HC Deb 27 February 2003 vol 400 cc466-74

Motion made, and Question proposed,That this House do now adjourn.—[Mr. Jim Murphy.]

4.5 pm

Ms Meg Munn (Sheffield, Heeley)

Daniel Hindle was a healthy, active teenager with a passion for music. He attended Sheffield college, studying media, English and information technology. He was a skilful guitarist and, by last summer, he had formed his own band, which had already started playing gigs and was in demand for further performances.

Daniel had a girlfriend and, last October, they decided that they would get a piercing together. They went to a popular studio in Sheffield, where his girlfriend had her eyebrow pierced and Dan had his lip pierced. That turned out to be the catalyst for the nightmare that was to ensue. A few days after the piercing, he became ill and slowly got worse. He was admitted to hospital and subsequently into the coronary care unit. He was infected by septicaemia, or blood poisoning, which attacked his major organs and left him too weak to fight the infection. A few days before Christmas, on 21 December, Daniel lost his fight for life. He was 17 years old.

Daniel and his girlfriend did what many teenagers do; they decided to get a piercing—the sort of thing that ordinary teenagers do. Tragically, Daniel was not an ordinary teenager. He had been born with a heart defect called tricuspid atresia—a condition that had necessitated two life-saving operations when he was younger. Both operations were 100 per cent. successful, and Daniel had grown up normally with an excellent quality of life.

Daniel was not aware that for him, piercing could pose a serious health risk. His mother, Christina Anderson, believes that if he had been aware of the risk, he probably would not have had it done. Unfortunately, nobody drew that possibility to his attention before or during his visit to the piercing studio.

There is no suggestion that the studio did anything wrong. It was not ignoring Government regulations. Astonishingly, there are no regulations for body piercers in Sheffield. Local authorities in London have powers to control ear piercing and cosmetic body piercing businesses by licensing, using provisions in the London Local Authorities Act 1991, or by registration and byelaws, using provisions in the Greater London Council (General Powers) Act 1981. The majority of London local authorities have adopted licensing powers. Local authorities outside London have powers to register and make byelaws for ear piercing businesses under the provisions of the Local Government (Miscellaneous Provisions) Act 1982, but not for cosmetic body piercing businesses.

Sheffield city council's website contains information about body piercing, stating that it does not require registration. It provides information, however, on how to register on a voluntary basis with the health protection service, which offers that service. Those who register with the authority receive a premises inspection to ensure that appropriate standards are being achieved and a certificate stating that the premises and practices are suitable and sufficient.

Sheffield's voluntary code of practice aims to offer guidance to body piercers regarding the practice of body piercing and outlines specific recommended hygienic procedures. That includes that body piercing shall not be undertaken on any person under the age of 16 unless parental consent is given, and an expectation that proof of age will be requested. It advises that the client's medical history should be discussed and draws attention to particular conditions that should lead a client to consult a general practitioner before proceeding. Those include heart disease, major infections, allergies and skin complaints. That is good advice, but registration is voluntary. No statutory requirement exists to find out how old someone is before piercing them, and no law exists stopping a child under 16 from being pierced. No compulsion exists to find out whether a customer, such as Daniel, has a heart defect.

The Government have stated on a number of occasions that they believe that primary legislation should be introduced to give local authorities outside London powers to regulate the hygiene and cleanliness of cosmetic body piercing businesses when parliamentary time allows. I am aware that that issue was raised recently in the Local Government Bill Committee. I have also spoken to my right hon. Friend the Minister for Local Government and the Regions urging him to seek to amend the Bill if at all possible to introduce this provision. Parliament needs to act now. Daniel's death is already one death too many.

Today, I am not just asking for legislation to be changed. I want to raise awareness of the health risks of body piercing and I want the Department of Health to consider what it can do to raise awareness. I understand from previous parliamentary answers that the Department does not have information on the number of people who seek medical help as a result of body piercing. In answer to my written parliamentary question in January, the Minister stated that the Department was not aware of any research into the risks of body piercing for individuals with congenital heart disease, although there have been a small number of published case reports from abroad of endocarditis in individuals with congenital heart disease following skin piercing.

