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Medical Aesthetics Industry: Regulation

Volume 660: debated on Tuesday 14 May 2019

[Albert Owen in the Chair]

I beg to move,

That this House has considered regulation of the aesthetics industry.

It is a pleasure to serve under your chairmanship, Mr Owen. I am again grateful to lead a debate on this issue, which is becoming more pressing and may affect many of our constituents. The previous debate on this topic was successful, and I thank those who took part and contributed. I also mention my constituent, Rachael Knappier, who has been brave enough to tell her story and who initially brought this issue to my attention.

As some Members will remember, Rachael received a lip filler from an unregulated beautician, who accidently injected it into her artery, causing a trauma to her lip. In January, I raised this with the Prime Minister at Prime Minister’s questions. Since then, some progress has been made by the Government and I welcome the announcement made today, but more progress is required. Following my championing of the issue, I am glad that the Government have begun to act. The Department of Health and Social Care is today launching a campaign to encourage consumers to seek professional advice when considering having procedures such as Botox, dermal fillers and cosmetic surgery.

I congratulate the hon. Gentleman on securing the debate. As he rightly says, there is need for a tightening of the regulations. In the media, there are children as young as 15 with botched lip fillers and injections; we need to do more to protect those children.

Does the hon. Gentleman agree that we must ensure that only medically-trained professionals, with a duty of care provided by their professional boards, carry out these procedures, under very strict regulations?

The hon. Gentleman is correct. We need to ensure that we have appropriate regulation with these procedures, or similar types of procedure. He is right to raise this issue on behalf of his constituents.

I thank the hon. Gentleman for securing this important debate. He will be aware of its importance as he is a vice-chair—along with my hon. Friend the Member for Swansea East (Carolyn Harris) and me—of the all-party parliamentary group on beauty, wellbeing and aesthetics. Does he agree that any new regulations that come forward need to consider non-medical regulation? We need to ensure we have properly qualified beauticians, with recognised qualifications, to carry out these procedures.

The hon. Lady is correct. I pay tribute to her and to the hon. Member for Swansea East (Carolyn Harris) for setting up the new all-party parliamentary group on beauty, wellbeing and aesthetics, along with me. I look forward to her interventions at meetings of that all-party group; I know she has a great deal of knowledge of this area. I agree that we do not want to stifle the beauty industry—we want it to grow and be successful—but we all want to protect our constituents.

I congratulate the hon. Gentleman on setting up the APPG. I am the chair of the APPG on the hair industry and I am keenly interested in this development. A possible solution to the problem has been put forward by the British Association of Beauty Therapy and Cosmetology. It appreciates the concerns about mandatory registration, but thinks that a regulatory framework, led by the Government, would be difficult to implement and that the voluntary self-regulatory framework is not working either. BABTAC believes that the time has come for the Government to institute a mandatory regulatory framework that would be self-governing and would include BABTAC and the Royal College of Surgeons. Does the hon. Gentleman agree with that?

I agree. The hon. Gentleman has been doing sterling work on behalf of his constituents in related matters with his sister-APPG, and we wish him every success with that. He is right that we have to look at the issue in the round and include professionals who are experts in the field, who contribute to our economy and who themselves want a properly regulated beauty industry.

I am grateful to my hon. Friend for giving way; he is on a bit of roll with interventions.

I pay tribute to my hon. Friend for the work he has done. A professional from a skin clinic in Ribble Valley came to see me at my surgery on Saturday. He told me that somebody could administer Botox—actually inject something into someone’s face—without proper certificates and perhaps even without proper training. He showed me photographs of instances where, sadly, the treatment had gone badly wrong. It is the NHS that has to pick up the misery, and in some cases it is far too late. I congratulate him on what he is doing, but we must get change in the system before more tragedy and misery occur.

My hon. Friend is correct. I am sorry to learn of the incidents he heard about from his constituent at his surgery. I had a similar matter. Indeed, that is what prompted me to champion this issue, along with other hon. Members.

I pay tribute to the Minister at this early stage of the debate. The welcome moves that she has introduced today, by coincidence, are exactly the sort of moves we want; they are on the right path. Today, we are arguing for more, and I am confident she is in listening mode.

Save Face, a Government-approved register for accredited practitioners, highlighted in its audit report last year that it had received just under 1,000 complaints about unregistered practitioners. This register is not compulsory and there are thousands of practitioners who have chosen not to sign up. The mark of a professional is someone who is regulated, qualified and licensed. They do not need to be a medic or a nurse to be able to be regulated, qualified or licensed to practise in this field. In the private sector, professionals such as solicitors—I declare an interest, as I am a solicitor—are regulated, have to be qualified and have to have an annual licence. Most importantly, they are obligated to carry professional indemnity insurance. That marks out those who are professionals and those who are not. That is why we urgently need a professional regulatory body for this industry.

