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Non-surgical Cosmetic Procedures: Regulation

Volume 654: debated on Tuesday 12 February 2019

I beg to move,

That this House has considered regulation of non-surgical cosmetic procedures.

It is a pleasure to serve under your chairmanship, Mr Hollobone, and I am grateful to lead this debate on an issue that I believe affects all our constituents.

We live in a time when there is a certain desire, especially among the young and impressionable, that one must always look one’s best, or in fact look different to how we may really be. There is nothing wrong with that; we live in a country that gives all citizens the ultimate freedoms over their choices and their own bodies. However, we in Parliament have a responsibility to the people, and our responsibility includes ensuring that those who wish to change their appearance and their body have all the information they need to make a fully informed and rational decision and, importantly, are able to trust those administering treatments and to have peace of mind that those treatments will be carried out correctly, with minimal risk to their health.

Does this matter not come down to a fundamental issue, namely that if something goes wrong, who do we sue? Is that not the nub of what my hon. Friend is trying to get at?

I thank my hon. Friend for that intervention. Yes, that is one of the core issues that I wish to raise today. The mark of a professional in our society is somebody who is regulated, who is trained, qualified and licensed, and who has ongoing regulation and development. However, in addition to that, in the private sector they must carry professional indemnity insurance, so that people do not sue men or women of straw and so that they have someone to sue when things go wrong.

My experience of non-surgical cosmetic procedures does not extend to Instagram celebrities or Kylie Jenner. Instead, I wish to inform you, Mr Hollobone, of the case of my constituent Rachael Knappier. First, I thank Rachael, her mother and her friend, who are all attending this debate here in Parliament. I also thank Rachael for her tremendous bravery and willingness to talk openly about the terrible injury that she sustained as a result of a botched non-surgical cosmetic procedure. I think Rachael has been a role model for hundreds, if not thousands, of people across the country who have read the articles in the British media about her trauma. They responded with sympathy, but most crucially an understanding of her experience, because—sadly—experiences such as Rachael’s are not confined to the few. Many hundreds of our constituents have suffered such botched procedures.

I thank the hon. Gentleman for giving way and I congratulate him on bringing this issue to the House. This debate was supposed to be held a few weeks ago, Mr Hollobone, but unfortunately it did not take place then, so I have looked forward to this opportunity today.

Very recently, I was contacted by one of my local councillors on behalf of a registered nurse in my constituency who is asking for regulation of non-surgical cosmetic services to be made compulsory and not voluntary. Does the hon. Gentleman agree that we must understand the belief of someone who sees the terrible effects of these treatments carried out by those who are not medical professionals, and that we should put legislation in place to address this grave concern? Whenever nurses or my councillors come and tell me their concerns, there is a real need for legislative change.

I thank the hon. Gentleman for his intervention. I agree that regulation is required and that legislation should underpin that regulation; there should not be voluntary regulation. Indeed, I would go further and say that, although I do not profess to know what type of expertise somebody should have to carry out these procedures, the regulator should identify the training, the expertise and the qualifications required and what products should be permitted in the market.

I am sure my hon. Friend will be aware that Sir Bruce Keogh conducted a review of the cosmetics industry and its unregulated nature earlier this decade, and he made exactly the points that my hon. Friend is making. Sir Bruce also made the point that if someone is going to perform operations on the human body, they should have the requisite knowledge and training to understand the anatomy involved and the consequences if something goes wrong. Far too often, unregulated practitioners do not have the skills or knowledge to understand what can go wrong, or indeed the skills or knowledge to advise people about the potentially adverse consequences of a procedure. I therefore agree with my hon. Friend that it is time for proper regulation of what are sometimes cowboy practitioners in this sector.

I could not agree more with my hon. Friend. The idea that anyone who is wholly unregulated and without any medical expertise whatsoever can inject people with foreign substances is shocking, to say the least. Again, however, it would be for a regulator to determine what type of qualifications and expertise one should need, whether that is medical expertise or otherwise. I would leave that matter in the hands of an appropriate regulator.

If hon. Members do not mind, I will make some progress and then give way again.

My constituent Rachael told me that a beautician had attended a party intending to administer some treatments to those in attendance. The beautician in question did not have any medical training, nor, to the best of my knowledge, did she have any formal recognised training in administering this type of injection. Rachael received, as many thousands of our constituents do, a lip filler injection while she was attending a social engagement with friends. As a direct result of the beautician’s mistake—it was not Rachael’s mistake—lip filler was incorrectly injected into Rachael’s artery, causing her lips to swell severely, requiring her to seek urgent medical attention, before being treated privately after the NHS was unable to help. Again, I commend Rachael’s bravery in talking so willingly about her experience, providing a multitude of younger people and others with a message of understanding and empowerment.

These types of procedures, which have been popularised by Instagram celebrities and reality stars such as the Kardashians, have experienced a huge rise in popularity, with more and more people seeking them.

