Botulinum Toxin and Cosmetic Fillers (Children) Bill

Second Reading

Moved by

That the Bill be now read a second time.

My Lords, I first congratulate Laura Trott MP on her success in skilfully navigating her Bill through the other place, and in particular on its arrival in this House unamended. I am afraid the beginning of my speech may be a bit of an Oscars speech, because so many people have campaigned on this issue to date. I want to mention Alberto Costa MP, who has campaigned for so many years following the high-profile case of one of his constituents who suffered a terrible injury following a botched lip filler administered by an unregulated and unqualified beautician, and Carolyn Harris MP and Judith Cummins MP, who are co-chairs of the All-Party Group on Beauty, Aesthetics and Wellbeing. I also pay tribute to the fantastic work of Save Face, which is a national register of accredited practitioners who provide non-surgical cosmetic treatments.

I was delighted when Laura Trott approached me to sponsor this Bill in this House and I hope, with the help of noble Lords, to steer it on to the statute book in the remaining weeks of this Session. I am sure we will have a very wide-ranging discussion about children and young people; for good order, I declare my interests as a non-executive member of the boards of Ofsted and DCMS.

The purpose of the Botulinum Toxin and Cosmetic Fillers (Children) Bill—which is very hard to say—is to prohibit specific cosmetic procedures being performed on people under the age of 18 in England, except under the direction of a doctor, thus safeguarding children from the potential health risks of Botox and cosmetic fillers. The Bill has cross-party and government support; we are very grateful for the collaboration from both Opposition Benches and the time that noble Lords have given me. I hope that will help its progress.

I still find it quite shocking that this Bill is needed at all. To be clear, I have no problem whatever with an individual’s right to alter their appearance, should they so wish. However, children are still developing, physically and emotionally, and without this legislation we are leaving them exposed to completely unacceptable risk. Laura Trott commented in the other place:

“The most frequent reaction I have received in response to my Bill is, ‘Surely, that is illegal already.’”—[Official Report, Commons, 16/10/20; col. 652.]

Today we have the chance to ensure we put this right.

In recent years we have seen a growing prevalence and normalisation of non-surgical cosmetic procedures; they are increasingly accessible and affordable on the high street because technologies and products in this field have advanced. Cosmetic fillers and botulinum toxin—which I will refer to as Botox, which is actually a brand name—have been identified as the two procedures most appropriate to be brought under the scope of the Bill, as they are two of the most accessible and invasive procedures available on the high street.

My Lords, I thank the noble Baroness, Lady Wyld, and the original mover of this Bill, Laura Trott, MP for Sevenoaks, for bringing this important issue to our attention. In particular, I thank the noble Baroness for setting out the issues so clearly today. I know that Nadine Dorries, Minister for Mental Health, Suicide Prevention and Patient Safety, has already indicated government support for the Bill, which is welcome. The noble Baroness laid out the main concerns set out in the Bill. I will simply emphasise the importance of this legislation and some of the possibilities and dilemmas involved.

The United Nations Convention on the Rights of the Child, along with other domestic legislation, sets out the need to protect children—under-18s—from all kinds of dangers. But children take risks, and hopefully learn from any mistakes. They must also be empowered by parents, schools and society to resist dangerous actions and say no to pressure—and there is a good deal of pressure on young people in relation to their appearance, particularly girls.

Social media exerts huge influence. As Laura Trott said at Second Reading in another place, girls see the attainment of physical desirability as unachievable without cosmetic surgery. This is increasingly available, no questions asked, through DIY efforts at home, despite Botox being a prescription-only medicine which should be administered by medical professionals who have taken account of the person’s age and believe them to be over 18.

It is clear from the evidence that procedures are inadequately regulated and may result in horrific injuries—physical, mental and emotional. Some 100,000 treatments of under-16s have been recorded, and the actual number is probably higher. Reparation of injury is expensive and difficult.

The Bill is very timely. Legislation is clearly needed, but so is a public health approach that informs and persuades people to change their behaviour. Young people may grow out of dangerous behaviour, but that may be too late and much regretted. Will any public health messages about botulinum toxin be directed at young people and parents? Are schools being warned to look out for symptoms? Is counselling available? How will perpetrators of illegal treatments be dealt with?

My Lords, I thank the noble Baroness, Lady Wyld, for bringing us the Bill, and I support it as far as it goes. However, I would like assurances that, using the powers to make regulations in Clause 5, the Government will ensure that, for the most part, botulinum toxin procedures on under-18s do not take place at all, even by a clinician.

We live in a world where young people, particularly girls, are under great peer pressure about their appearance and their weight. Undertaking a dangerous procedure such as this is not necessarily the answer. If the matter affects the mental health of the young person, it should be treated as a mental health issue, not with Botox.

