§ Dr. David Clark (South Shields)
I am pleased to have the opportunity to raise in the House the subject of body piercing. Many of us recognise that body piercing is a fashion and perhaps makes a generational point. There may be those who consider it a trivial matter, but I hope to make it clear that the repercussions of body piercing can be serious.
My attention was first drawn to the matter by my local newspaper, the South Shields Gazette, which is proud to be the oldest provincial daily newspaper in the country. It celebrates its 150th year of publication this year. It is a campaigning newspaper, and body piercing has been the subject of one of its campaigns.
My original concern related to the body piercing of minors. I was aware that under the Tattooing of Minors Act 1969 it was illegal to tattoo young people, but that apparently does not apply to body piercing. The matter was drawn to my attention by the case of a constituent whose daughter, aged 13, had returned home with her nipples pierced. To put it mildly, my constituent was not pleased when he found out.
I started to pursue the matter and found that apart, perhaps, from recourse to the common law and to assault, there was probably little that could be done in that case. I originally thought that the problem of body piercing could be overcome by extending the provisions of the Tattooing of Minors Act 1969, but that would not solve the problem. The matter is not so simple. One immediately thinks of the practice of ear piercing, which has gone on for centuries in this country. It would be draconian for legislation to ban ear piercing for people under 18.
I generally take the view that the fewer restrictions and regulations we impose, the better, so I am not keen to overregulate society. However, there is a case for us to examine the need for the regulation of body piercing. The more I have investigated the problem, the clearer it has become that it does not affect only young people.
What people decide to do with their body is entirely a matter for them, but the House has a responsibility to protect minors. We also have some responsibility to guarantee to our citizens that if they decide to have their bodies pierced, they can do so in safe and hygienic conditions. That is certainly not the case at present.
The Sunday People picked up on a series of parliamentary questions that I tabled on 20 April. It held random tests in various parts of the country, sending young people to body piercing establishments to see whether the practitioners would carry through a body piercing. I am sad to report that body piercing is widely available in Bristol, the west midlands and Merseyside—and on Tyneside as well—to young people aged 13 or 14.
§ Dr. Clark
Or younger, as the hon. Gentleman says, but in this case the young people were 13 or 14-year-olds.
The general problem is not as acute in London because, under the London Local Authorities Act 1991, the local authorities in London can act in a more stringent manner than local authorities outwith the capital. The Sunday 285 People discovered that none of the young people it sent out in London—minors who were under 16—were able to have their bodies pierced. Perhaps there is a lesson in that.
Outside London there is a major problem, as certain environmental health officers, medical practitioners and health authorities have recognised. Foremost among those, I must pay tribute to the Bury and Rochdale environmental health departments, which got together and wondered what they could do to address this problem. They also had meetings with the respective health authorities. At the end of last year, they decided to survey the general practitioners in their areas to discover the extent of the problem, and the results are revealing.
Over three weeks, the departments surveyed 209 GPs in the Bury and Rochdale areas and 113 replied, saying that they had had to treat patients as a result of inadequate and unsuccessful body piercing. Treatment varied according to the type of piercing and cases involving the navel were the most difficult to treat. The GPs reported 191 cases involving infection of the navel and, although I suspect that there will have been many more, 167 cases involving ear piercing. There were 57 cases involving nose piercing, 23 involving nipple piercing and 17 involving tongue piercing.
Although I emphasise and admit that only one survey has been carried out, I have no reason to think that the situation in other parts of the country would be substantially different from that pertaining in Rochdale and in Bury. The figures for the two authorities were almost identical; there was some variation, but not much.
We have evidence that a problem exists—not only a problem with minors, but a problem with the way in which body piercing is undertaken. There is a lack of action, and local authorities lack the powers to try to ensure that they can provide some protection to their citizens who decide, quite legitimately and quite understandably, to have their bodies pierced.