Does the hon. Gentleman agree that although the vast majority of beauticians undertaking these procedures do so in a professional setting and manner and are concerned about the reputation of their businesses, maintaining that professionalism requires some form of regulation, which would stop these Botox parties where things go horribly wrong and people have no redress, and would improve the whole industry?

I thank the hon. Lady for her intervention. She is right to use the word “professional”, but the mark of a professional is somebody who is regulated, and in the private sector it is somebody who has professional indemnity insurance behind them. It is easy for someone to call themselves a professional, but a real professional is someone who is regulated. I am a solicitor and I am regulated by the Solicitors Regulation Authority, and behind me there is professional indemnity insurance. If I give advice negligently, a consumer has redress against the insurance product. We want a healthy, thriving industry in non-surgical cosmetics, where people can freely choose these procedures, but we have a duty as MPs to protect the health and safety of consumers, enabling them to make informed choices when seeking treatment from professional beauticians.

I thank the hon. Gentleman for giving way again. Regarding the training that those administering these sorts of treatments need, I recently spoke to a father whose 19-year-old daughter had received Botox injections, to which she had suffered a severe allergic reaction. This is the realm of medical practice. Anyone administering Botox should be aware of the possibility of those receiving it having an allergic reaction and should know what to do if they do. That is an area that regulation needs to address.

The hon. Lady is exactly spot-on. It is beyond belief that somebody can inject someone else with a foreign substance and have no medical expertise whatsoever. That is the nub of the problem.

We see more and more young people seeking these types of procedures, and at younger ages. It is incumbent on the Government to act swiftly and decisively to ensure that proper regulation and protection are in place for our constituents, of all ages, before the situation spirals out of control.

According to data from Save Face, a Government-approved voluntary register of accredited practitioners, there has been an alarming rise in reports of botched cosmetic procedures in the UK. The number of complaints about unregistered practitioners of treatments such as lip fillers and Botox reached almost 1,000 last year, showing that there is a large gap in safety and proper process that must be bridged.

Further, there is a separate but inextricable link between the rise of non-surgical cosmetic procedures and the pressures that young people in our society feel. Members may have seen Sky News this morning about social media, selfies and changing one’s image. That is clearly a major issue, particularly among the younger generation. Social media also has a responsibility regarding advertisements for non-surgical cosmetic procedures that are particularly targeted at minors. Although it is a person’s prerogative to undertake any treatment they wish, they should be able to do so through the prism of an informed decision, and with the peace of mind that the treatment they receive has been tried, tested and regulated by a professional body.

Colleagues might have seen the news about Superdrug a week or so ago, in which NHS England’s medical director strongly criticised the trusted high street retailer for not conducting “medically responsible” checks before customers receive their treatment. Similarly, NHS England’s chief executive sternly warned ITV about screening advertisements for these types of treatment in breaks during programmes such as “Love Island”, which is hugely popular with young people. Many colleagues will be shocked, as I was, to find that anyone can carry out non-surgical cosmetic procedures, with no regulation or expertise whatsoever.

A multitude of small businesses, and even individuals, spread across Facebook and, especially, Instagram, offer their services to impressionable young people. Many of them have no corporate responsibility or regulation and there are therefore absolutely no safeguards for consumers. Although I appreciate that many colleagues may have never seen an episode of “Love Island”—I confess to being in that category; I do not even have an Instagram account—

Dreadful, shocking. [Interruption.] Resign? With immediate effect. Members may also inexplicably not even know the different between their Kylie and Kendall Jenners, but there can be no doubt that most of our young constituents do. Those things are staples of the young generation, and are prevalent reminders, and in some cases advocates, of these types of non-surgical cosmetic treatment.

The Times recently conducted an investigation in which an Instagram account was created purporting to be that of a 13-year-old. Almost instantly after the account had followed social media influencers and celebrities, posts promoting such procedures appeared in the app’s “explore” feature. That reveals the shocking ease with which our younger constituents can be exposed to these types of treatment, under the guise of their being the new norm in today’s society.

In addition, young people’s physical access to the treatments is of tremendous concern. Although the law rightly restricts tattooing and the use of sunbeds for those under 18, there is no age-related restriction for either surgical or non-surgical invasive cosmetic procedures. The Nuffield Council on Bioethics recommends that children and young people under the age of 18 should not be able to access cosmetic procedures unless there is a medically relevant reason to do so. With the prevalence and exposure of the procedures specifically aimed at the young and impressionable in our society, action is required to protect children.

