Cystic Fibrosis Drugs: Orkambi

Alberto Costa Excerpts

Monday 10th June 2019 Westminster Hall

[Paul Scully (Sutton and Cheam) (Con)]

I beg to move,

That this House has considered e-petition 231602 relating to access to Orkambi and other drugs for people with cystic fibrosis.

It is a pleasure to serve under your chairmanship, Mr Bailey. I will read the petition, if I may:

“Children & young adults with CF endure lifelong suffering & early death. They need Orkambi and other precision medicines as they are developed. Sufferers in the EU, US & Australia can access the drugs, but not the UK. Hundreds have died in the 3 years since these drugs were licensed. All MPs who debated the petition in March were passionately in favour of supplying the drugs. Despite an ever-increasing abundance of evidence as to the drugs’ effectiveness, CF sufferers still do not have access. Case studies report miraculous improvements in health. Consultants nationwide have asked the NHS to make the drugs available. Doctors have expressed distress at seeing children die whilst the drug they need is on the shelf. After 3 years, conclude negotiations and fund these drugs.”

I pay tribute to Catherine Meredith, who started the petition, and the 108,144 people who had signed it as of this morning. Many hon. Members present are here because of their constituents and their long-lasting championing of cystic fibrosis treatment and the need to get these drugs to market as soon as possible.

Cystic fibrosis is a severe, devastating and progressive disease. It is a genetic disease, so we know the exact number of people living with it—70,000 around the world. It is considered by many to be a Celtic disease; the UK has 12% of all sufferers, which makes it an important place for research and an important market for pharmaceutical companies, such as Vertex, that have been working on treatment.

[Alberto Costa (South Leicestershire) (Con)]

I congratulate my hon. Friend on securing a clearly important debate. If Orkambi were available on the NHS, my constituent Amelie-Rose Sullivan, who is only two years old, would be able to take that life-saving medicine. Having spoken with her family, I understand that she has needed antibiotics on five occasions, which involves a two-week course each time—a cost to the NHS. Antibiotics might not have been needed if she were taking Orkambi, which underlines the need for Orkambi to be available. Ultimately, it would be better value for the taxpayer and our constituents.

[Paul Scully]

My hon. Friend is absolutely right. Before I led a similar debate for the Petitions Committee roughly this time last year, I went to the Cystic Fibrosis Trust, as I did this morning, where I met and spoke to a lot of parents whose children are suffering, as he has mentioned. This morning, I met a number of adult sufferers, who I will speak further about in a minute. One of them, who is 43, described the disease—this is harsh, especially for any sufferers watching—as his lungs filling up and effectively drowning. That is pertinent to me, because my father died of mesothelioma 30 years ago, after a year of suffering. This man is 43; I cannot imagine that suffering. Early treatment for children, however, stops that build-up in the first place and allows them to keep their lung capacity higher for longer, so they can have a proper standard of living.

Medical Cannabis under Prescription

Alberto Costa Excerpts

Monday 20th May 2019 Commons Chamber

[James Cartlidge (South Suffolk) (Con)]

It is a pleasure to follow the hon. Member for Glasgow North (Patrick Grady), who made a very good speech. It is always a pleasure to see someone fighting hard for their constituents, as we all are. He is right that all Members are mentioning similar cases, and I will also be doing so, but I first want to pay tribute to my right hon. Friend the Member for Hemel Hempstead (Sir Mike Penning) and the hon. Member for Gower (Tonia Antoniazzi) for the great passion and tenacity with which they have campaigned on the behalf of those who are suffering such pain. Sufferers are looking for a way to reduce their pain, and they believe that they have found one. That is the key challenge for us.

My case concerns a four-year-old girl called Indie-Rose. Her parents Anthony Clarry and Tannine Montgomery live in Clare in my constituency. Indie-Rose has Dravet syndrome and, as we have heard in other cases, suffers from frequent terrible seizures as a result of her epilepsy. Her parents have found that cannabis-based medicine reduces those seizures dramatically—they estimate by around 75%—but it comes at a huge cost, because my constituents have had to crowdsource thousands of pounds to go over to Holland, pay for the medicine and bring it back. I strongly feel that we must examine this issue because, as others have said, that situation cannot be sustainable, especially in a country that has a free healthcare system that is designed to help not just those in need but the most vulnerable in particular.

