Health and Care Bill

Laura Trott Excerpts

2nd reading
Wednesday 14th July 2021 Commons Chamber

[Laura Trott (Sevenoaks) (Con)]

In the past, successful reorganisations have been centred on patient care. We have seen that with cardio and we have seen that with cancer. The reason why this will be successful now is that the aspect of patient care that will improve, including the outcomes for patients, will be around accountability. There are three ways in which the Bill does that quite successfully, but there are also ways in which it could do more.

First, on the involvement of the Care Quality Commission, having the CQC inspect social care services will be crucial for increasing visibility and transparency in terms of the outcomes for patients. The criteria that the CQC uses when inspecting social care and focusing on patient outcomes will make a difference in terms of the quality of care that patients will get—that is also true for integrated care systems as well. We need to make sure that these services are not measured on bureaucratic targets, but on what they are actually doing for patients.

As a side note, let me say that we have talked a lot about GP surgeries today. The CQC, as we all know, inspects GP surgeries. There is a question as to whether these surgeries are doing enough, especially at the moment, when it comes to the outcomes for patients. I have a lot of very good GP surgeries locally, but the levers by which we as Members of Parliament can get them to improve the quality of services are somewhat lacking in many cases and this is something that could be looked at as part of that admirable proposal to increase the involvement of the CQC as part of the Bill.

The second area I want to touch on is to do with the Healthcare Safety Investigation Branch. We have seen through the Health and Social Care Committee how important it has been in terms of changing the culture within the NHS. What we have also seen, though, is the number of times that the recommendations have not necessarily been followed through. More focus on that within HSIB and a mechanism by which the Department of Health and Social Care can be mandated to follow through on the outcomes could really add to the accountability part of the Bill.

The final point is around the somewhat thorny issue of political control. I happen to think that my constituents have a right to be involved in decisions that are made by the health service on their behalf that are not clinically based. It is absolutely right that we have a health service that has to explain to my constituents why it wants to do a reorganisation in the area. If my constituents do not agree with it, I should have a mechanism by which I can go to the Secretary of State and say, “Do you know what? I do not agree with what you are doing here. This is not right for my constituents.”

I understand the arguments that are being made today, but the fundamental point about accountability is the one that will really shape the future of our health service. It is a very positive thing, and the mechanisms in the Bill will have a positive effect on the outcome of patients within my constituency and nationwide.

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.

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[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.

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[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.

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.

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[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;”

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[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.

Covid-19

Laura Trott Excerpts

Wednesday 11th November 2020 Commons Chamber

[Neale Hanvey (Kirkcaldy and Cowdenbeath) (SNP)]

Despite its dreadful impact, the coronavirus pandemic has brought out the very best in people, from Captain Sir Tom Moore’s inspiring fundraising efforts to volunteers in communities across my Kirkcaldy and Cowdenbeath constituency who have mobilised to ensure that the vulnerable among them receive food and medicine as they shield from this deadly virus. I would like to pay tribute to some of them today: Fife Voluntary Action, Benarty emergency response team and the many “Scotland Loves Local” high street heroes award winners to name but a few. But of course I would also add my thanks to all the key workers who kept us all going throughout lockdown.

The pandemic has also, however, laid bare the opportunism of some: a profiteering cronyism that runs through the heart of this Westminster Government—what Canadian author and social activist Naomi Klein calls “disaster capitalism”. In her award-winning book “The Shock Doctrine”, Klein presents a convincing narrative of a political strategy that exploits large-scale crises, such as this pandemic, to push through neo-liberal policy that systematically deepens inequality while simultaneously enriching the already wealthy with connections to those in power.

In the crisis we face today, ordinary people are focused on the daily challenge of survival, yet in parallel we have repeatedly witnessed new private companies springing up to profit directly, greatly assisted in those efforts by a political class prepared to make strenuous efforts to line the pockets of many with close links to the party of government. As my hon. Friend the Member for Gordon (Richard Thomson) incisively said of this phenomenon, people across these islands are in the grip of a cronyvirus at the heart of this Government that may be every bit as deadly as the coronavirus

[Laura Trott (Sevenoaks) (Con)]

Does the hon. Gentleman accept that the private sector has played a role in helping tackle the virus, and specifically that Pfizer, as a private company, has only got the money to invest because of its profit and share nature?

[Neale Hanvey]

I do not dispute the role of private companies in meeting the challenge of the coronavirus. I will go on to discuss the transparency and the appropriateness of how contracts have been awarded by this Government during the pandemic.