Let me give a simple example. As a nation of animal lovers, we would not consider taking a cat, a dog or even a hamster to an unregulated vet to have an injection. Therefore, why are we allowing our constituents to have the option of going to someone who is unregulated to have potential poison injected into them, as my hon. Friend the Member for Ribble Valley (Mr Evans) mentioned?

My hon. Friend makes some good points about the need for better regulation. The challenge is about who we would be regulating, how we would set up a new body and how indemnity insurance would work for people working in the cosmetics industry. We know that healthcare professionals who do cosmetics have indemnity insurance; they have a regulated body they can be held accountable to. Would it not be better, as the Keogh review looked at, to have other practitioners responsible to healthcare professionals, so they had the oversight of healthcare professionals, who would make sure they were engaging in their practices correctly? Is that not an easier way to put into place quickly and effectively something that could actually deal with the issue of regulation?

My hon. Friend, in his time as the relevant Minister in this area, contributed enormously to this field, and I pay tribute to the work he has done in pushing for regulation of the industry.

I am not sure how to answer my hon. Friend’s point, because regulation takes many different forms. I think we would all argue that we want a healthy, thriving, competitive beauty industry. We do not want to strangle it or place an unnecessary obstacle before the business. We seek to achieve a safe beauty industry, where our constituents can approach any beautician of their choice, safe in the knowledge that these individuals have been properly trained and are qualified and regulated. I am certainly up for having the debate on whether they should be regulated by the General Medical Council, the overarching regulator of healthcare professionals or some other regulatory body, but regulation is the key.

I would also like to highlight the distinct difference between Botox and dermal fillers. Botox is a prescription-only medicine that can be prescribed only by a regulated healthcare professional, such as somebody regulated by the GMC. However, there is a loophole. At present, the prescriber is able to delegate the administration of the injections to another person, which unfortunately creates a way for people who are perhaps not regulated at all to administer the product. On the point my hon. Friend made a moment ago, if we were to have a regulatory body that somehow was able to delegate to others, we would have to ensure that those to whom the administration of the procedure was delegated were suitably trained to administer the procedures.

It is evident that these procedures are becoming more popular, and social media has an influence: so many young people are having procedures such as dermal fillers and Botox that that is almost normalising them. Given that the procedures are so widely seen on social media, they are being viewed by young people as equivalent to, for example, having one’s hair cut, as they are just as accessible. I have heard that people will say, “I’m just going out to have my lips done,” just as we might say, “I’m just popping out to have my hair done.” The normalisation of a procedure that can result in trauma should be looked at carefully.

Freyja Medical, in my constituency, provides an excellent service, but it also pointed out to me the important role that it sees Parliament performing in highlighting the impact and consequences of some of the very poor work that is carried out on individuals. I would certainly like to join the all-party parliamentary group, and I think one of the most important things we must do is get the message out to people on how dangerous the administration of these products can be.

I agree entirely, and I encourage the hon. Gentleman to join both the excellent APPG of the hon. Member for Falkirk (John Mc Nally), and that set up by the hon. Members for Swansea East and for Bradford South (Judith Cummins) and me. They are complementary APPGs and we would welcome the hon. Gentleman’s interest and expertise.

I mentioned a moment ago that this debate should not centre on the conversation about medics or non-medics carrying out these procedures; I believe it is fine for properly qualified and regulated beauticians to be able to offer them. I also highlight the fact that people who receive botched fillers often end up having to go to our national health service to pick up the pieces, as my hon. Friend the Member for Ribble Valley mentioned a moment ago, so that ultimately the taxpayer has to foot the bill.

As the Keogh review concluded:

“Dermal fillers are a particular cause for concern as anyone can set themselves up as a practitioner, with no requirement for knowledge, training or previous experience.”

In February 2014, it was made illegal to offer dermal fillers without training, but the training has not been clearly defined, and some of those who may be qualified to give lip fillers may not have the necessary training to be able to dissolve them or identify when something has gone wrong. We have met or heard from beauticians who would argue that they are properly trained or qualified, but in some instances they can be trained or qualified only for one part of the procedure, and not necessarily for when things go wrong. Surely, anyone carrying out these procedures should be able to identify when things have gone wrong and remedy them immediately.

The British Association of Aesthetic Plastic Surgeons would like to see the development of clinical guidelines on the use of dermal fillers. The Royal College of Surgeons has also expressed that it would like to see dermal fillers classified as a prescription-only medicine. Serious complications of cosmetic procedures can include infection, nerve damage, blindness, blood clots and scarring. That links to what the Government have helpfully announced today, as the campaign will help to inform consumers of those risks. They are also recommending that consumers go to a regulated healthcare professional.

