Non-surgical Cosmetic Procedures: Regulation

(Limited Text - Ministerial Extracts only)

Tuesday 12th February 2019 Westminster Hall

[The Parliamentary Under-Secretary of State for Health and Social Care (Jackie Doyle-Price)]

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.

[Judith Cummins (Bradford South) (Lab)]

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?

[Jackie Doyle-Price]

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.

[Dr Poulter]

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.

[Jackie Doyle-Price]

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.

[Liz McInnes]

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.

--- Later in debate ---

[Jackie Doyle-Price]

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.

[Melanie Onn]

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?

[Jackie Doyle-Price]

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)).