That is not the only area of medical risk, however. A search of the internet has revealed the following information. Dr. Junaid Hanif of Heath hospital in Cardiff carried out a study of body piercing last year. He discovered that more than 95% of GPs in Greater Manchester have treated complications caused by body piercing in the past year and incidences in England and Wales of damage to ear cartilage caused by piercing have doubled in the last decade with more than 2,000 cases reported in 2001. Writing in the August 2002 issue of the journalEmerging Infectious Diseases, Drs. Akhondi and Rahimi of the Mercer university school of medicine in Georgia reported the case of one 25-year-old man who became seriously ill soon after having his tongue pierced. The man had a heart defect, and blood tests revealed that his heart was infected with a type of mouth bacteria, and the stud of the piercing also tested positive for the presence of the same bacteria. Thankfully, that young man survived after a period in hospital.

Almost as common and potentially far more serious than jewellery allergies are infections, which result in redness, swelling, tenderness, pain and, often, swelling of nearby glands. When sterile techniques are not used, bacteria and viruses can be introduced into the bloodstream, including the hepatitis B virus that can cause chronic hepatitis and liver cancer, and HIV, the virus that causes AIDS. In people born with heart valve disorders, bacterial endocarditis, a potentially deadly infection of the heart, can result if they fail to take preventive antibiotics. Piercing the nose can result in a staphylococcal infection and piercing the cartilaginous part of the ear, which has a very poor blood supply, can result in an infection necessitating surgery and can result in permanent deformity. Even tetanus is a risk in people who have not been immunised in the past 10 years.

In an article in theStudent British Medical Journal last year, Jamie Wilson of Leeds said: The largest ever 'body art' study has found that a fifth of students with body piercings have excessive bleeding, bacterial infection, and tissue trauma. The research was reported in Mayo Clinic Proceedings … after 454 undergraduates from a New York college completed questionnaires on the subject. More than half the students had piercings outside the traditional domain of the earlobe, and 29 per cent. of women had a navel ring or belly bar. Complications were most likely for nipple, navel and genital piercings, and bleeding and bacterial infection were the most common ailments. Piercings were most frequently permanently removed from the nose, tongue, eyebrow and male nipple. In September 2000, a woman with 118 piercings, including six lip rings and 11 belly bars, died from bacterial septicaemia. She refused to seek medical attention, believing she could offset any infections with saline swabs.

The Chartered Institute of Environmental Health contacted me stating that it, too, is calling for stricter licensing controls on body piercers in response to concern about health risks. It has issued a set of recommendations for consumers designed to inform and educate the public about the possible health implications of skin piercing treatments ranging from body art and tattooing to electrolysis and acupuncture. The institute echoes my concerns that there is no control over who can set up in business as a body piercer, and there are certainly no recognised standards for new practitioners. It also calls for any piercing below the neck to be made illegal for under 16-year-olds.

Body piercing has become much more fashionable in the past few years, with many teenagers thinking nothing of going out and getting a piercing done. Daniel Hindle did that and a life was cut short. Given the concerns and the possible medical risks that are already known, will the Minister's Department consider commissioning further research on the risks of body piercing, especially if there is an underlying heart condition? The Department of Health is aware that a small study in the United States stated that physicians should advise patients with heart conditions against piercing, but that if the person decided to go ahead, antibiotics should be taken, which is usually the case for dental or surgical procedures. Further research is needed to understand the risks and to ensure that proper advice is given.

Daniel's death has devastated his mother, his family, his friends and the whole college community at Norton in Sheffield. A website has been set up to raise awareness and to commemorate his life at www.danaid.com. I am not against body piercing; I am against ignorance about the effects that such piercings can have. No other young person should lose his life in that way. In spite of her grief, Christina Anderson, Daniel's mother, has dedicated herself to preventing that from happening. Now it is the turn of the Government to act.

4.18 pm
The Parliamentary Under-Secretary of State for Health (Ms Hazel Blears)

I congratulate my hon. Friend the Member for Sheffield, Heeley (Ms Munn) on her success in obtaining this important debate. I know that she has taken an increasing interest in the regulation of cosmetic body piercing in recent months. I am grateful to her for giving me the opportunity to explain the Government's position on the issue. I also hope to respond to the specific queries raised.

As body piercing becomes more common, especially among young people, the problems associated with it become more important, too. I am aware of the tragic case of Daniel Hindle. I should like immediately to put on record my sympathy for his family, friends and community. I have looked at the website and am aware of the tremendous campaigning work that Daniel's mother has undertaken. Sheffield city council is carrying out a detailed and thorough investigation of the circumstances surrounding Daniel's death. As the investigation is not yet complete, it would not be appropriate for me to comment further. However, it will be important to consider whether there are any general lessons to be learned once the investigation is completed.