Turning to the industry itself, I have repeatedly said that non-health professionals who provide non-surgical cosmetic procedures are not regulated in an appropriate statutory manner. There is, however, an independent voluntary Joint Council for Cosmetic Practitioners, which has launched two new registers, one for practitioners who meet the clinical standards required to provide the treatments and another for accredited education providers. In the absence of an obligatory statutory register, as a minimum there should be clear public information about the need to seek a practitioner who is, at the very least, registered with that independent voluntary regulator. Nevertheless, a voluntary independent register, however laudable, does not go far enough. Dermal lip fillers, as one of the more popular non-surgical cosmetic treatments, are a good case in point regarding the total lack of standards in respect of the administered products.

I am mindful of time, so will make a few closing remarks. It was mentioned that the Keogh review, undertaken by the coalition Government, expressed huge concern that nothing prevented entirely unskilled practitioners from offering invasive treatments using unregulated products. The review stated that

“dermal fillers are a crisis waiting to happen.”

Despite the Minister at the time of the review’s publication advocating that its recommendations be taken forward, sadly this is, apparently, not happening. I therefore ask both the Minister, who I know has been a champion of ensuring appropriate health and safety standards for consumers, and the Government to at least consider setting out a cohesive and comprehensive plan to properly regulate the non-surgical cosmetic industry.

My constituent Rachael has been forthcoming, and willing to discuss her experience, but many hundreds out there have suffered botched treatments and are embarrassed or unable to come forward. As Members of Parliament, we have a duty to our constituents, and indeed to all others who may consider these treatments, to provide public information and to ensure that the procedures are administered by trained, qualified and regulated individuals. We also must ensure that, yes, those individuals are able to work in a thriving and competitive industry, but also that consumers have choice and that professional indemnity insurance is obligatory, so that our constituents are protected when things go wrong and the taxpayer is not burdened through the impact on the NHS.

I thank my hon. Friend the Member for South Leicestershire (Alberto Costa) for introducing this extremely timely debate. It is good to see so many colleagues showing an interest. I am delighted to see my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter), who made a start on regulating what is a growing industry. These days, we are all concerned about our body image. We all want to look good, and the industry has grown very rapidly. However, it is important to ensure that the public understand the risks associated with the procedures, and we need to do our best to improve standards throughout the industry.

Does the Minister agree that as well as looking at regulation we need to celebrate the beauty industry, which is led predominantly by women, predominantly employs women, and contributes hundreds of millions of pounds to our economy?

I am happy to endorse that point. It is worth bearing in mind that in wishing to regulate the sector we do not want to undermine its dynamism and competitiveness. What we really need is to ensure that consumers are properly educated, so that they can make informed choices about where they seek treatment and can protect themselves. Medical professionals are equipped to deliver some of the treatments, but we do not necessarily want that as a monopoly. Provided we have an appropriate system of regulation with everyone signing up to the same expected standards, such a system can be embraced.

We have had reference to Sir Bruce Keogh’s invaluable review, led by my hon. Friend the Member for Central Suffolk and North Ipswich. The Government have acted to improve the regulation and registration of those performing cosmetic interventions, but we clearly need to make much more rapid and substantial progress if we are to protect consumers properly. The industry is ever-expanding. We have heard that treatments are now available on the high street in places such as Superdrug, but this is not like going to have a haircut. When things are injected into a person’s face, if it goes wrong, it takes a lot longer to fix than letting their hair grow again would. We need to be sure that we are properly looking after consumers, including their safety.

I welcome what the Minister has said about wanting to go further with regulation. Historically, the challenge has been other Government Departments pushing back against the position of the Department of Health, which has wanted to protect people—seeing them as not just consumers but people who would be considered as patients in other capacities—and put in place adequate regulation of this sector. I hope that, given the Minister’s interest in this topic, she will be able to take the challenge to other Government Departments, and overcome the out-and-out free-market instincts that are putting people at risk.

I could not agree more with my hon. Friend. He is absolutely right: the priority for us in the Department of Health and Social Care has to be the safety of people undergoing these procedures. Aligned with that, I was pleased to see in the challenge to Superdrug a recognition of the fact that people’s seeking these sorts of treatments can be an indication of dysmorphia and an underlying problem. We need to make sure that all practitioners in this field have the ability to recognise those problems.

I also wanted to raise the issue of dysmorphia, which strays into the area of mental health. I am concerned that we seem to be accepting that it is okay for people to want to change their appearance. The issue of body dysmorphia illustrates that people may be asking for these procedures for the wrong reasons, and I question whether somebody on the high street who is not a qualified mental health practitioner is able to determine whether somebody is suffering from body dysmorphia.

The hon. Lady goes to the nub of this issue. We need to achieve an appropriate balance between allowing consumers to choose to embark on procedures that will enhance their appearance, and identifying whether the issue is something deeper. Again, it comes down to how we regulate those practitioners, the codes of conduct that they will sign up to, and the policies that they will put in place themselves. To an extent, the hon. Lady is right: dysmorphia can only be diagnosed by a medical professional. However, there are signs that can be taken into account, that can lead to the person’s being asked, “Do you really want to do this? Is this an appropriate procedure for you?” Perhaps there should be cooling-off periods, with bookings being made properly, and customers being advised about the risks that such treatments involve, so that they can make an informed choice. The hon. Lady is right to highlight the growing issue of dysmorphia, which we need to be very alive to.