We only have to look at the PPE fiasco to see how this has been brazenly put into action, with large contracts awarded to small firms with little to no experience in the relevant field but with numerous links to the Conservative party. How on earth did the Government find them? In what amounts to a covid bonanza for these tiny companies, Government contracts worth more than £10 billion have been awarded in this way since March. Under the cover of the pandemic, the standard rules have been put aside, enabling contracts to be issued in extreme urgency with little to no oversight; I refer to the comments made by the right hon. Member for North Somerset (Dr Fox) about scrutiny.

With the emergence of promising vaccine candidates, we collectively hope that there is light at the end of the tunnel. However, the darkness of our journey through this pandemic must not be allowed to obscure our important public duty to act in good faith and with financial probity. We simply cannot emerge from this experience with the dismissive “at any cost” excuse deployed from the top of this Government down. We must ensure that the burden is shared equally together.

Enormous amounts of public money have been dished out in the absence of any tendering process, value for money assessment or assessment of whether any of these companies have relevant experience. We have all heard stories of UK businesses with expertise whose offers of help went unanswered by this Government. Why? On PPE, £108 million went to a tiny pest control company with net assets of £18,000. Another £108 million went to a modestly sized confectioner in Northern Ireland, while a third contract worth £252 million was awarded to an opaque private fund owned through a tax haven. The more that Members and external interested parties scratch the surface of this Government’s contract profligacy, the more serious are the questions that arise.

It is not just PPE. Under the fast-track rules, private firms have been handed a total of 843 direct contracts, including those that administer covid-19 tests and provide food parcels and medical supplies. Then, of course, there is the disastrous £12 billion test and trace failure, led by Conservative peer Baroness Harding. In yesterday’s joint Select Committee hearing, a possible reason for that was revealed. In July, the CMO claimed in a Select Committee that the ability to ramp up testing was “significantly strained”. Yesterday, Professor Sir Chris Ham gave evidence that increasing capacity over the crucial summer months was too slow, yet Baroness Harding claimed that testing capacity was increasing throughout the summer. What is the truth of the matter? Unfortunately, that was not the only incongruity, as Baroness Harding did not show a clear command of her brief, failing to answer or, in some cases, understand what was being asked.

The global pandemic is an absolute disaster for so many, with an unimaginable loss of life, yet the brightest and best of humanity have been working tirelessly on effective treatments and a vaccine. Rightly or wrongly, the appointment of Kate Bingham has proven controversial. There are no doubt questions to be asked about the absence of any clear recruitment process, but when she appeared before the Health and Social Care Committee recently, she was impressive. She was clearly on top of and in command of her brief.

However, that does not vacate the responsibility of this Government and any appointees to act ethically and in good faith and, most importantly, to account transparently for their actions. There are concerns about Kate Bingham’s astronomical public relations bill and claims that she shared sensitive information with investors. Further concerns emerged in The Guardian yesterday—in simple terms, how can a job be considered unpaid when the postholder has a position of influence or control in the process of awarding a £49 million investment in a company in which they remain a managing partner and from which they will surely benefit? Whatever the Prime Minister’s bluster, these matters must be fully scrutinised.

Sad as the pandemic is, what saddens the most is that these conditions are seen by some as an opportunity for Governments and corporate interests to implement political agendas that would otherwise be met with great resistance and opposition. The Government are on notice that, despite the disorientation of the public health crisis we are living through, these matters are being pursued.

This chain of events is not unique to the current crisis; it is a blueprint that neo-liberal politicians and Governments have been following for decades. Many thought that the meltdown of the global financial system in 2008 would prompt a comprehensive rethink of the principles underlying global capitalism, but in reality it was exploited to implement austerity and defund public services and social welfare provision on a grand scale. Covid illustrated that no more keenly than in respect of social care.

The 2018 report on social care from the other place pointed to a gap in service for 1.4 million people. This year, the Independent Care Group suggested that 1.5 million people are already living without the care that they need. The number keeps growing. One and a half million vulnerable and elderly people throughout England—husbands, wives, parents, grandparents, brothers and sisters; each and every one deserves much better from their Government. The Government are presiding over a social care system that is close to collapse.

Sir Simon Stevens, chief executive of the national health service, told the BBC that the covid-19 crisis had shone “a very harsh spotlight” on the “resilience” of the care system. The truth is that it comes down to priorities and political choices. To reform social care to pre-austerity levels will now cost more than £14 billion. That is a large sum, but it is £9 billion less than the bank bail-outs of 2007-08, which cost the public purse £23 billion overall. The annual operating costs of Trident nuclear weapons come in at £2 billion—far short of the £14 billion we need to repair the economic vandalism of austerity but, according to the costs worked out by Skills for Care, enough to recruit and train almost 550,000 new social careworkers every single year.

