Botulinum Toxin and Cosmetic Fillers (Children) Bill

Laura Trott Excerpts

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

[Laura Trott (Sevenoaks) (Con)]

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

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

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

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

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

[Dr Luke Evans (Bosworth) (Con)]

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

[Laura Trott]

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

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

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

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

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

“nowhere for these people to turn to”

when things go wrong. She continued:

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

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

[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.

[Mr Speaker]

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

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[Laura Trott]

With the leave of the House, I will make some final remarks. There have been some passionate and personal speeches today, and I am very grateful for the support from all parts of the House and from those on the Front Bench. A key thing that has emerged is the impact of social media—a pernicious impact in far too many cases.

My hon. Friend the Member for East Surrey (Claire Coutinho) put it well when she said we have a generation who are the most anxious, the most depressed and with the lowest sense of self-worth. We must do all we can to support our young people. My Bill will deal with some of the symptoms of the problem, but not necessarily the cause. My hon. Friend the Member for Bosworth (Dr Evans) is doing a good job on some of the problematic causes of this issue, and I hope his work is taken forward.

My hon. Friend the Member for West Bromwich West (Shaun Bailey) said that this Bill should only be the start, and he is right. My hon. Friend the Member for Wantage (David Johnston) rightly pointed out that the dangers of unlicensed and unscrupulous providers apply to all ages, not just the young. It is absolutely correct that we need more consultation, as my hon. Friend the Member for Clwyd South (Simon Baynes) pointed out; more accountability, as my hon. Friend the Member for Bosworth pointed out; and minimum qualification levels, as my hon. Friend the Member for Wolverhampton North East (Jane Stevenson) rightly highlighted. I am glad to hear that the Department will be taking registration and licensing forward.

As my hon. Friend the Member for Meriden (Saqib Bhatti) said, the Bill is not an attack on the industry. There are so many providers that are doing this well and are looking after the people they are treating, but we must stop the ones who are not. We must make sure that women—there are men involved as well, but 92% of these procedures are done on women—are protected, and that should be true for all ages.

My hon. Friend the Member for South Suffolk (James Cartlidge) rightly pointed out that we need to be careful about over-regulation, but equally, we must ensure that procedures are safe. We do not expect to go down to our local pharmacy and for the nail varnish to burn our fingers off. Equally, if someone is going to have an invasive procedure, the state should make sure that it is safe.

There was a specific question from my hon. Friend the Member for Totnes (Anthony Mangnall) about enforcement. Local authorities will be able to enforce in their local area, and businesses or providers will be subject to unlimited fines.

The purpose of my Bill is simple. No child needs cosmetic botox or fillers, and such treatments on the vulnerable must be banned. Too many young people’s lives have already been seriously impacted because of cosmetic procedures gone wrong. As my hon. Friend the Member for Wolverhampton North East says, it makes no sense that it is illegal to tattoo a person under the age of 18, but it is not illegal for practitioners to provide these extremely high-risk services to vulnerable and insecure young people.

The Minister rightly set out the Government’s work on the regulation of cosmetic procedures to date, and I thank him deeply for his support. I also place on record my thanks to the Minister for Patient Safety, Mental Health and Suicide Prevention for her help and her work in this area. It has been remarkable and is correcting an oversight that has gone on for too long. We must stop the dangerous and unnecessary non-medical procedures that can ruin children’s lives, and I welcome the Minister’s support today in ensuring that we are now one step closer to achieving that. I commend the Bill to the House.

Question put and agreed to.

Bill accordingly read a Second time; to stand committed to a Public Bill Committee (Standing Order No. 63).

Botulinum Toxin and Cosmetic Fillers (Children) Bill

Laura Trott Excerpts

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

[Ms Dorries]

Thank you, Ms Rees.

The hon. Member for Swansea East has tabled her amendments. I wish again to reiterate the Government’s support for this legislation. On amendments 1 and 2, I should say that the Government are responsible for understanding the impact of any regulatory policy through the completion of a post-implementation review within the first five years following implementation. The review should assess whether the objectives of the regulation have been achieved and are still relevant, the cost of the policy and any wider unintended effects of the policy.

The indicators of the success of this policy would be a reduction in the numbers of businesses offering or performing treatments on under-18s. That may assessed through means such as measuring public, practitioner and stakeholder awareness and experience of the policy, to understand the policy’s reach and effectiveness, and gathering intelligence on the level of enforcement by the police and local authorities.

I was concerned to hear the hon. Lady’s comments about practitioners who were finding reasons and excuses to continue practising. That is something that I know my hon. Friend the Member for Sevenoaks has been made aware of, and we will keep it under review.

[Laura Trott (Sevenoaks) (Con)]

It is honour to serve under your chairmanship, Ms Rees. Before I start, I thank everyone in the room today. This has long been an overlooked area of policy, but with the work of everyone here, perhaps that will not be the case for much longer. As the right hon. Member for North Durham has said, it is a welcome first step.

I pay particular tribute to the work of the hon. Members for Swansea East and for Bradford South, and the all-party parliamentary group on beauty, aesthetics and wellbeing that they lead. The group’s findings have underpinned the substance of the Bill and I thank them for sponsoring it.