The compound that Indie-Rose’s parents have been purchasing is artisanal and unlicensed. It is a mixture of Bedrolite and Bedica, which of course contain THC, and the single greatest issue for me is that while there is evidence about the impact of CBD, there is little evidence about THC. When I first became involved in the case, I felt that I had a duty to understand it more and to appreciate why there was resistance in what we might loosely call the medical establishment to prescribing a THC-based solution, such as that which was already being given to Indie-Rose and which was successfully, in her parents’ opinion, reducing her pain and suffering. I organised a meeting to discuss the situation in April at Addenbrooke’s hospital with some of the most senior clinicians that one could hope to have in a room, all of whom were familiar with Indie-Rose’s case. We are lucky to have hon. Members in this House with serious medical experience, but most of us are not clinicians, and none of us is the clinician in the cases that we are talking about. We are politicians, so I wanted to understand better the barriers to the NHS prescription that my constituents were seeking.

At times in this debate, the situation has been spoken of as if the argument is about whether cannabis-based medicine should be prescribed at all, but it is clearly about the type of medicines that should be prescribed. There is clearly nervousness in the medical establishment about THC. We should not hide from that point, and there is perhaps a very good reason for that point of view.

[Alberto Costa (South Leicestershire) (Con)]

Does my hon. Friend agree that the points he is making are further evidence for why the conclusions of the interim report of the NHS’s review of the situation, as requested by the Secretary of State, should be published as soon as possible? The report will help us to identify answers to my hon. Friend’s points, and it may help my constituents Evelina Lukoševičius, who is two years old, and Maya Fairlie, who is seven years old, to access this life-saving medicine—if, indeed, that is what the review concludes.

[James Cartlidge]

My hon. Friend makes a good point. I would just be cautious about using the term “life-saving”, because this is about easing pain. These medicines are not cures; they relieve the pain of seizures. However, I understand my hon. Friend’s point, as we all did.

The meeting that I organised was instructive for me in many ways. Since then, I have obviously continued to correspond with my constituents to try to explain to them the powers that I have in this case and the next steps that they need to take. When this debate came up, they emailed to ask me to put one question to the Minister. Remember, they are not being prescribed THC-based compounds; they have been offered Epidiolex, which is a CBD-based medicine. They want me to ask whether any other children with epilepsy, or any other condition—of course, it is primarily complex epilepsy—have been prescribed THC-based medicines.

That information is in the public domain in the form of a written answer. As I understand it, 110 items—items, not people—of CBD-based medicine have been prescribed, along with 16 items of THC-based compounds, six of them on the NHS. That is an important point, as my constituents want to know whether others have been granted such medicines, and clearly they have. Where is the consistency? That is the confusion. Of course we cannot know the unique personal medical facts of each case, which must always be down to the clinicians, but we now know that THC-based solutions have been prescribed.

Medical Aesthetics Industry: Regulation

Alberto Costa Excerpts

Tuesday 14th May 2019 Westminster Hall

[Alberto Costa (South Leicestershire) (Con)]

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.

[Jim Shannon (Strangford) (DUP)]

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?

[Alberto Costa]

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.

[Judith Cummins (Bradford South) (Lab)]

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.

[Alberto Costa]

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.

[John Mc Nally (Falkirk) (SNP)]

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?

[Alberto Costa]

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.

[Mr Nigel Evans (Ribble Valley) (Con)]

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.

[Alberto Costa]

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?

[Dr Dan Poulter (Central Suffolk and North Ipswich) (Con)]

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?

[Alberto Costa]

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.

[Ian C. Lucas (Wrexham) (Lab)]

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.

[Alberto Costa]

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.

[John Mc Nally]

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.

[Alberto Costa]

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.

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

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.

[Alberto Costa]

South Leicestershire.

[Jackie Doyle-Price]

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—

Non-surgical Cosmetic Procedures: Regulation

Alberto Costa Excerpts

Tuesday 12th February 2019 Westminster Hall

[Alberto Costa (South Leicestershire) (Con)]

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.

[John Howell (Henley) (Con)]

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?

[Alberto Costa]

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.

[Jim Shannon (Strangford) (DUP)]

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.

[Alberto Costa]

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.

[Dr Dan Poulter (Central Suffolk and North Ipswich) (Con)]

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.

[Alberto Costa]

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.

[Several hon. Members rose—]

[Alberto Costa]

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.

[Melanie Onn (Great Grimsby) (Lab)]

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?

[Alberto Costa]

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.

[Liz McInnes (Heywood and Middleton) (Lab)]

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.

[Alberto Costa]

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—

[Jim Shannon]

That makes two of us.

[Alberto Costa]

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.