I agree with my hon. Friend that the health risks of body piercing and the measures in place to control them are crucial. People considering body piercing should be aware of the risks and should be confident that appropriate controls are in place. Where existing health conditions may be relevant to body piercing, that should be clear to all concerned. That applies not just to heart defects but to other pre-existing conditions. I am aware that there is great concern about the piercing of children. Body piercing has become more fashionable in recent years, and the trend has been stimulated by celebrities who have had their bodies pierced. It can be extremely worrying for parents when their children have ear or body piercing done against their wishes.

I should like to address my hon. Friend's concerns by considering the possible health risks and the measures in place to control the situation. If cosmetic body piercing is carried out in an unhygienic manner or incorrectly, it may cause a variety of problems such as local, usually trivial, wound infections, as well as transmission of serious blood-borne viral infections such as hepatitis B. Most complications are local, minor wound infections that do not appear to be caused by the piercing itself. Typically, they may be caused by exposure to bacteria, for example, by touching the piercing in the days following the piercing with unwashed hands or by the wound coming into contact with hair, bedding, clothing and so on.

As my hon. Friend said, I stated in a recent parliamentary answer that there has been a small study in the United States that investigated ear piercing and tattooing in patients with congenital heart disease. In that study, no patients experienced serious infections following ear piercing and tattooing, although a quarter of them experienced minor local skin infections following ear piercing. As my hon. Friend said, there have been a small number of case reports abroad of endocarditis—infection of the heart valves and perhaps the heart lining—in people with congenital heart disease following skin piercing. My hon. Friend asked whether the Department of Health can carry out more investigation into the extent of difficulties that arise as a result of skin piercing. I am pleased to tell her that we are considering the feasibility of a special study in that area. I have asked my officials to look into that, because it is important that we have an evidence base on the extent of those problems. My hon. Friend's information about the GP survey is tremendously interesting, as it reveals the extent of problems in the Greater Manchester area.

Non-infectious complications can result directly from body piercing, and include swelling around the piercing and allergic reactions to jewellery, metal and antiseptics. Serious complications, as far as we know, are uncommon, according to case reports in the published literature and surveillance by the Public Health Laboratory Service. None the less, it is vital that we have the right measures in place to ensure public protection. A pressing question for us is how to regulate body piercing businesses in the face of those possible risks. We have a legislative framework in place that facilitates the promotion of safe and hygienic practice to try to minimise those health risks. We intend to strengthen that framework, as I shall explain. Local authorities have powers under specific and0 general legislation to regulate cosmetic body piercing businesses. In London, local authorities may regulate those businesses by licensing and inspection, or by registration, byelaws and inspection, depending under which legislation they have chosen to proceed. The vast majority of London local authorities have adopted licensing powers, and can set the conditions under which a licence is granted. Licence conditions may cover matters such as cleanliness, hygiene of the premises, and equipment and its safety. Local authorities can refuse to grant, renew or transfer a licence, or they can revoke a licence if they are not satisfied that the business will provide a safe and hygienic service.

My hon. Friend is right that local authorities outside London do not have specific powers to regulate cosmetic body piercing businesses. When the legislation governing skin piercing businesses outside London was introduced in 1982, I think in the Local Government (Miscellaneous Provisions) Act 1982, cosmetic body piercing was not widely known about or practised to the extent that it is these days. My hon. Friend will recognise that many—probably most—cosmetic body piercing businesses also carry out tattooing or ear piercing. Such businesses often operate side by side in the same premises.

Local authorities outside London have powers to regulate by registration and byelaws both ear piercing and tattooing. Local authorities therefore have the opportunity to work with businesses that offer cosmetic body piercing together with tattooing or ear piercing to provide safe and hygienic practices. That will be to the benefit of all their customers, whether they come for tattooing, ear piercing or cosmetic body piercing.

In addition, local authorities can 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. Sometimes the health and safety powers are under-utilised, perhaps because local authorities do not see them as local government powers, but they exist and they are extremely strong powers in terms of improvement and prohibition notices. Local authorities can use those powers if they are appropriate.