According to Age UK, 167,000 older people and their families throughout England now have to fund their own care because of the means test for free or subsidised support. Older people who are obliged to buy their own care have spent more than £7 billion in the 12 months since the Prime Minister took office and promised to fix social care. Every single day in England, 14 people exhaust their assets paying for care.

The reality is that the social care system that entered the pandemic was underfunded, understaffed, undervalued and at risk of collapse. Any response to covid-19, however fast or comprehensive, would have needed to contend with this legacy of political neglect. Government policies to support social care have faced major and widespread problems, not least the PPE crisis, which has led to a lack of protection for some people using and providing adult social care. Local authorities report that additional Government funding has been insufficient to cover the additional costs.

As has become all too clear throughout the recent crisis in England, protecting social care has been given far too low a priority. When the Minister for Care appeared before front of the Health and Social Care Committee last month, despite admitting that

“the social care system needs fixing”

and making a commitment to do so, she was unwilling to give any date for when the disinvestment of austerity would be rectified. If not now, when?

The UK Government do not even need to look far for inspiration: although challenges remain, they could learn much from Scotland’s approach. The story north and south of the border is very different, as is evident in our approaches to social care post covid. The Scottish Government have established an independent review to look at the creation of a national care service for all. As the Nuffield Trust points out, Scotland’s reforms are

“the most advanced of the countries…having set out an ambitious and comprehensive vision for a social care service.”

Because free personal care has been in place in Scotland since 2002, two thirds of those receiving social care support in Scotland do so in their own homes.

A further lesson from Scotland is the introduction of Frank’s law in April 2019. Under this legislation, free personal care was extended to all adults. Despite all these significant advances being made in Scotland, the system continues to struggle because we are part of the UK. Let us take funding, for example. The simple truth is that, without independence, we are limited in our funding options. Hoping for Barnett consequentials anytime soon seems unlikely, given the UK Government’s timidity towards social care reform in England. Then there is Brexit. While the Government celebrate the end of freedom of movement, the loss of its opportunities is lamented in Scotland. The Migration Advisory Committee is entirely right that this poses a stark risk for social care, given that the services are dependent on EU nationals. UK policy delivers to Scotland a triple threat: a lack of reform to tackle the many pre-existing issues; the Government’s irrational and ideological approach to the EU; and an immigration policy that refuses to acknowledge, never mind accommodate, the specific needs of Scotland.

I had a fleeting hope in March that covid would raise this Government’s eyes to injustice and the value of those in healthcare. I felt sure that honouring all the heroes in our NHS and care sector would naturally follow, but no. With the weekly clapping now a distant memory, many do not feel valued or do not feel that their efforts are properly recognised. Campaigners are calling on Ministers to boost nurses’ pay without delay. The Scottish Government are currently delivering the highest pay award in the UK for NHS Agenda for Change staff of at least 9% over the three years from 2019. They also gave an immediate 3.3% pay rise to social care workers and have just announced £50 million for the social care staff support fund for those who contract covid-19.

This Government sprang into action to approve countless contracts for their wealthy friends at the start of the pandemic, but that sense of urgency is sadly lacking when it comes to taking action on nurses’ pay or addressing the poverty of carers. The Prime Minister demonstrated yet again today that his ears are made of cloth. He ignores repeated calls for the £20 uplift to universal credit to be made permanent and extended to legacy benefits, which is backed by the Joseph Rowntree Foundation and Save the Children, and he defended his Government’s refusal to feed children in poverty during the summer holidays, yet brags about Marcus Rashford’s campaign this winter. It was support grudgingly given through shame.

We are seeing a return to the lack of compassion of the 1980s, but what we are witnessing now casts minds back further still, not just to the Thatcher years but to Dickensian Britain where great wealth and extreme poverty existed cheek by jowl, conjuring images of barefoot children with empty bowls and a population without access to medical or social care. This is the stark reality of Tory Britain: poverty, a pay-to-access suboptimal social care system, an assault on employment and working conditions, and the exclusion of the self-employed. Coronavirus must not be allowed to cover for the crony virus at the heart of this Government. Some say that Scotland gets too generous a settlement, but that is a false narrative. These policies exist in Scotland because—

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[Laura Trott (Sevenoaks) (Con)]

I was glad to hear the Minister, in his opening remarks, refer to the need to focus on data because I am going to use my limited time today to argue for more data analysis specifically on the effectiveness of lockdown restrictions, and to support the move towards an approach that Professor Sir John Bell calls enablement, which essentially means using testing to allow us to continue as normal a life as possible.