I completely agree with the sentiments behind the amendments. It is right that we should restrict these treatments for under-18s to only where it is absolutely medically necessary. The advice I have received is that that is covered in the Bill, inasmuch as UK doctors must be registered and hold a licence to practise with the GMC. The GMC publishes specific ethical guidance that says that doctors performing cosmetic interventions can provide treatment to children only when it is deemed to be medically in the best interests of the patient.

I accept that, as the right hon. Member for North Durham said, in some cases at the moment this is not happening correctly when it comes to botox, but to create a new legal precedent around the wording “deemed medically necessary” would add a layer of complexity, given that it is generally for the GMC to decide what is in the best interests of the patient. As he also mentioned, it would also produce two different authorities—the GMC and the court—which would then opine on the same issue. That could cause confusion.

I understand the thrust of the amendments, but if the hon. Member for Swansea East is content to withdraw them, I will work with hon. Members on some form of strengthened wording, which we can bring forward on Report.

[Carolyn Harris]

I welcome the comments from both the Minister and the hon. Member for Sevenoaks. We would welcome the opportunity to work with the hon. Lady to ensure that we strengthen the Bill. I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

[Ms Dorries]

Again, I thank the hon. Lady for moving the amendment. I understand that it will not be pressed to a Division, but I give her my absolute assurance that all comments made in the Committee today will be taken away and reviewed by my hon. Friend the Member for Sevenoaks and me before we move forward on to the next stage of the Bill. I thank all hon. Members for their contributions today.

[Laura Trott]

Again, I agree entirely that we must ensure providers have proof of age before carrying out treatments. However, I worry that the amendment is too narrow, in that it is for the defendant to establish the steps that they took to evidence proof of age. It is already implicit that that could and should include recording information, but it should not be limited to that. For example, it should be for them to establish the veracity of the documents produced, rather than just recording them.

While I completely agree with the intent of the amendment, I argue that it is not needed on the face of the Bill and would be more appropriately contained in guidance, which I would expect professional bodies to produce when the Bill becomes law. I would like to continue discussions with the hon. Members on the topic.

[Judith Cummins]

I am happy with the assurances that we will be listened to and that our words will be considered throughout the passage of the Bill. I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

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

[Laura Trott]

Clause 1 of the Bill creates a new criminal offence of administering in England botulinum toxin injections and cosmetic fillers to persons under 18. Currently, children and young people can access invasive cosmetic procedures on the commercial market without the requirement for any medical or psychological assessment. As the hon. Member for Bradford South said, that cannot be right.

--- Later in debate ---

[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;”

--- Later in debate ---

[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—

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[The Chair]

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

[Laura Trott]

Clause 2 sets out a duty on business owners to ensure that substances are not administered to a person under 18. This does not apply to administration by a doctor or regulated healthcare professional. Subsection (1)(b) sets out that a business owner commits an offence if they or someone acting on their behalf makes arrangements for botox or filler to be administered by injection for cosmetic reasons to a person under the age of 18. This will cover, for example, making an appointment, or agreeing to make an appointment by social media. By making it an offence to make arrangements to administer the products covered by the legislation, prosecutions can be brought even when the person aged under 18 does not go on to have the procedure administered because, for example, they changed their mind or there was an intervention by an enforcement body.

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[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.

Botulinum Toxin and Cosmetic Fillers (Children) Bill

Laura Trott Excerpts

Report stage & 3rd reading
Friday 12th March 2021 Commons Chamber

[Laura Trott (Sevenoaks) (Con) [V]]

I am very grateful to have reached this point today. This is an important Bill that will protect young people. We are short on time, so I will cover the substance of the amendments quickly. On amendment 1, consequential provisions are essential to ensure consistency with other legislation. On amendment 2, six months will enable the necessary changes to be made to the human medicines regulations under the consequential provisions that were just discussed.

[Alex Norris (Nottingham North) (Lab/Co-op) [V]]

I have been reassured by the answers given to the promoter of the Bill, the hon. Member for Sevenoaks (Laura Trott), so I do not intend to support either amendment or delay proceedings any further.

--- Later in debate ---

[Laura Trott [V]]

As discussed, time is short, so I will keep my remarks to a minimum. I thank everyone who has been involved in this Bill. I pay tribute to my hon. Friend the Member for South Leicestershire (Alberto Costa), the hon. Members for Swansea East (Carolyn Harris) and for Bradford South (Judith Cummins), and the right hon. Member for North Durham (Mr Jones), all of whom have raised the profile of this very important issue over a number of years. I also pay tribute to the work of Save Face, a campaigning organisation that has done brilliant work to safeguard many, many young people over many years. Lastly, I also thank the Minister, whose support throughout this has been absolute, and I am very grateful.

--- Later in debate ---

[Laura Trott [V]]

I am grateful to my hon. Friend the Member for Christchurch (Sir Christopher Chope) for his remarks, and to the Opposition and the Government for their support.

Question put and agreed to.

Bill accordingly read the Third time and passed.