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Tattoo Artists, Body Piercers and Cosmetic Clinics: Licensing

Volume 741: debated on Tuesday 28 November 2023

Motion made, and Question proposed, That this House do now adjourn.—(Scott Mann.)

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.

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?

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.

I congratulate my hon. Friend the Member for Winchester (Steve Brine) on securing this important debate and reiterate the Government’s commitment to improving patient safety in this area. We recognise that for some time, there have been concerns about the lack of regulation of these procedures, both here and abroad, the dangers they can pose to consumers and the long-term impact when they go wrong. As my hon. Friend pointed out, we have heard many horrific stories, both in this Chamber and in Westminster Hall, about what can go wrong when procedures are done poorly or consumers or patients experience side effects that they were not expecting.

As my hon. Friend pointed out, there are existing regulations for body piercing and tattooing, which I will touch on in a moment. However, we take this area so seriously that the Health and Care Act 2022 gave the Secretary of State powers to introduce a licensing scheme for non-surgical cosmetic procedures in England. The scheme we intend to introduce in England will be more extensive than the Welsh scheme that my hon. Friend mentioned; it will cover more than the four areas outlined in the Welsh Government’s recent piece of work. Obviously, we have just held our consultation, and at the moment we are looking to see whether the scheme will also cover some of the existing powers around tattoos and piercings that are enforced by local councils.

We want the licensing scheme that we intend to introduce to support people in making an informed choice, and to ensure that when they make their choice, they experience safe care for any non-surgical cosmetic procedure. We want the scheme to address three areas, the first of which is to ensure that services are administered by suitably trained and qualified practitioners. That does not necessarily mean regulated healthcare professionals, but it does mean that anyone who undertakes procedures must be trained and qualified to do so. We also want practitioners to hold appropriate indemnity cover, so that they and the patients they are treating are covered should something go wrong, and to be operating from premises that have appropriate standards of hygiene and cleanliness.

As my hon. Friend said, we have been working closely with many professionals from a variety of backgrounds to start the process of introducing the licensing scheme. The cosmetic procedures sector includes a vast and expanding range of treatments and techniques. We want to future-proof regulation so that we cover as many emerging techniques, treatments and procedures as possible—we do not want to be revising regulations on a regular basis—and cover a wide range of practitioners and businesses. We want those businesses to thrive—they contribute to our economy and provide a very popular service—but we need to make sure that they are safe and well regulated, so that those undergoing procedures are safe and can make informed choices about treatments.

In introducing the licensing scheme, we need to make sure that we consider all eventualities. There are a number of factors to consider, from who undertakes the procedures to the types of procedures that are covered and who undertakes inspections once the regulations are introduced. Through our engagement, we have developed proposals on which treatments are to be included, who should be permitted to perform them, and whether age restrictions need to be introduced for certain procedures.

As my hon. Friend said, we rolled out an initial consultation, which closed at the end of last month. We received over 12,000 responses from across England, which is a pretty significant number of responses to a Government consultation; we do not normally get so many. To reassure my hon. Friend, 43% of those responses were from aesthetic practitioners and about 40% were from the various regulated health professionals, so there was an even mix of practitioners and regulated healthcare professionals. We received a fair balance of views, and we are working through the responses at speed. I thank everyone who responded, because the consultation will inform how the regulations are developed.

Over the next 12 months, we will work through the consultation responses and set out exactly which procedures will be covered by the regulations; the education and training standards that will be required of practitioners; the types of premises that will be allowed; the types of licence fees that will be introduced, if any; and who will enforce the regulations to ensure that they are complied with.

That will take time—we estimate that it will take most of next year—but I can assure my hon. Friend that it is crucial. Like him, I thought that we would be able to get this done pretty swiftly, but once we start to unearth which procedures should be covered, who should be doing them and the types of premises they should be operating from, it is a can of worms. It is really important that we take the time to get this right, so that we have a really robust, extensive and safe regulatory licensing scheme in operation across England.

My hon. Friend touched on tattoos and piercings. As he said, those are regulated by measures such as the Local Government (Miscellaneous Provisions) Act 1992 and the Local Government Act 2003, as well as legislation specific to geographical areas of England. The existing legislation gives local authorities the power to register practitioners and their premises, and to take enforcement action if practitioners are not abiding by byelaws. He is right that that varies across England, but the measures local authorities undertake do reduce the risk of transmission of blood-borne viruses such as HIV and hepatitis B and C. The Department has a model byelaw template—if local authorities want to introduce that in their local area, they can contact us for it—to try to get as much consistency as possible.

We are looking at whether tattoos and piercings should also come under the non-surgical cosmetic procedures regulations. We are engaging with those sectors to see whether we should have one wide piece of legislation and regulation, or a dual system, because many tattoos and piercings practitioners feel that that works quite well for them right now. We have not ruled out a change, but it is important to note that, as the legislation stands, there are already regulations for tattoos and piercings, which should be being enforced by local authorities up and down the country.

I want to touch on cosmetic procedures abroad, because that is becoming more of a topical issue. As costs rise and procedures are often cheaper abroad, it is so important that we make sure that people from the UK travelling for non-surgical cosmetic procedures are informed about the risks and do their research before they travel. While excellent healthcare is available internationally, we are aware of tragic cases—even cases in which people have lost their lives—arising from treatments outside the UK. Our team are actively engaging with international partners to consider how best we can support people considering travelling abroad for such treatments. Having a safer, regulated system in England will help inform people that, if they are travelling abroad, the country involved should be operating to the same standard as the licensing scheme we are intending to introduce in England.

I absolutely understand the urgency with which my hon. Friend wants to see the licensing scheme come forward. That is why we introduced the power in the Health and Care Act, but this is a complex area. We need to decide who will undertake these procedures and which procedures will be covered, and to future-proof so that we cover as many as possible. We also need to look at the premises that practitioners are operating from and who the regulator will be. It could be the Care Quality Commission, local government, the Nursing and Midwifery Council or the General Medical Council, which all have a role to play in this. There is a lot to decide before the legislation and regulations come before us.

I can assure my hon. Friend that we will be working to respond to the consultation early in the new year, and we will then set out the framework for the legislation. We will conduct a further consultation on that before finally announcing it, because, as he said, there are concerns across the sector. There will also be an interim period so that, if we introduce mandatory training for practitioners, there is time for those operating in this space to take on qualifications and training, to upgrade their premises or to look at which procedures they undertake. We want to ensure that those who can practise safely have the time to develop their skills and upgrade their premises accordingly. I assure my hon. Friend we will consult again so people will be fully aware of the changes coming through.

I look forward to working with my hon. Friend and his Select Committee to make sure that we have an extensive scheme of regulation across England as quickly as possible, but also that it is robust and meets the needs, most importantly of patients, but of the sector as well.

Question put and agreed to.

House adjourned.