There was a consultation exercise on these matters in 1996. Following that consultation, we concluded that there should be primary legislation to give local authorities outside London the specific powers that they lack to regulate cosmetic body piercing businesses. As my hon. Friend said, we have been trying to find parliamentary time to ensure that that happens. We know that there is substantial support from local authorities and from businesses for such legislation. The good businesses in operation want to ensure that they are providing excellent and safe practices. There has been heavy pressure on parliamentary time. I cannot be precise about when it might be possible to introduce legislation, but we shall take every opportunity that we can.

My hon. Friend mentioned the Local Government Bill. If possible, we want to pursue that, but I cannot give a commitment at this stage. That does not mean that cosmetic body piercing businesses outside London are entirely regulated. There are powers in place for local authorities to inspect, advise and, if necessary, enforce the legislation. The framework enables local authorities to play a role in driving up standards and promoting good practice. It is important that we build constructive partnerships with the businesses and get the proper advice out to the public.

My hon. Friend referred to the voluntary registration scheme and code of good practice introduced by Sheffield city council for body piercing businesses. We are also aware that some local authorities have produced information for the public on the risks of body piercing and how to choose a reputable body piercer. In Bury and Rochdale councils area and in Southampton such guidelines and information for the public have been introduced. The Department of Health has used the Bury and Rochdale body piercing leaflet as an example of good practice in our recently issued strategy on hepatitis C. It is important that we encourage local authorities to issue such information.

Action is being taken by industry bodies such as the Association of Professional Piercers and the European Professional Piercers Association, which have also produced good practice guidelines. Those need to be distributed widely. There has also been guidance from the Health and Safety Executive, which in October 2001 produced updated guidelines. Those guidelines should assist local authorities in advising businesses on issues such as hygiene practice, treatment of customers with existing health conditions, after-care, and adopting a reasonable approach to age of consent issues.

All these measures and activities should help in promoting safe practice. That must include prospective customers being made aware of the potential health risks of body piercing, the relevance of existing health conditions, the need for medical advice, and the proper after-care of the piercing to reduce the risk of infection. Those are all aspects that my hon. Friend highlighted in her contribution.

On the age of consent, I know that my hon. Friend is concerned about young children having body piercing done without parental consent, in terms of whether that is appropriate and also because of the possible health risks. Overall, Government policy on the age of consent is the responsibility of the Home Office. However, let me explain the position on skin piercing.

Only the tattooing of minors is controlled by specific legislation—the Tattooing of Minors Act 1969. The question of what is a valid consent for cosmetic body piercing is governed by common law. If a person under the age of 18 is capable of understanding the nature of the act that is to be done, he or she is capable of giving a valid consent to it unless statute provides otherwise. 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 upon his or her age. I understand that parents are concerned when their children have had body piercing done without their consent. However, I am advised by local authorities and the industry that body piercing should not be carried out on children without parental consent. Obviously, practice in individual businesses may vary.

Our concern is that, if we introduced a minimum age of consent, we could end up increasing the health risks of body piercing. Children might try to pierce themselves or each other in an unsafe or unhygienic manner or they would go to disreputable piercers rather than to those who abide by a code of practice and guidelines. It is a difficult issue on which to make the right judgment, but I am sure that we are all aware that, when an activity is subject to prohibition, the prospects of it taking place with greater risk always remain on the horizon. We are keeping the age of consent under constant review and will continue to consider whether it may be appropriate to introduce a minimum age of consent for this practice. Most reputable businesses would like guidelines that make it clear that people under the age of 16 should not be pierced.

In conclusion, our primary concern is that cosmetic body piercing is provided in a safe and hygienic manner. I have outlined the legislative framework that is in place and said that we plan, wherever possible, to strengthen that framework. We want to encourage local authorities outside London to use their existing powers under the Health and Safety at Work, etc. Act 1974 and under the provisions to regulate ear piercing and tattooing.

We will keep the position under review in the light of any new evidence that emerges, and we will consider the need for further action once the investigation into the tragic case of Daniel Hindle has been completed. I am keen that we learn the lessons of that case. I am pleased to confirm to my hon. Friend that we will consider the feasibility of carrying out a special study to make sure that we increase our evidence base on this issue. That will become increasingly important in the future as cosmetic body piercing becomes more popular, particularly among young people. It is important that Government keep up to date with developments.

I thank my hon. Friend for raising a matter that is important not just to her constituency but to the country.

Question put and agreed to.

Adjourned accordingly at twenty-seven minutes to Five o'clock.