The medical director at NHS England, Professor Stephen Powis, has said that professionals who provide procedures such as fillers should be encouraged to join the new Joint Council for Cosmetic Practitioners. That is very sensible, as it has been set up to assist members of the public, although it is not obligatory. We also face the surrounding issue of body dysmorphia and mental health. Professor Powis has also argued that practitioners should be officially registered and trained to identify people who may be suffering from a body image or other mental health-related issue.

Social media is a powerful tool for young people to look at and to share their experiences. Platforms such as Instagram and Facebook are often used as a principal source of information when people are researching fillers and Botox. I argue that that should not be the case: education on those matters should ideally be face to face when someone is having the procedures, with a trained and regulated practitioner.

Rather surprisingly, there is no age restriction on cosmetic procedures, and I argue that we should have one. The Nuffield Council on Bioethics recommended that children under 18 should not be able to have these procedures unless there was an overriding medical reason for them to do so. As a comparison, the law as it stands in England is that if someone wants to use a sunbed, they must be over 18. I mentioned unregulated vets earlier; we would not consider taking a valued pet to an unregulated vet to have an injection, so why would anyone let, for example, their 16-year-old daughter have someone unregulated inject something potentially poisonous into her face? I invite the Government to consider age restrictions.

The other point I will make is about the content of many dermal fillers. There is a total lack of regulation on the content—that is, the chemical ingredients. According to the British College of Aesthetic Medicine, there are more than 60 dermal fillers available in the UK market alone. It should shock us that we often do not know the content of those fillers and what poisons they may well contain that might have a negative impact on someone’s body.

I believe that urgent regulation is required to protect consumers—our constituents. The steps that the Minister and her Department have taken today are very welcome indeed, but we must do more. I look forward to the Minister’s comments, because I am confident that she is looking into this.

People who put their life savings into investing in their businesses need reassurance that their investment is protected and not undermined by poorly-trained practitioners, because we all make assumptions—seemingly unfounded ones—that those businesses all operate legally and above board. I must bring to the attention of hon. Members the fact that I have met with the insurance companies, which are deeply concerned about the lack of regulation in this particular business. I wonder whether the Minister will comment on how businesses could be better insured and how we could make this a viable business that would not be undermined by other people.

The hon. Gentleman makes an important point, because this goes to the heart of what professional indemnity insurance is. One of the principal points of regulation is that a consumer knows that, if the professional is negligent, as people often are—people make mistakes—they will not be suing a man or woman of straw; that professional will have professional indemnity insurance behind them. That is the right form of protection in our society, in addition to qualifications and training.

I am pleased to champion this issue, along with the hon. Members present. I once again encourage the Government to continue doing the right thing, and to lead us to a situation in which we have a properly functioning and regulated beauty industry.

It is a pleasure to be here this afternoon during Mental Health Awareness Week, for which the theme is body image, so it is particularly appropriate that we are discussing this issue again, thanks to my hon. Friend the Member for—I can never remember.

Thanks very much—my hon. Friend the Member for South Leicestershire (Alberto Costa). I am pleased that the all-party parliamentary group has been established since we last debated the issue in this place, and I thank the hon. Member for Swansea West—

I thank the hon. Members for Swansea East (Carolyn Harris)—I never know my east from my west—and for Bradford South (Judith Cummins) for joining that group. It is great to have the hon. Member for Falkirk (John Mc Nally) here, who obviously takes a keen interest in these matters.

I apologise, Mr Owen; I tried to get here earlier. May I first congratulate the Department on today’s announcement? Our all-party parliamentary group’s inquiry is the first to assess the current regulation of non-surgical cosmetic procedures and its adequacy in ensuring customer safety. I offer the Minister the opportunity to come and to talk to us and hear the inquiry’s findings.

I accept that invitation most gratefully, and I look forward to hearing the conclusions. The time is right for us to take action on this, and I am grateful for the support of Members from across the House in wanting to do that and to do the right thing, with the intention of protecting consumers, which is obviously central to us, but also ensuring a system of regulation that is proportionate for the industry. We need to make sure that we balance both of those.

We have not really given the industry enough attention, given the speed with which it has grown. We increasingly see examples of consumers receiving poor treatment; my hon. Friend the Member for South Leicestershire referred to his constituent, to whom I am grateful for sharing her story. We need to make everyone much more aware of the risk because, as he says, people think it is just like having a haircut; it is becoming extremely normal to have what are poisons injected into the face. We need to make sure that everyone is aware of the risk before they undertake such a procedure, so that they can make an informed judgment.

I am not taking exception to the idea of it being just like having a haircut, but I have been involved in the business of hair salons for more than 50 years and have run salons, and it is not just like having a haircut. There is a similarity in terms of the investment put into any business, which is long term in some cases. When somebody comes along who has not properly trained and has little knowledge, there will be consequences of what they practise. In my all-party parliamentary group’s inquiries, we have come across modern-day slavery, trafficking, money laundering and all sorts of things, which just builds the case for a mandatory regulatory framework.

