox prescriptions is to ask whether those people can justify what they are doing. If we go online, we see umpteen adverts for botox treatments, and those people who are doing this are not doctors, so where are they getting them from?

[Ms Dorries]

Again, the right hon. Gentleman has done his cause justice by raising those concerns and saying what he has in Committee. We will have a look at that.

[Laura Trott]

Thankfully, the future of the GMC is slightly wide of the scope of the Bill, so I will leave those matters to the Minister. However, the right hon. Member for North Durham made the point well that there is widespread abuse by doctors who prescribe botox for cosmetic purposes, particularly for under-18s. It is absolutely right that we are looking to fix that through the Bill, and we will talk further about the wording on it.

The right hon. Gentleman rightly made the case for wider reform of that area, which has not been regulated to the extent that it should have been over the years. The Bill will, I hope, be a first step in addressing that, as we discussed earlier.

Question put and agreed to.

Clause 1 accordingly ordered to stand part of the Bill.

Clause 2

Offence by persons carrying on a business

[Mr Kevan Jones]

I beg to move amendment 4, in clause 2, page 2, line 31, at end insert—

“(c) a person advertises or otherwise promotes the administration, in England, to another person (“A”)—

(i) botulinum toxin, or

(ii) a subcutaneous, submucous or intradermal injection of a filler for a cosmetic purpose, where A is under the age of 18;”

[The Chair]

With this it will be convenient to consider new clause 1—Report on preventative measures—

“(1) The Secretary of State must prepare a report on steps that are being, and will be, taken to seek to prevent offences being committed under this Act.

(2) That report must include any steps to prevent the advertising or promotion of the cosmetic use of botulinum toxin and fillers on children.

(3) The report must be laid before Parliament no later than the end of the period of six months beginning with the day on which this Act is passed.”

[Mr Jones]

Again, this is a probing amendment to get concerns on the record. These issues affect not only under-18s, but people in the wider sector. The amendment deals with the broader issue of the way that the industry has developed. The concern is that botox is a prescription medicine, but if someone were to look at online adverts, they would think it was something that they could just pick up on the street corner. In fact, it can be picked up on the street corner, because the individuals who advertise the injections are not regulated.

Online, people offer home injections, botox parties or injections on premises that are not regulated in any way to ensure that basic hygiene is in place. The other worrying point is that the individuals who carry out the injections are not qualified in any shape or form. There are clear instances when people ask, “Well, what’s the danger?” There are dangers to injecting anything into someone’s body, but particularly in some of the areas in which botox is injected, such as the eyes and other areas. Such injections can lead to nerve damage and quite severe problems, and a medical professional would obviously know not to do them. With someone who is completely unqualified, there is a huge danger that under-18s, and even older age groups, could be affected by those problems.

[Judith Cummins]

Would my right hon. Friend’s amendment cover the eventuality that I described? That was related to me by the APPG’s most in-touch consultant, my daughter, who told us about her friend who, for her 16th birthday, had a lip filler injected by her cousin.

[Mr Jones]

That is the point. Part of this is about a process of education to teach people what the dangers are. These products are marketed and sold to people—especially young people—as if they are just like make-up.

Well, they are not make-up—this is a medical procedure that can have life-threatening consequences if it goes wrong. It is clear that some of the advertising on Facebook and other sites is directed at under-18s. The Minister mentioned body image, and the Mental Health Foundation’s report from last year on that issue shows that the marketing is for young people.

This is a probing amendment to get this issue on the record. We need to look at ways to ensure that young people are protected from advertising. It is not newspaper advertising; that is for old-fashioned people like me. It is advertising on Facebook, Instagram and elsewhere. I have raised this issue with Facebook. Of course, we get the usual guff from Facebook: “Oh well, we take them down.” I have even written to Sir Nick Clegg asking whether he will do anything about it. Getting an audience with or response from the Pope would be easier than getting a response from him. Those platforms are making money out of this, and they are targeting their adverts at young people, not older people.

Do not get me started on the Advertising Standards Authority, which is a completely toothless, useless tiger, frankly. It takes down some adverts, but they keep proliferating. The social media companies need to do something about it, because young people are being put at risk and because there is a market. Botox is supposed to be a medically controlled substance, but it is not; it is advertised. The way the companies get around that is that, although they cannot advertise botox, they can advertise a consultation, which just happens to be for botox. Facebook, Instagram and others could take down those adverts overnight and just stop them, but they are not doing that because there is clearly money to be made in this sector. Some of those issues will come out in the private Member’s Bill of the hon. Member for Bosworth on body image, but if we do not tackle them, this Bill could be enacted and the Facebooks of this world could still make money on the back of this sector.

The purpose of new clause 1 is to ensure some oversight over the effectiveness of the Bill. It calls for a report when it is under way so that we can assess whether it is effective. It also relates to advertising and promotion. By raising this issue with the Minister, I want to put on the record that there is an issue. I accept that advertising is not directly within her remit as Public Health Minister, but I want to see what more can we do not just on the targeting of under-18s, but on the broader issue of the way in which big business is trying to circumvent the law—advertising botox is supposed to be illegal.

There are two ways of doing that. The first is to stop the supply of botox from prescribers, and the second is to crack down on it very heavily. The Mental Health Foundation’s report on body image shows that, in this age of the internet and the internet of things, young people are in a terrible situation and are suffering due to their body image. That is reinforced by advertising. Botox is seen as a quick fix, but it is potentially dangerous. We need to try to stop this danger to our young people.

[Ms Dorries]

The right hon. Gentleman has made wide-ranging and important comments. I am not sure it was any easier to speak to the former right hon. Member for Sheffield, Hallam when he was in this place than it is now—there is not much change there—but I thank the right hon. Member for North Durham on all our behalf for his efforts to do so. Outside of the Committee and official channels, he still keeps batting away and trying to get results. We thank him for that.