The charity Changing Faces has provided us with the voices of young girls affected by “visible difference”. One said, “Everywhere I looked, clear-skinned models told me the same thing. I never saw a public figure that looked like me and I felt totally alone. I spent hours researching various scar removal surgeries and extreme treatments and started saving for them.” These young people require support, information, the attention of professionals and the protection of the law.

When the Bill was debated in another place, amendments were tabled to ensure that medical practitioners could provide non-surgical cosmetic procedures to a person under 18 only if it was medically necessary. I agree with this. There may be situations where facial disfigurement from whatever cause is causing physical or mental distress to the patient and for which botulinum toxin is considered by a doctor to be the appropriate treatment, rather than more intrusive cosmetic surgery. In such cases, regulations could be used to lay down those matters which should be considered before a clinical decision is reached.

Laura Trott MP, the sponsor of the Bill, argued that it already had safeguards to ensure that under-18s would receive these procedures only where medically necessary. The Minister, Nadine Dorries, agreed that there would be a review of the regulations to assess any unintended consequences. I would like an assurance that this review will consider regulations to restrict the use of this procedure except in certain clearly defined conditions of medical need.

My Lords, I congratulate my noble friend on bringing this Bill forward and on her excellent presentation, which set out very clearly its purposes and justification. I very much support it.

My noble friend will know, and the House may well recall, that the Bill is in line with one of the recommendations from the Review of the Regulation of Cosmetic Interventions led by Sir Bruce Keogh and published in April 2013. Of course, as Secretary of State, I asked him to lead that review back in January 2012, following the PIP breast implant scandal disclosed the previous month. It is fixed in the memory of Health Ministers across the globe—the problems were disclosed by the French Government the day before Christmas Eve, so we all lost our Christmas in 2011. One of the consequences was that the many issues and problems associated with cosmetic interventions and medical devices were exposed. Indeed, the Keogh review did a great deal to help to bring that forward. I think this Bill will be extremely welcome.

While I have this moment, I would mention the Cosmetic Surgery (Standards) Bill in my name, which is way down in the Lords list of Private Members’ Bills. It is not going to have the benefit of the House’s attention in this parliamentary Session; I hope it may in a future one, perhaps even with the benefit of support from the Government at some point. It also follows up one of Bruce Keogh’s recommendations. It was very good that our honourable friend the Member for Sevenoaks was able skilfully to bring this Bill through. I know how difficult it is in another place to get a Private Member’s Bill through, even if one is fortunate to get a place in the ballot.

I briefly mention two other things. First, Kevan Jones, who also supports my Bill, spoke in the other place about the issues associated with advertising cosmetic interventions, increasingly on social media these days, and he was right to do so. That is an issue raised in the review that needs to be followed up. I also hope that, in line with my Bill, the Government will encourage the General Medical Council, regardless of legislation or otherwise, to use the Royal College of Surgeons interspecialty committee’s work on certification for cosmetic surgery to try to ensure that it is indicated on the medical register, so that people can identify who is properly certified and qualified to provide cosmetic interventions.

My Lords, I too congratulate the noble Baroness, Lady Wyld, on bringing the Bill to the House and on her excellent introduction.

Restricting the use of Botox and cosmetic fillers in young people seems to me such an unarguable proposition that I could resume my seat at this point. However, I would like to take a moment to set this legislation in the wider context of body image and, in particular, the causes and impact of body image negativity in children.

The term “body image” describes our relationship with our body—how we think and feel about it and how much other people’s opinions affect that view. The recent report from the Women and Equalities Committee in the other place reveals that 66% of children feel negative about their body image, with body dissatisfaction identified in children as young as five.

Poor body image matters because of where it leads: low self-esteem, depression, anxiety, body dysmorphic disorder and eating disorders. Poor body image prevents young people from taking exercise, joining clubs, visiting their GP or even speaking up in the classroom. It increases risky behaviours, reduces quality of life and, at the extreme, can lead to self-harm and suicide ideation. It does not go away: poor body image lasts a lifetime. It is not surprising that Professor Chambers of the Nuffield Council on Bioethics describes body image as nothing short of a public health issue.

The factors acting on our sense of our bodies are manifold and unrelenting. From early childhood, we are bombarded with images of unrealistic bodies on screen, in print and online—ideals that young people internalise and then pursue, with social media the perfect platform to idealise and compare. The Commons inquiry highlights the damaging impact of digitally altered or filtered images in advertising across social media, with image editing apps readily available to change our shape or our appearance—apps regularly used by 45% of 11 to 16 year-olds.

My Lords, I speak in full support of this Bill. I congratulate my noble friend Lady Wyld for sponsoring it and thank Laura Trott MP for her work on it in the other place.

