Sunbed Use: Health Implications

Steve Brine Excerpts

Wednesday 13th February 2019 Westminster Hall

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

It is a pleasure to see you in the Chair, Mr Hosie. I thank my hon. Friend the Member for Mid Derbyshire (Mrs Latham) very much. We use the term “hon. Friend” a lot in this place, but she knows that she is my very good friend as well as my hon. Friend. Well done to her for securing the debate.

I was interested to hear the word search statistic from my shadow, the hon. Member for Washington and Sunderland West (Mrs Hodgson). It was very interesting, but not at all surprising. The hon. Lady and I spend a lot of time in Westminster Hall, but this is not an issue that we have covered before, although we have obviously covered cancer a lot. This issue affects so many people’s lives. We heard from my good and hon. Friend about how it has impacted on her family and, as the hon. Member for Washington and Sunderland West said, it was very good to hear that she herself has managed to deal with it successfully.

I do not know about other hon. Members, but sunbeds feel very 1980s to me. As someone who was at secondary school in the 1980s, I thought that they had been left behind there, because we do not hear much about them these days, but it occurs to me that there is a large sunbed salon in my constituency of Winchester. There is a reason why the 1980s came into my mind. Hon. Members may remember an episode of “Only Fools and Horses” called “Tea for Three”. The infamous character Trigger has a niece whom Del and Rodney remember from her much younger years and who comes to stay with Trigger for a period. The niece, Lisa, is now 25 and—well, let’s just say that she has matured into a very attractive young lady. Del and Rodney set out to impress her, both thinking that they have a chance. I remember the episode well, and the reason why it is relevant to the debate is that Rodney decides to lie on the sunbed in the flat at Nelson Mandela House to improve his look for young Lisa and falls asleep. Del then turns up the dial, and Rodney spends the rest of the episode with a bright red face—in many ways. It is interesting that tanning was portrayed in that sitcom as a technique to attract the ladies. It backfired, as everything seemed to, on poor Rodney, but it was interesting how it was used and it explains why I connect sunbeds with the 1980s. As we have heard today, however, sunbeds and their impact are very much current phenomena.

As my hon. Friend is keenly aware, there are huge health consequences from exposure to both natural and artificial ultraviolet radiation. The most significant is of course skin cancer, which we have talked about, but there are other impacts, such as sunburn, which is very unpleasant and uncomfortable, accelerated skin ageing—the “prune” factor that we have discussed—eye inflammation, which my hon. Friend the Member for Ayr, Carrick and Cumnock (Bill Grant) mentioned, and temporary immunosuppression. Importantly, though, there are measures that we all know we can take to reduce the impact of exposure to UV radiation from the sun, such as using sunscreen and seeking shade. Equally, there are many precautions that should be taken when using sunbeds, such as only using a staffed facility that provides guidance to users and limiting regular use of a sunbed. I will come on to those two points. Younger people who use sunbeds are at greater risk, which is why in 2011, regulations were introduced banning the use of sunbeds by under-18s in England and Wales, as we have heard.

Melanoma skin cancer is one of the most common cancers in the UK today. About 15,500 new cases of melanoma are diagnosed each year and more than 2,000 people die every year in the UK from melanoma. In recent years, skin cancer has become much more common in the UK, which is thought to be the result of increased exposure to intense sunlight on holidays abroad. Many people these days can afford foreign holidays, which come with much fun but also many dangers. It is worth noting that more than one quarter of skin cancer cases are diagnosed in people under 50, which is unusually early compared with most other types of cancer. Cancer Research UK estimates that 86% of skin cancers are preventable. I often say in Westminster Hall debates—my shadow will have heard me say this many times—that two thirds of cancers are down to bad luck and one third of cancers are preventable. When we consider the high percentage of skin cancers that are preventable, we realise that this is an area where we can move the dial in the prevention space. That is why I am interested in today’s debate and so grateful to my hon. Friend the Member for Mid Derbyshire for initiating it.

My hon. Friend referred to the many people who would not have skin cancer if they had not used sunbeds. It is difficult to be certain about how many cases of skin cancer are due to sunbed use, as most people will also have had natural exposure to UV from the sun. Obviously, there are a few people who have skin conditions that mean that they must remain 100% covered up or who do not go outside, for other health reasons. It is vital—my hon. Friend made this point very well, as did others—that the public are fully aware of the risk from their overall exposure to UV and how to minimise the risks.

We have not mentioned vitamin D much in this debate. Vitamin D is a hormone that is very important in musculoskeletal health, and vitamin D synthesis is triggered in the skin through exposure to UVB, including from sunbeds. However, we do not advise people to use sunbeds to enhance vitamin D levels, because any beneficial effect of increased vitamin D synthesis is outweighed by the adverse effects that we have heard about in the debate. We recommend alternative sources of vitamin D, such as dietary supplements.

Public Health England, for which I am responsible, discourages the use of sunbeds for cosmetic tanning, and rightly so. Those individuals who have very fair skin, who burn easily in the sun—I think of the hon. Member for Linlithgow and East Falkirk (Martyn Day) when I say that, and it certainly applies to me—or who have had skin cancer previously would be at increased risk and obviously are advised not to use a sunbed. This is the point that the hon. Member for Rhondda (Chris Bryant) made about the race that we are and the part of the world in which we live.