To support the need for action, I cite the excellent work of Professor Norman Noah, one of the foremost experts in the world on the issues affecting body piercing. He works in the communicable disease surveillance centre of the Public Health Laboratory Service, which is based at Colindale avenue in London. Over the years, he has done a great deal of work on tattooing and on body piercing. He has drawn up the guidelines for a number of professional tattooing and body piercing organisations and believes that, if those guidelines could be extended and were adhered to, we could probably overcome some of the more routine problems.
I have mentioned the effect of piercing on parts of people's bodies, but it has been put to me that we cannot ignore viral infections such as AIDS—acquired immune deficiency syndrome—which could be spread by body piercing. It does not take a great deal of imagination to realise that a needle could be used, perhaps innocently, on someone who is HIV positive and then on someone else, transmitting the disease.
There are major problems and Professor Noah identifies five. The first is body piercing of minors. Although I am open to listening to other opinions, I take the view that body piercing other than ear piercing—although it should perhaps not be illegal for under-16s—should not be undertaken without parental consent. Other Members of the House may want to pursue that debate at some other 286 time. It would be tidiest if we transferred the regulations on tattooing across to body piercing, but my instinct is that that would probably be too draconian.
Secondly, Professor Noah raises the valid issue of the use of local anaesthetic by non-medical personnel. Clearly one can imagine that that could cause all sorts of difficulties. The third problem, which was highlighted by the survey in Rochdale and in Bury, is the incidence and the effect of local infections and other complications arising from body piercing.
The fourth problem, which is a more complicated socio-medical issue, is the incidence of side effects of body piercing, such as scar tissue resulting from nipple piercing and the effect that that could have subsequently on breast feeding. Body piercers have said that such piercing has no effect whatever, but I suspect that we do not know sufficient to be so categoric about that.
The final issue is the training of body piercers themselves. There are professional associations—professional may not be the right term, but I concede that point—connected with body piercing. They have all told me that they would welcome guidance and some regulation. They are concerned that there are cowboys out there who are quite prepared to charge £20, £30 or £40 to pierce the body of any person without any regard for the outcome. The training and the qualifications of body piercers must be examined to find a way forward.
I concede that we are perhaps at an early stage of the debate. I tabled a number of parliamentary questions to the Home Office Minister responsible for overall regulation on 20 April and he conceded that the previous Government had been concerned about body piercing and had established a working party, conducted a survey and concluded that there was a need for legislation. I know that this Government take a similar view, but, equally, I know that a great deal of other legislation is vying for time in the House.
We may have to wait some time before we can expect legislation to be discussed on the Floor of the House or elsewhere, so we must take some action. I suggest that the work conducted in Rochdale and in Bury should be extended to other parts of the country to discover whether the problem is as serious as the survey suggested. If the problems are as acute and serious as that, we should consider taking action even outside the realms of formal regulations.
I know that the Department of Health is aware of Professor Noah's research. Could it study his work to find ways of extending, on a voluntary basis to begin with, the code of practice that he devised? That could be done with the agreement of the Department of Health, and after consultation with local authorities and the professional associations of body piercers. It would be a positive way forward while we are waiting for legislation. There is a great willingness to do that. We could also consult the local environmental health authorities on the extent of the problem and on ways of making progress on this matter.
This issue is of concern to Labour Members, and I know that Opposition Members have some sympathy with my arguments. The Minister is aware of the problem, and I know that she and Ministers at the Home Office want to make some progress. I hope that this short debate is only the first step, because if we make some real progress, we can allow our citizens to follow the fashion of body piercing and at the same time guarantee that if young 287 people—it is mainly young people who have this done—go to a body piercing establishment they can expect the highest standards of hygiene, and that the body piercing will be performed as safely as possible.
§ The Minister for Public Health (Ms Tessa Jowell)
I congratulate my right hon. Friend the Member for South Shields (Dr. Clark) on his success in securing the debate, and on the energy that he has expended in recent weeks to raise the profile of concern about the possible risks of body piercing. I am grateful to have the opportunity to set out the Government's position on the regulation of body piercing, which, as my right hon. Friend has rightly explained, spans the Department of Health and the Home Office, as the Home Secretary has important enforcement and legislative responsibilities.