The non-surgical cosmetic treatment industry is worth over £2.75 billion and accounts for over 75% of all cosmetic enhancements carried out each year. However, it remains almost entirely unregulated, meaning that legally, cosmetic injections can be administered by pretty much anyone.

A number of reports over the years have highlighted and flagged this problem. The review by Sir Bruce Keogh, commissioned by my noble friend Lord Lansley, found that, among other things, non-surgical cosmetic procedures were almost entirely unregulated. In 2017, a report by the Nuffield Council on Bioethics highlighted several concerns, including “inadequate” controls on the safety of some of the products and the absence of any statutory requirements for practitioners who perform such procedures to have particular qualifications or experience.

I am pleased that the Government have been considering ways that training and qualifications could strengthen sector standards and that they have been exploring the regulation of premises, practitioners, products and consumer safeguards. I welcome moves from practitioners to make these procedures safer, and I commend the work of bodies such as Save Face, an organisation that provides a national register of accredited practitioners.

This Bill is needed, and needed now. We know this is a problem that needs resolving. There are clear complications that can occur through such treatments, which other noble Lords have highlighted. The number of cases of botched jobs has at least doubled in the last year and, given the unregulated nature of the industry, that is probably just the tip of the iceberg.

As the demand for treatment has continued to increase, so have the number of unscrupulous treatment providers. We know that tens of thousands of under-18s undergo cosmetic enhancements every year, with cosmetic fillers being the most common procedure. Children should not be able to access these procedures from unregulated and unqualified providers, let alone with no prior medical or psychological assessment required.

My Lords, I too fully support this Bill and thank my noble friend Lady Wyld for introducing it to this House.

If you need to be 18 to get a tattoo or a sunbed session, it stands to reason that Botox and fillers should also be illegal, to protect children under 18 from themselves and from unscrupulous practitioners. It is normal for teenagers to worry about their appearance. However, as we heard earlier, the pressure put on them by social media has led to the increasing normalisation of cosmetic interventions among the young. Children who are still growing should not be considered candidates for cosmetic treatments, particularly with products such as Botox, which paralyses muscle and is used to lessen the appearance of wrinkles. Of course, there may be instances where the prescription of Botox is medically needed, even for under-18s, as we heard, but Botox is at least classified as a medicine, so it must be prescribed by a medically qualified practitioner. The problem is that it can be injected by somebody with no qualifications at all.

Fillers, on the other hand, are classified as devices as opposed to medicines, which means that they are wholly unregulated. Children can, for instance, walk into a shop and get their lips injected by someone with no qualifications at all. Botox and filler parties are quite common among the young, where they inject each other. As with Botox, complications with fillers are not uncommon. They can include the filler moving away from the treated area into other parts of the face. As we heard, some individuals were left with rotting tissue and lumps on their faces, and required lip amputations.

The medical profession itself has tried for many years to get fillers classified as medicines and not devices and to close loopholes such as online purchase, whereby unscrupulous doctors prescribe a product and have it delivered for a fee to someone with no qualification whatever. The young and vulnerable should be protected from unscrupulous exploitation. In other countries, legislation prohibits cosmetic procedures under a certain age. In Germany, for example, no procedure can be done on someone under 18, whether aesthetic or otherwise, without parental consent. In Spain it is the same, and in France the law is even stricter.

My Lords, this is one of those debates where it is very difficult to find somebody who disagrees with the central thrust of what is proposed. The main thing we can say is, why on earth was this not done earlier? I hope that the noble Baroness, Lady Wyld, will accept my congratulations and pass them on to everybody who worked on this Bill in the other place, and to all those who did the prior spadework. This should have happened already. We are patching up a hole here, not dealing with some new problem. The noble Baroness, Lady Bull, described very well—much better than I could—the pressure of social media.

This is not new. When I first came here all those years ago, we were talking about photoshopping images in magazines. However, it is more intense now. It is also not an exclusively female problem. The body image issue generally affects both sexes, but due to fashion, it affects girls predominantly. Can we please make sure that we keep this under review? The Government should be doing more of this—but they should be doing more of many things. I therefore hope that the House and indeed Parliament as a whole will keep an eye on what is going on here.

I had one or two other points to make but my noble friend Lady Walmsley—I am very glad to be on the same team as her—did an excellent job of saying everything I was going to say, and more succinctly.

I conclude by asking the Minister to make sure when he sums up that we get an idea of the Government’s overview of this subject. Can he confirm that where these procedures are needed for a medical problem, whether physical or psychological, they will still be available? Their unavailability is the only conceivable objection I can see to this measure being adopted.

I hope that we will all give this Bill a great round of applause—a metaphorical one—so that it gets through quickly, because it will make life a little bit safer and better for people. Even if such a botched procedure is only temporary, that still involves more trauma, which will add to any problems that made the person go there in the first place.