As with many across the House, I had hoped that we could continue the management of coronavirus through a system of regional alert levels. Sadly, it was clear that that was not the case. Although it controlled the virus, the virus was spreading faster than we could accommodate in the NHS. The key question we now need to ask ourselves is, why was that the case? Why did the regional approach not slow the spread of the virus fast enough? We need to establish why, so we can fix it and resume the regional system with renewed confidence that it will contain the virus without the need for further national lockdown.

One aspect that needs more analysis in particular, is compliance. It is possible, indeed probable, that a lack of compliance played a role in the regional tier approach insufficiently controlling the virus, but we do not have the data at the moment to fully establish that. Baroness Harding, the NHS’s test and trace head, appeared before a joint evidence session of the Health and Social Care and Science and Technology Committees yesterday. She gave preliminary data showing that 54% of people quarantine when asked, but also cautioned that the remaining 46% will include many people who have gone outside very briefly to get some fresh air or maybe to get some food that was completely necessary. It is clear that we need firmer data on this because, as we focus on driving up the number of contacts reached, it will ultimately not be effective if those people are not staying at home when they are asked to do so. We need a clear-eyed understanding of whether people are complying and a strategy for addressing it—whether we need to change the monetary incentives or the information we are giving people, or simply change the rules.

Professor Sir John Bell raised the point that we need buy-in for people to want to have a test and quarantine. He believes that many people are being put off having a test for fear of condemning their contacts to two weeks of quarantine without hope or reprieve. He suggested a system where the contacts of those infected are tested and released from quarantine if they test negative, and then rechecked every few days. I am really pleased that the Department has confirmed that it is pursuing that approach and trialling it in limited areas, and I hope it is something we can go forward with, because the data-led approach that accepts a level of risk in order to drive up compliance, with the aim of allowing people to return to normal as far as possible, is something that we should applaud.

I wholeheartedly echo the remarks of my right hon. Friend the Member for Clwyd West (Mr Jones) about testing in care homes and making sure that we get the relatives and friends of people in care homes tested so that they can visit, because it has been a devastating time for so many.

On the topic of evidence, please can we have the evidence base behind why golf, tennis and children’s sports have not been given an exemption from lockdown rules? If people can take a walk outside, they might as well be able to do it with some golf clubs.

Back on the theme of data, may we have a data-driven approach on whether we still need the curfew if we go back into a regional approach? While I completely understand why we introduced it, it had a devastating effect on hospitality across the country. If it works, we can understand why it is imposed, but if it does not work, we will all be better off without it.

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.

--- Later in debate ---

[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).

Independent Medicines and Medical Devices Safety Review

Laura Trott Excerpts

Thursday 9th July 2020 Commons Chamber

[Ms Dorries]

I thank the hon. Lady for her ardent campaigning on this issue. I can only say again that I have absolute sympathy with the families on whose behalf she has been campaigning, but once again I refer to my earlier answer: owing to pending legal action I cannot comment on Primodos.

[Laura Trott (Sevenoaks) (Con)]

This report was an incredibly difficult read, but what one of the things that stuck with me most is the guilt that so many mothers have felt for taking drugs that inadvertently harm their babies. I would like to echo what is said in the report: this was not your fault. Please can the Minister reassure all pregnant women across the country and the House that action has been taken to improve the monitoring of drugs used during pregnancy?

[Ms Dorries]

I thank my hon. Friend for her comment. She is absolutely right. The report is entitled “First Do No Harm”, and we here have to do some good in response to it. Work is being undertaken—the all-party group for valproate and other anti-epileptic drugs in pregnancy works incredibly hard. It is about getting information out there. For some women with epilepsy, sodium valproate is the only drug that works, and the pregnancy prevention programme works alongside this. As I have said, I cannot comment on Primodos, but work is ongoing. We have seen a decline in the number of pregnant epileptic women taking sodium valproate. That decline needs to be driven down even further, in tandem with the pregnancy prevention programme, but my hon Friend is absolutely right. I hope that nobody ever has to come to the Dispatch Box again to discuss a report such as the Cumberlege report and have to apologise for what happened, with the glaring inconsistences in treatment that has been provided to those women who have not received the information they should have received when taking those drugs.

Covid-19 Response

Laura Trott Excerpts

Tuesday 2nd June 2020 Commons Chamber

[Matt Hancock]

If it’s sunny in Manchester, it really must be hot. [Interruption.] Coming from the north-west myself, I know how much it rains in that part of the world. The, the—I have completely lost my train of thought. The hon. Lady raises a very important point about test and trace. Subject to patient confidentiality, which I take very seriously, of course we will publish data on the test and trace system and will work with the UK Statistics Authority on the best way to do that. I spoke to David Norgrove earlier today about that and how our teams should work together to make sure we can publish it in the right and appropriate way.