The Be Clear on Cancer campaigns, which Public Health England leads on behalf of the Government, are designed to raise the public’s awareness of specific cancer symptoms, encourage people with those symptoms to go to the doctor, and promote the diagnosis of cancer at an early stage. We are about to roll out the next iteration of the Be Clear on Cancer campaign, about cervical cancer, on which there was a big debate in this Chamber last month, and we have had the campaign on breast cancer in the past. It is fair to say that there is no shortage of applications for the next iteration of Be Clear on Cancer. And often we are limited in what we can do in those campaigns in relation to the impact that people would then be driven into the health service. However, one of the things that I will take away from this debate is that it would be well worth my placing on the radar of the Be Clear on Cancer team melanoma and skin cancers generally for the campaign as we roll it forward. That will hopefully be one positive outcome from the debate.

It is critical—it is important that Health Ministers say this at the Dispatch Box—that people are aware of their skin. They need to be skin aware—in the same way as so many women have, hopefully, been trained to be breast aware—and to seek advice from their GP if they notice any changes, particularly in terms of moles that itch, bleed or change shape. I remember being taught that as a youngster and I wonder whether the younger generation are still as aware of that health message, but Be Clear on Cancer is something that we can look to with hope.

Let me touch on regulation. The Sunbeds (Regulation) Act 2010 came into force in April 2011 in England and Wales, as has been mentioned, to prohibit under-18s from using sunbeds. Restrictions on sunbed use by under-18s also apply in Scotland and in Northern Ireland. Guidance has been provided to support local authorities’ authorised officers in successfully implementing the Act, by providing information on the duties of businesses and how to carry out inspections. The local environmental health departments in England are responsible for monitoring and inspecting sunbed salons everywhere, except those situated in local authority leisure centres, which are regulated by the Health and Safety Executive. It is worth making that distinction.

My hon. Friend the Member for Mid Derbyshire talked about banning sunbeds. Should they be banned? A range of options to minimise the adverse effects of sunbeds has been considered. Public Health England has contributed to the most recent World Health Organisation review, published in 2017, on the public health interventions to manage sunbeds. Banning sunbeds was one option under consideration, but the adverse impacts need to be considered carefully to avoid unintended consequences, such as increased use of home machines—like Del and Rodney had—with more harmful impacts.

We have to be aware of the unintended consequences. One of the unintended consequences of banning the use of commercial sunbeds by under-18s was the opening of a market for home hire of second-hand sunbed equipment and sunbed parties—believe it or not. I have been to many parties in my time, but I have yet to be invited to a sunbed party. The mind boggles—it is probably best to leave it there. My swimming trunks have not had an outing for years, but that is probably for the best. It is vital to equip people with the information to avoid the risks of over-exposure to UV radiation. In this way, we empower individuals to protect themselves from UV sources.

Before I address prevention, diagnosis and treatment, I will respond directly to my hon. Friend’s suggestion that sunbeds should be banned. I think we need to look at the regulations again, as the shadow Minister mentioned. They have not been changed for a number of years. My hon. Friend has brought this issue to this Chamber with great force, intelligence and evidence. Now is a good time because we have published the prevention strategy and we are working on a Green Paper on prevention. I am interested in any and every idea that is related to prevention.

As a Minister, I am often given papers by officials, and stuff to look at and sign off. However, in this process of preparing the Green Paper on prevention I can say to my officials, “I want real blue-sky thinking here. I want you to look out into academia, to see where the really interesting and cutting-edge work is going on around prevention and future prevention.” This Green Paper process is really open-minded and based on open-source planning. If we look at the evidence and think that banning the commercial use of sunbeds, while taking into account the possible unintended consequences, could be part of prevention, I will not rule it out. I absolutely do not rule that out.

Wherever possible, the aim is to prevent skin cancer from developing in the first place. I met Melanoma UK at the Britain Against Cancer conference just before Christmas. It has a fantastic team, who I am sure have been very helpful to my hon. Friend ahead of today’s debate. I am proud to say that Public Health England and Melanoma UK have had great success in raising awareness of the risks, and the actions to take to reduce the risk of exposure to the sun and the use of sunbeds. The Health and Safety Executive plays a vital role in raising awareness through leaflets and posters, reflecting its guidance for tanning salons and their customers about the safe operation of sunbeds. My hon. Friend used many quotes from people who are engaged in this issue. One interesting quote was from the lady who runs a salon and said that she wants people to feel good about coming into her business, and that sending people away with a potentially life-threatening condition is not a good look for any business. That was an important point.

A tan may give you a so-called healthy glow. The hon. Member for Ayr, Carrick and Cumnock pointed to the magazines and the media image: people always have that healthy glow. However, I have never thought of a good tan as a healthy glow. The National Institute for Health and Care Excellence guidance, published in February 2016, is clear that there is no healthy way to tan. The idea that there is such a thing as a healthy tan, as my hon. Friend said in her opening remarks, is a myth. Any tan can increase your risk of developing skin cancer, whether through natural or artificial UV, and getting a tan does very little to protect your skin from the harmful effects of the sun, which is my hon. Friend’s fundamental point.

NICE, NHS England and cancer charities, including Cancer Research UK and Macmillan, are all clear that if you want browner-looking skin, fake tan is the way to go. It is much safer to use a fake tan product on your skin than to sunbathe or use a sunbed. As the expression goes, “Fake it, don’t bake it”. I think that is what they say in the Department of Health and Social Care these days. I do not know whether you are aware of that, Mr Hosie.

I hope that I have covered a lot of the points that have been raised. I hope that I have demonstrated the Government’s commitment—my commitment—to improving outcomes for people in this country living with skin cancer, and the many more who are at real risk of developing this disease. The Government’s ambitions outlined in the long-term plan for the NHS, the Secretary of State’s prevention strategy, and the Green Paper will ensure that we strive to do even better over the next decade. In conclusion, I agree completely with the hon. Member for Linlithgow and East Falkirk that, while we learn a lot in this place, there is a lot of repetition in many of the debates, but that this debate has not been one of those.