Tattoo Artists, Body Piercers and Cosmetic Clinics: Licensing

Steve Brine Excerpts

Tuesday 28th November 2023 Commons Chamber

[Steve Brine (Winchester) (Con)]

Earlier this year it was announced that Wales was set to become the first UK nation to introduce mandatory national licensing for what we call special procedures: tattoo artists and those working in body piercing, semi-permanent makeup, acupuncture and electrolysis. The licensing regime in Wales is being introduced under part 4 of the Public Health (Wales) Act 2017. Happily, section 180 of the Health and Care Act 2022, passed by this place, gave the Secretary of State the power to introduce a licensing regime in England. I am really glad that we are now doing that and that our Government are taking the issue seriously.

In this very short debate, I am keen to hear from the Minister what the Government are doing to speed up the introduction of that regime in England, something that the Health and Social Care Committee, which I chair, called for when it published a report on body image back in 2022. I want to mention my hon. Friends the Members for Bosworth (Dr Evans) and for Sevenoaks (Laura Trott), who did good work on that regard when they were on that Committee.

As we are all well aware, non-surgical cosmetic procedures such as Botox, dermal fillers, chemical peels and aesthetic procedures such as tattooing and body piercing are soaring in popularity. The beauty industry is valued at an estimated £3.6 billion in the UK. That boom has been fuelled by sales on social media and in beauty shops on the high street. However, while these procedures are popular, they carry risks that must be managed to protect both those who undergo the procedures and those who provide them.

At present, healthcare professionals such as doctors, nurses and dentists who carry out non-surgical cosmetic procedures must be trained and insured as part of the requirements laid down by their own regulatory bodies or Royal Colleges. However, there is no set training for beauty therapists and other non-professionals, something that is a cause for concern and an issue that many respected practitioners have campaigned on for some time. It is, after all, in their interests; as the sector has boomed, there has been a rise in people being physically and mentally harmed by poorly performed procedures. The aesthetics sector has been described to us by some, in part, as the “wild west”, which clearly is not ideal for anyone, patient or practitioner.

Further to that, a survey carried out by the British Association of Aesthetic Plastic Surgeons found that 69% of its surgeons have seen patients with complications following temporary fillers. Again, that outlines the need for the licensing scheme to be introduced and enforced. An estimated 900,000 Botox injections are carried out in the UK each year, with 3,000 complaints registered in 2022. The public need to be educated on the risks; they cannot assume that someone who is carrying out an aesthetic treatment is trained. It goes without saying that people should take the time to find a reputable, insured and qualified practitioner, if they decide that such treatments are for them.

To my mind, the licensing scheme is an important step towards better outcomes for the industry and consumers and, I hope, towards removing rogue practitioners from the industry. Practitioners must have adequate training to deal with complications and to minimise them in the first place. For instance, if a blood vessel is blocked while a patient is undergoing a procedure, it could easily block the blood supply to their eye. I was contacted with the horror story of one woman who was unable to open her eyes for 16 weeks following botox treatment.

Wales opened its 12-week consultation on its licensing scheme in January of this year. The scheme aims to reduce infections, eliminate poor working practices and create a central public register for licensed practitioners and approved business premises. That is important as the industry continues to increase in popularity. The Welsh chief medical officer said at the time that he was

“very pleased that these impending changes have been widely welcomed by practitioners in Wales, with many already volunteering to meet the new standards.”

One tattoo shop owner who has been working with the Welsh Government on the new qualifications said—this was widely reported—that:

“The increase in quality of tattoos in the last decade has been exponential so the hygiene needs to be raised. This is all positive for the industry and helps shake the image of it being dark and shady. It’s reassuring for those getting tattooed as well.”

I obviously very much agree with that statement, which shows why we need further legislation—or regulation off the back of legislation—in England to protect both clients and practitioners. In answer to a written question earlier this month, the Welsh Government confirmed that the aim is for their statutory licensing scheme to come into force in the summer of 2024, when it will initially apply to the four special procedures specified in their 2017 Act: electrolysis, body piercing, tattooing and acupuncture.

As I say, I was pleased when the Health and Care Act 2022 introduced powers for the Secretary of State to establish a mandatory licensing scheme in England, following calls for greater regulation of non-surgical cosmetic treatments—not least from my Select Committee. It is important that the scheme is introduced sooner rather than later, which we emphasised in our report on body image.

It was positive when the consultation in England finally opened at the beginning of September this year with pretty much the same intentions as the Welsh piece of work. However, concerns have been raised with me by those in the industry that the consultation in England has been far too heavily biased towards medical input rather than input from those in the cosmetics industry, which makes up a large part of the sector. As part of our body image inquiry in 2022, the Health and Social Care Committee recommended that the introduction of licensing for non-surgical cosmetic procedures be made a priority and introduced by July this year. The Committee also suggested that a safety taskforce be set up to bring stakeholders together, but I understand that the Government decided not to follow that route. The National Hair and Beauty Federation says that it is concerned that the Government have not reached out to an adequately broad range of stakeholders. Why have the Government not pursued the route recommended by the Select Committee?