Healthcare (International Arrangements) Bill (First sitting)

Alberto Costa Excerpts

Committee Debate: 1st sitting: House of Commons
Tuesday 27th November 2018 Public Bill Committees

[Justin Madders]

Q Okay. I think my constituent’s situation was an emergency and I do not think that any consideration was given to the type of hospital. I think that what you are saying is that reciprocal arrangements do not necessarily give you the same or equivalent coverage in other countries, because it depends on the system that operates there.

Alisa Dolgova: Yes. It will give you more coverage across all countries, but what that coverage is depends on what the situation is in that country.

[Alberto Costa (South Leicestershire) (Con)]

Q You said that private insurance policies cover the areas above the benefits of the EHIC. But is it not the case that those of us who take out private travel insurance policies precisely for the healthcare benefits may not make use of EHIC? And is it the case that, because of that, the premium costs for private travel insurance are less, given that those of us who take out private insurance might not use EHIC and might rely on the private healthcare side instead?

Alisa Dolgova: It depends on the specific terms of the travel insurance policy that you have. For example, some policies have a specific provision that you need to use EHIC first and then have resort to your insurance policy, and insurers may also provide incentives to use EHIC as well. For example, they might provide a waiver for access costs of EHIC; that has been used.

[Alberto Costa]

Q What I am trying to ask is whether it might be the case that, without this Bill and without reciprocal arrangements, the cost of travel health insurance is likely to go up? Those of us who take out these policies are not necessarily reliant on EHIC, because we would refer to the private claim, whereas others who perhaps do not have healthcare benefits under a travel insurance policy would be entirely reliant on EHIC. What I am trying to tease out is whether, without this Bill, the healthcare side of travel insurance—the premiums—would potentially go up?

Alisa Dolgova: The claims cost will definitely increase, which may lead to an increase in travel insurance costs as well.

[Matt Western]

Q Out of interest, can I ask you a really simple question? What happens currently, but also perhaps in future, when someone is abroad and has an injury, an accident or whatever for which some form of implant is required, and that implant subsequently fails when the person returns to the UK and it is not supported by the NHS? Where does the cost burden fall and how does that impact on insurance, and how may that work in future if we do not have regulatory alignment?

Alisa Dolgova: Sorry, your question is who would pick up the cost if treatment were provided overseas, but it fails?

NHS Long-Term Plan

Alberto Costa Excerpts

Monday 18th June 2018 Commons Chamber

[Mr Hunt]

The hon. Gentleman is right to raise that issue, which is of great concern to us, as I know it is to him. The Minister of State responsible for hospitals, my hon. Friend the Member for North East Cambridgeshire (Stephen Barclay), visited the trust last Thursday and I know is working incredibly hard to try to resolve that situation as soon as possible.

[Alberto Costa (South Leicestershire) (Con)]

I congratulate the Secretary of State on his very welcome intervention in ensuring the longevity of our NHS with these wonderful proposals. Will he give some consideration to the way in which doctors are trained? At present, it is a costly and time-consuming affair. Only around 10 UK medical schools have a graduate entry system. In his long-term plan, looking at recruitment, will he consider how the skillset that we see among our population—for example, medical scientists and other related professionals—can best be harvested in training future medics?

[Mr Hunt]

My hon. Friend asks a profoundly important question. The medical school students who are going to medical school this year will become consultants in 2031 at the earliest, so we have to make sure that we update the way people are trained for the totally different world that they will be facing in terms of technology, medical innovation and the demarcations and roles inside hospitals and community care. This is very much part of the long-term workforce plan that will be announced alongside the NHS long-term plan later this year—it is what that will be about.

Breast Cancer Screening

Alberto Costa Excerpts

Wednesday 2nd May 2018 Commons Chamber

[Mr Hunt]

I thank the hon. Lady for making that fair and important point. I will make a special effort in the case of Northern Ireland to understand what the situation is and to ensure that it is publicised to the people of Northern Ireland. Absent politicians are able to do that.

[Alberto Costa (South Leicestershire) (Con)]

I also thank the Secretary of State for his measured and sensitive tone in delivering this afternoon’s statement. He mentioned that the figures of 450,000 and 309,000 were estimates. What is not an estimate, however, is that 65,000 letters will be going out at the end of this month. Will he assure us that his team in the Department will write to Members of Parliament to indicate the number of women affected in each constituency, so that we can prepare for the inevitable contacts that constituents will make with us?

[Mr Hunt]

I am very happy to make that commitment.