The key issue is the need to address the possible health risks of body piercing, and to assess the effectiveness and adequacy of the measures in place to minimise those risks. We shall examine the points made by my right hon. Friend about the consent for and the safety of the body piercing of children. These issues must be considered against the background of the increasing fashion for body piercing in recent years. We show our age when we say that we can barely understand the appeal of body piercing. Parents are concerned, and I am anxious that body piercing should be performed in a safe and hygienic manner, so that young people, who are most at risk if it goes wrong, get the protection to which they are entitled.
I shall begin by considering the possible health risks and the measures in place to minimise them. If carried out incorrectly and unhygienically, cosmetic body piercing can cause a variety of problems. They are usually local and trivial, and arise from wound infections. However, body piercing can also result in the transmission of serious blood-borne viral infections, such as hepatitis B. There may also be other non-infectious complications directly resulting from the procedure, such as swelling around the piercing and allergic reactions to jewellery metal and antiseptics. It is essential, therefore, that we have the right measures in place to ensure public protection from such risks.
It may be helpful if I explain briefly the legislative framework that is already in place to regulate these businesses, and how that facilitates the promotion of safe and hygienic practice with the express aim of minimising the health risks. Local authorities have powers under specific and general legislation to regulate cosmetic body piercing businesses. In London, local authorities may regulate these businesses by licensing and inspection, or by registration, byelaws and inspection, depending on which legislation they have adopted. The majority of London local authorities use licensing powers.
Under the licensing provisions, local authorities in London may set conditions under which a licence is granted to body piercing businesses. The freedom to set conditions is an important leverage. The licence conditions may cover matters such as the cleanliness and hygiene of the premises and equipment, and the safety of equipment. Local authorities may refuse to grant, renew 288 or transfer a licence, or they may revoke a licence, if they are not satisfied that the business will provide a safe and hygienic service.
Local authorities outside London do not have specific powers to regulate cosmetic body piercing businesses. That is because when the legislation governing skin piercing businesses outside London was introduced in 1982, cosmetic body piercing was not included as it was not widely known about or practised. I suspect that some people could hardly believe that such practices took place. However, many, perhaps most, cosmetic body piercing businesses also carry out tattooing or ear piercing, which local authorities outside London have powers to regulate by registration and byelaws. Local authorities will, therefore, have the opportunity to work with businesses offering cosmetic body piercing to promote safe and hygienic practices, which will be to the benefit of all customers, including those who go for body piercing.
In addition, local authorities are able to use general enforcement powers under health and safety at work legislation. That allows them to use improvement and prohibition notices, and ultimately to prosecute cosmetic body piercing businesses, if they judge that there is a risk to customers' health and safety.
Following a consultation exercise under the previous Government in 1996, we concluded that primary legislation should be introduced to give local authorities outside London specific powers to regulate cosmetic body piercing businesses, when parliamentary time allows—a point made by my right hon. Friend.
We are aware that there is support from local authorities and businesses themselves for legislation to control cosmetic body piercing outside London, and our decision on the consultation results is a clear indication of our continuing commitment to protect the public from potential risks. There is heavy pressure on parliamentary time from a wide range of Government priorities. It is not possible, at this point, to be more precise about when such legislation might be introduced.
However, as I have already explained, that does not mean that we have left cosmetic body piercing businesses outside London completely unregulated. Local authorities outside London are able to inspect, advise and, if necessary, use enforcement powers for cosmetic body piercing businesses through a combination of existing specific legislation and health and safety at work legislation.
The legislative framework enables local authorities to play a key role in ensuring quality and driving up standards. Local authorities can also be effective in promoting good practice by building constructive partnerships with body piercing businesses and organisations.
I am aware that local authorities and body piercing organisations are seeking to promote safe and hygienic practices through good-practice guidelines, training courses and conferences. For example, local authorities in Oxford, Brighton, Norwich, Tameside and south Somerset have produced, or are producing, guidelines for body piercers, or the public, on cosmetic body piercing. Moreover, last September Doncaster metropolitan borough council held a conference on body piercing for local authorities, body piercers and the medical profession.