In the pre-consultation phase, it was felt that more medical organisations than beauty organisations were consulted, which the NHBF has suggested caused a bias towards the medical sector. That is creating concern that routes into aesthetics via the beauty sector will therefore be restricted, which will have obvious consequences for many legitimate and reputable businesses. It also creates the risk that the new regulatory regime may drive some practices into the underground market rather than increase quality and standards across the industry, which is what we are aiming to see. The NHBF also said in September that it had written to the Government twice this year regarding the new licensing scheme but was yet to receive a response. Maybe that has been updated since.

When implementing mandatory licensing, we need to ensure that we establish a framework that demands a higher standard of care and proficiency from all practitioners. Further to that, another issue that needs to be addressed by the national scheme is procedures carried out in tattoo and piercing studios in England, which are currently subject to regulation by local councils. As there is no national scheme, we currently lack the reassurance needed. Practitioners need to contact the local council where their premises are based to get a tattoo, piercing or electrolysis licence. They must then register both themselves and the premises with the local council. However, registration is a fairly simple process, there is no requirement for the provision of proof of qualifications, and local authorities have few powers to refuse a registration. The current licence with local authorities covers tattooing, semi-permanent skin colouring, cosmetic piercing, electrolysis and acupuncture.

Local councils do, it must be said, conduct regular inspections of premises to ensure that they are compliant with health and safety laws, and there is a requirement for every tattoo artist to be licensed by their local council. To remind the House, tattooing without a licence or tattoo certificate is illegal. However, the fact that licensing is determined by local councils in England means it differs on what standards must be met across the country by those who apply. For example, some councils demand that all practitioners have access to their own sink, while others are happy for shared sinks, which risks cross contamination—posing a health risk. A new compulsory licensing scheme would ensure that both clients and practitioners are adequately protected, and practitioners would have to abide by the same rules across England.

The purpose of registration with councils is to protect the public from the transmission of blood-borne viruses such as HIV, hepatitis B, hep C and other infections, and to ensure that the health and safety regulations are followed. I think a national licensing scheme would increase this protection. As I have already set out, although section 180 of the Health and Care Act enables the Secretary of State to establish a licensing scheme, it is yet to be fully enacted. The consultation process closed a month ago today, and the advances to implement this hugely important scheme have been slow in England. When does the Minister think the Government will respond to the consultation?

There are four key priorities that must be addressed in the new licensing scheme to make sure that there is adequate protection for practitioners and clients. The first is the design and implementation of the national licensing scheme for all premises, as well as practitioners of non-surgical cosmetic procedures, to ensure that those who practise invasive procedures are competent and safe for members of the public—our constituents. Secondly, all practitioners must hold the correct insurance to provide these procedures. Thirdly, there needs to be official guidance on the training and qualification expectation of all practitioners, such as the knowledge and application of infection controls and first aid training should things go wrong. Fourthly and finally, we need a system that effectively records adverse incidents and public awareness raising so that all cases that go wrong can be tracked. I think such a system would dramatically improve safety standards. It would also ensure that members of the public are better equipped, as they would have better tools and knowledge surrounding the procedures and the practitioner that they were using.

The Government did assure the Joint Council for Cosmetic Practitioners, the British Beauty Council and the Chartered Institute of Environmental Health that they were committed to the licensing of the non-surgical aesthetics sector in England, so I ask the Minister when we can expect to see further action, following the consultation that I have mentioned.

[Jim Shannon (Strangford) (DUP)]

I commend the hon. Gentleman for bringing this debate forward. My council, Ards and North Down Borough Council, has a policy in relation to piercings specifically. It has initiated a piercing guidelines policy to make both piercers and those who get piercings aware of the guidelines and policies that, in its word, “must” be followed. Does he agree that there could be more discussion of providing this information—in local schools, for example—because many people who get piercings are under 18 years of age, and are often naive to the guidelines and hygiene policies that piercers must follow? Educate them early: does the hon. Gentleman agree?

[Steve Brine]

We have enough debates in this House about some of the things that we teach in schools, and I can but imagine some of the responses we would get to this, but in my view education can never be a bad thing. There is nothing wrong with tattooing and piercings. It is not my personal choice—I do not know about the hon. Member for Strangford (Jim Shannon)—but if people are going to do it, I think they should go with their eyes, or any other part of themselves, wide open; and that is why the hon. Gentleman’s point on education is well made. [Interruption.] Did that amuse you, Mr Deputy Speaker?

In closing, would it be possible for the Minister to outline the timeline, even in rough terms, for the introduction of the licensing scheme? Finally, I understand that it is complicated and a bit like peeling an onion—the more you take, the more you find—could the Government outline which procedures will fall under the new licensing scheme? On that, I will close; I look forward to hearing from the Minister.