I believe everyone has the right to make informed decisions about their bodies and our role in Government is to support young people in making safe, informed choices and, where necessary, to protect them from the potential harm that cosmetic procedures can do to their health. This Bill is a really important step on that path and in that process.

On indemnity, the Government passed legislation in July 2014 requiring all practising regulated healthcare professionals to have appropriate indemnity arrangements in place as a condition of registration with the regulatory body and, therefore, their ability to practise. For doctors, those regulations came into force in August 2015. Failure to comply may mean that they are dealt with under fitness-to-practise procedures. That means that all practising surgeons are affected by the legislation, including overseas surgeons practising in the UK. I hope that information helps.

[Mr Kevan Jones]

I am not against the cosmetics industry. I agree with what the Minister just said—it is about informed choice—but it has to be done safely. I welcome her comments on professionals. The big grey area, which this Bill cannot cover but which needs covering, is those who administer botox and fillers. Most of those people are not medical professionals. They have done “a course” in injections, which in some cases I have seen is just a tick-box exercise. That is the area we need to move on to next—not only who can prescribe, but who can inject these fillers and botox.

[Ms Dorries]

As the right hon. Gentleman notes, those matters are not within the scope of the Bill and the Bill will not seek to achieve the points he has made. As I have said before, I will take the comments away and will continue to work on them and review them.

[Laura Trott]

I thank the right hon. Member for North Durham for all his work in this area. On amendment 4, the pressure that young people are put under by social media is undoubtedly a motivating factor behind many of them seeking out these cosmetic treatments. That was discussed at length on Second Reading by the hon. Member for Clwyd South, among others. In many case studies that we have heard, discounts were one of the reasons that a young person went to have one of these treatments.

I note that there is a lot more work going on this area, which is welcome. In January, the Committee of Advertising Practice and the Medicines and Healthcare Products Regulatory Authority issued an enforcement notice to the beauty and cosmetics industry and have started to use monitoring tools to take down posts on social media, which is a welcome development, although obviously we need more.

I completely agree that further work is needed in this area. However, as the right hon. Gentleman rightly notes, it is outside the scope of the Bill. I will be making those points in the debates on forthcoming online harms regulations. I imagine he will be doing the same.

[Mr Kevan Jones]

These were probing amendments. I took the opportunity to get them on the record, as it is important to ensure that we tackle this area. I welcome the Minister’s comments on this being an area that we need to look at further. I know the Department of Health and Social Care does not like to bring legislation forward because it is still suffering from the Care Act 2014—

[Ms Dorries]

Nonsense.

[Mr Jones]

Well, I was told that by a Minister in her Department. One simple thing we could do is to regulate those who administer these fillers and botox. That would be a huge step forward. I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Question proposed, That the clause stand part of the Bill.

[The Chair]

With this it will be convenient to consider clauses 3 to 6 stand part.

--- Later in debate ---

[Ms Dorries]

My hon. Friend the Member for Sevenoaks has said everything that needs to be said about these clauses.

[Mr Kevan Jones]

Are we now debating whether the rest of the clauses stand part of the Bill?

[The Chair]

indicated assent.

[Mr Jones]

Right. I again put on the record my thanks to the hon. Member for Sevenoaks for bringing the Bill forward. Will the Bill solve all our problems in this sector? No, it will not, but as I say, it is a welcome first step. It also gives us an opportunity to put on the record other concerns, which I know the hon. Lady shares.

This industry—because it is a multibillion-pound industry—is very lightly regulated. When these fillers and botox procedures go wrong, they can cause damage to individuals and costs for the NHS. There are cases of people having to go through expensive procedures on the NHS to put things right before we even mention the cosmetic surgery industry, which costs this country an absolute fortune when operations go wrong and the cost of people’s life-changing conditions have to be met by the taxpayer.

Going right back to when I was chair of public health in Newcastle upon Tyne in the early ’90s, I am reminded a little bit of the same lack of regulation that there was around tattoo parlours. The Government changed that and gave local authorities clear powers. Now, largely, the rules on administering tattoos, for example, are clear. They are enforced by local authorities and the standards are high. To go back to what the Minister said, I agree: I do not want to close the industry down. It has to be about personal choice. If people want some type of what they consider necessary enhancements, that is entirely up to them; but it must be done in a safe and regulated way. I referred to the wild west, and it is like that: there is little control over what is happening.

I think it is five years since the Keogh review recommended increased regulation, and it is now time, with the Bill, which will be a first step forward, to try to get those recommendations put into law. I think that if that proposal came forward there would be no problems about getting cross-party support. I would be a huge champion of such regulations. The issue is not just with fillers and botox, but the broader cosmetic surgery industry. It is about people making informed choices and ensuring that work is done in a safe and effective way. At the moment, the system is in many ways completely unregulated, and regulations that exist are being ignored.

I congratulate the hon. Member for Sevenoaks on bringing the Bill forward, and thank the Minister for how she has responded and taken the issues on board. I think that, although on occasions we have our disagreements, she believes at heart that in the sector in question things should change, and patient safety should come first and foremost for everyone.

[Laura Trott]

Many good points have been made today about the wider work that we need to do in this, but when the Bill goes through it will be the next step towards protecting children, in an area where at the moment they are open to physical and mental scarring for life. I thank everyone who is here today for their work in supporting the Bill, and I thank you, Ms Rees.

Question put and agreed to.

Clause 2 accordingly ordered to stand part of the Bill.

Clauses 3 to 6 ordered to stand part of the Bill.

Bill to be reported, without amendment.

10.23 am

Committee rose.