289 The European Professional Piercers Association and the Association of Professional Piercers produce guidelines on safe and hygienic body-piercing techniques. Government can also play a role. The Public Health Laboratory Service has issued guidelines on skin piercing, which give detailed advice on matters such as infection control, surface anaesthesia and after-care, and the Medical Devices Agency has issued guidelines on sterilising equipment. All those measures should help to drive up standards, and, most important, to protect the public.
I know that my right hon. Friend is particularly concerned about the body piercing of young children without parental consent, both in regard to whether it is appropriate and because of the possible health risks. As he will know, Government policy on the age of consent is the responsibility of my right hon. Friend the Home Secretary; but let me explain the position as it relates to skin piercing.
Only the tattooing of minors is controlled by specific legislation—the Tattooing of Minors Act 1969. Currently, there are no plans to introduce legislation to make the body piercing of minors a criminal offence, but, without a valid consent, the piercing of one person's body by another person could be held to be an assault. In English law, the age of majority is 18, but, in the case of most forms of skin piercing other than tattooing, the question of what is a valid consent is governed by common law, which means that whether an offence has been committed depends on the circumstances of each case. The degree of competence that can be exercised by children will depend in each case on the relative maturity of the child concerned, as well as on his or her age. If a person under 18 is capable of understanding the nature of the act that is performed, he or she is capable of giving a valid consent to it unless statute provides otherwise.
Some types of body piercing, however, are not necessarily subject to those provisions. For example, children under 16 may not consent to what would be an indecent assault. Whether an indecent assault had taken place would depend on the facts of the individual case. Neither the Government nor the Crown Prosecution Service know of any prosecutions arising from body-piercing incidents.
As for the issue of the age of consent, I hope that I can give my right hon. Friend some reassurance by telling him that I understand it to be recommended good practice in the industry for body piercing not to be carried out on children without parental consent. The European Professional Piercers Association says that it should not be carried out on anyone under 16 without parental consent, and the Association of Professional Piercers 290 suggests a minimum age of 18 without such consent. I have also heard of individual businesses taking a similar line on the cosmetic body piercing of children. One body piercing business that responded to the 1996 consultation exercise said that it turned down business amounting to between £120 and £150 each week in refusing to pierce the bodies of children who did not have parental consent.
As far as I can tell, and given the advice that is available, the industry appears generally to treat the piercing of children's bodies in a responsible way, and—as it should—to err on the side of caution. Nevertheless, parents feel concerned when their children have body piercing done without their consent, and they are right to feel concern. I have therefore asked officials to monitor reports of problems arising from the piercing of children, and the extent of public concern. If there is evidence of widespread concern and a widespread failure to adhere to the good practice set out in the recommendations for self-regulation, we will not hesitate to consider the need for further controls.
§ Dr. Clark
I am grateful for the information that my right hon. Friend has just given, which constitutes a considerable step forward; but would it be possible for her to extend the good work that has already been done—the voluntary work, and the establishment of a code of practice—to ensure that the professional associations have an interchange with local authorities outside London, and best practice can be observed?
My hon. Friend will have noted the evidence from Bury and Rochdale health authority. Could she use her good offices to ensure that other health authorities conduct similar surveys to measure the extent of the problems?
§ Ms Jowell
I should be happy to implement my right hon. Friend's proposals for the strengthening of public protection through the mechanism of self-regulation. I shall explore the options that he has suggested, as well as investigating the case for further dissemination of Professor Noah's guidelines, which, as my right hon. Friend pointed out, provide a standard for good practice.
The Government's primary concern is for cosmetic body piercing to be done in a safe and hygienic manner, so that the public are protected from possible risks to their health. I have described the legislative controls that currently exist and those that are planned, as well as measures taken by local authorities and the industry to protect those who choose to have their bodies pierced. Our strong preference is for good practice to be spread by means of self-regulation, and we intend to work with the industry to secure that objective. Let me also signal our intention to take further steps if there is evidence of abuse or negligence that puts the health of the public at risk.