The hon. Gentleman makes a good point, because when we talk about these examples, there is a danger that people can apply that prejudice to the entire industry. It is in the interests of everyone involved in this industry to welcome regulation, not least to celebrate the professionalism of what they do. There are some very reputable practitioners out there who are not actually in the medical industry. For example, semi-permanent make-up—a surgical procedure that does not involve any invasion—clearly does not require as strident regulation as what we are talking about with injectables, but it is the same industry, and we need to ensure an adequate registration system.

I very much welcome the Minister’s announcement today. On training and regulation for beauticians—non-medical people who constitute around 50,000 jobs in the UK economy—there is huge appetite and support within the industry for proper and appropriate regulation, and there is recognition of the urgent need for that. However, there are no regulated qualifications available for non-medical practitioners for injectables at the moment. Going forward, does the Minister think there will be some kind of progression route for beauticians to go into this kind of industry, so that we can guarantee proper standards for the consumer?

The hon. Lady is right, and I am grateful for the spirit in which she makes her comments. Anyone who establishes themselves in business as a beautician wants to deliver a good service, has pride in what they do and would not want to be accused of doing anything unsafe.

My first focus of activity is those organisations that train people in these procedures, because I can see a situation in which a beautician will have paid thousands of pounds to go on a course and will then think that they are qualified, but they might not be. That is where we need to bring the focus of regulation in the first instance, so that when somebody proudly displays their certificates, consumers can have some guarantee that they are legitimate. I welcome the opportunity to air these issues with the all-party parliamentary group as we move this system of regulation forward.

Sadly, we only have 30 minutes for this debate, so I doubt whether I will be able to get through as much as I would wish, but I will do my best. I am grateful for the interest of all Members here. We will continue this discussion. It is worth saying that Botox treatments and dermal fillers are increasing and, along with laser hair removal, now represent nine out of 10 non-surgical treatments performed in the UK. This is a major area of risk.

Hon. Members have referenced the campaign that we launched today. Clearly, consumers will be the best defenders of their own interest, but we must make sure that they have access to appropriate information with which to do so; we need to do much more to inform people about the risk. Just as in my hon. Friend the Member for South Leicestershire’s example of his constituent, I am quite sure that many people who have had fillers—who have gone to have their lips done, like they do—would have no idea that there is a risk of their artery being injected with poison. We need to make sure that consumers are much more aware of that, which is why we are doing so much more in the next six weeks to try to raise public awareness.

We will focus on targeting our messages to women aged 18 to 34, on whom the majority of the treatments are undertaken. I am pleased that we are working with Bauer Media, which publishes Grazia, Closer and Heat, which I hope will be appropriate vehicles to reach that audience. We will make sure that the NHS information is kept up to date and remains a meaningful resource for consumers.

Yes, absolutely. I am committed to bringing forward legislation to do that at the earliest possible opportunity. I would really like to engage with the all-party parliamentary group to see what other conclusions they can bring forward quickly, so that we can make use of that legislation, to strengthen the opportunities to have a meaningful register, and indeed to look at the whole issue of insurance and what we should expect everyone involved in this to do.

I am open to debate, and I am absolutely committed to bringing the age restriction in line with things like tattoos and sunbeds. Frankly, it is ridiculous that there is an age limit for getting on a sunbed but anybody can have poison injected into their face. That is clearly ridiculous, and we need to tackle it.

We will encourage consumers to look at choosing a reputable practitioner and to properly interrogate the person doing the procedure, asking them about the risks. I am pleased that Superdrug, which has moved into this field, is having pre-screening conversations with clients and giving them cooling-off time before embarking on the treatment. I think that is really good practice and is something we could encourage throughout the industry, not least because it encourages practitioners to think about how they engage with their consumers and to properly understand the risks themselves.

We are moving into a new period of regulation of dermal fillers. My hon. Friend the Member for South Leicestershire is quite right that they are completely unregulated at present, but they will become regulated by the Medicines and Healthcare Products Regulatory Agency,[Official Report, 12 June 2019, Vol. 661, c. 5MC.] which will put them on a similar footing to Botox and will mean that they need to be given by the prescriber. He is right to highlight the risk of people being able to delegate that responsibility for prescribing, and again we should look at legislating on that. Clearly we could also ask the regulators of medics to look at that, because, frankly, delegating the responsibility for prescribing does not really seem consistent with patient safety. We need to look at that.

I am fast running out of seconds, so I will conclude by thanking my hon. Friend and all hon. Members for their interest in this subject. I hope that we all continue talking about this, so that we can take action quickly. This is massive area of risk for consumers and we need to take action to fix it.

I am grateful to both the hon. Member for South Leicestershire (Alberto Costa) and the Minister for taking so many interventions.

Question put and agreed to.