[Laura Trott (Sevenoaks) (Con)]

I welcome the progress that has been made on testing, but I have a specific case of a care home in my constituency that caters for people with disabilities. Because the residents are typically under 65 and do not have dementia, they do not have access to testing in the same way those in other care homes do. Could the Secretary of State look into this case?

[Matt Hancock]

Yes, of course, and I will get back to my hon. Friend.

Oral Answers to Questions

Laura Trott Excerpts

Tuesday 5th May 2020 Commons Chamber

[Matt Hancock]

We do work globally, and we do work together. As the Prime Minister made clear yesterday, we have committed £744 million to the global response to coronavirus. We are significant funders of the WHO, and I am grateful for its work. We are also a significant funder of the Coalition for Epidemic Preparedness Innovations, which is leading the global search for a vaccine. In fact, we are making the largest contribution of any country in the world to the global search for a vaccine, and three of the top 10 vaccine candidates are being developed here in the UK.

[Laura Trott (Sevenoaks) (Con)]

What plans the Government have to test, track and trace people with covid-19.

[The Secretary of State for Health and Social Care (Matt Hancock)]

We are developing a new test, track and trace programme to help to control the spread of covid-19, and to be able to trace the virus better as it passes from person to person. This will bring together technology through an app, an extensive web of phone-based contract tracing and, of course, the testing needed to underpin all that. The roll-out has already started on the Isle of Wight, and I pay tribute to and thank the Islanders for the enthusiasm with which they have taken up the pilot. I hope that we learn a lot from the roll-out, so that we can take those learnings and roll the programme out across the whole country.

[Laura Trott [V]]

I thank the Secretary of State for his answer. I welcome the plans to introduce the contact-tracing app, but for it to be effective it will need to be rolled out to a large proportion of the population. What plans does the Secretary of State have to achieve that, and how will he alleviate privacy concerns?

[Matt Hancock]

I am grateful to my hon. Friend for that question. She is right to say that the more people who download the app, the more people will protect themselves, their families and their communities. The cross-party support for this test, track and trace programme is important, and right across this country people need to know that the app has privacy in its design. The data it holds is held on people’s phones and it does not go to the Government, until of course someone needs to get a test, in which case of course they have to get in contact with the NHS. So privacy is there by design, there is cross-party support and, according to a very early poll, 80% of people on the Isle of Wight want to download it. These are good early signs and we will have a big communications campaign to explain to people the benefits of the test, track and trace programme as we roll it out across the country.

Covid-19 Response

Laura Trott Excerpts

Wednesday 22nd April 2020 Commons Chamber

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

The Secretary of State has talked today about the test, track and trace strategy, and he has indicated that the effectiveness is determined by the incidence in the community. Can he give us guidance on what the incidence level is and when, based on current modelling, we might achieve it?

[Matt Hancock]

The current level of incidence is unknown until we expand testing yet further, but it is far higher than where it needs to be. Although, as I have said, we have high confidence that we are at a peak in this disease, obviously we need to see that come down. The reason I am not giving a numerical answer is because it is a question of degree. The fewer new cases, the more effective test, track and trace are as a way of keeping the disease down, and therefore the more social distancing measures can be lifted. This is all a question of degree, and we do not have an answer to the question of when that will all be doable, because we have not yet seen the curve start to come down and we do not know the pace at which the curve will come down under the current social distancing rules.

Coronavirus

Laura Trott Excerpts

Tuesday 3rd March 2020 Commons Chamber

[Matt Hancock]

I have already made it clear that we have a robust statutory sick pay system in this country, that self-isolation counts as illness within that system and that we are keeping the system under review. So people can have confidence that, if they are asked to self-isolate, that is exactly what they should do.

[Laura Trott (Sevenoaks) (Con)]

Sadly, it is healthcare professionals who are likely to be most exposed to the virus. What steps is the Secretary of State taking to make sure that we have sufficient numbers of healthcare professionals at work to deal with this crisis?

[Matt Hancock]

That is an incredibly important issue, not least because of the impact of the virus directly on healthcare workers in other jurisdictions—we have seen the impact here, too. We have a broad programme, led by the NHS, to make sure that we protect healthcare workers—not only clinicians but the non-clinicians mentioned by the hon. Member for St Albans (Daisy Cooper)—and have as much support in the NHS as possible, including from, for instance, recently retired people, and from volunteers, as mentioned earlier. If the virus becomes widespread, it will be all hands to the pump in the NHS, as with social care. We have extensive planning under way to make sure that the NHS can respond.