This is a really important point. Even in the realm of plastic surgery, which is a regulated industry, we see grotesque transformations of people’s bodies and faces: people having ribs removed, leaving their external organs exposed, or having their entire appearance amended to make them look like a human Ken doll. We know that regulation in that sector is not really working, so can we make sure that in the currently unregulated sector of Botox injections and dermal fillers, we keep a closer eye on such things?

The hon. Lady makes an extremely good point. The worst thing is that the media representation of those quite grotesque transformations encourages us to look on them as entertainment, yet the person we are looking at has no idea, because those transformations are symptomatic of dysmorphia. The media have to be a lot more sensible about their portrayal of these things. My hon. Friend the Member for South Leicestershire mentioned the adverts during “Love Island”; these artificially enhanced images of people are becoming entertainment. I am delighted that in this country we have banned the Brazilian butt lift, which aims to make people look like one of our friends the Kardashians, but even so, people still aspire to look like that.

We can discuss regulation and ensuring that consumers understand the risks, but there is a wider challenge to society in how we celebrate learning to love ourselves. We have talked generally about the pressure that social media creates, which is becoming much more intense, but there is a hell of a lot more to do. Sadly, we could probably debate this issue for quite some time—we do not have the opportunity to do so today—but the debate about cosmetic regulation and making cosmetic procedures safe brings out these questions, which we as a society need to be better at addressing. If we do not address them, these issues about dysmorphia will only get worse, because our young people are faced with an intensity of images that make them want to change their bodies. It is just not good for them.

As there is limited time left, I will bring hon. Members up to date about what has happened since the Keogh review. Sir Bruce Keogh’s report identified several areas for change: the principles that underlined it were those of high-quality care, using safe products, administered by skilled professionals and responsible providers to an informed and empowered public. We still have a long way to go in both empowering the public and ensuring that all such procedures are administered by skilled practitioners. I wholly endorse the demand by my hon. Friend the Member for South Leicestershire that such practitioners should have professional indemnity insurance. It is important that the NHS has the opportunity to recover the costs of repairing procedures carried out by those practitioners, who should bear the risks. As I say, this is not like going to the hairdresser’s for a haircut: there are risks associated with such procedures, and those engaged in them should bear those risks.

Updated guidance for doctors about this area has been issued by both the General Medical Council and the Royal College of Surgeons. We have introduced a voluntary certification scheme for surgeons working in the cosmetic sector, and Health Education England is developing a training and qualification framework for providers of non-surgical interventions. A key outcome of the Keogh review was setting standards that anyone who wishes to perform non-surgical cosmetic procedures should meet. To that end, the Joint Council for Cosmetic Practitioners was established, and in April 2018 it launched a register for both medical and non-clinical cosmetic practitioners. That register will provide a framework for regulation, but we need to do much more to encourage non-clinical cosmetic practitioners to sign up to it.

Alongside the Cosmetic Practice Standards Authority, the JCCP released an updated competency framework last September, and launched its education and training register. To receive accreditation on that register, providers offering education and training in these procedures must meet rigorous standards set by the JCCP. We need to work closely with the JCCP to develop hallmarks that people who wish to undergo these procedures can look for, so that they can be sure that they are obtaining treatment from a regulated practitioner. We have heard references to Save Face, which also holds a register for clinical cosmetic practitioners who provide non-surgical cosmetic treatments. Some 600 practitioners are currently covered by these registers, but I am sure that hon. Members from across the House will appreciate that significantly more than 600 practitioners offer these treatments. There is some way to go in ensuring that all those involved in this industry perform to the standards that we can legitimately expect, and that those who are not doing so exit the industry. However, I am sure that my hon. Friend the Member for South Leicestershire will agree that those registers are major steps forward in enabling consumers to make informed choices about cosmetic procedures.

I am grateful to my hon. Friend’s constituent for coming forward and telling her story, because probably the best way of helping consumers protect themselves is to have a visual illustration of the risks and someone who can demonstrate their experience. I am very grateful to her for her courage in sharing her story. We need to do much more in the area of public education, to ensure that consumers fully appreciate that there are risks involved in injecting substances into one’s face, and to ensure that the person doing so has appropriate qualifications. Botox is obviously a prescription drug, but the person injecting it does not have to be the person who obtained the prescription. That is another thing that we need to address. I can also advise my hon. Friend that we will be making dermal fillers a regulated medical device, which will remove some of the risks associated with them. However, as I have said, there is plenty more to do.

Motion lapsed (Standing Order No. 10(6)).

Sitting suspended.