Body Piercing
The final item of business today is a members' business debate on motion S1M-994, in the name of Dr Sylvia Jackson, on body piercing. It will be a half-hour debate.
Motion debated,
That the Parliament notes that body piercing carries a risk of hepatitis, HIV, cellulitis and wound infections; further notes that local authorities have introduced very different ways of regulating the industry; recognises the potential dangers of this situation; believes that an enforceable national regulatory framework to govern body piercing should be introduced, and urges the Scottish Executive to bring forward legislation to cover this industry.
I welcome to the gallery representatives of the body piercing industry and local authority officers, who have supported this motion to introduce more regulation to the industry.
I thank the many members who have given cross-party support to the motion. Over the past year, Margaret Ewing and I have asked parliamentary questions on the regulation of body piercing. Thanks go also to the Scottish Parliament information centre, which provided a useful briefing document many months ago.
As body art in general, and body piercing in particular, become more popular, it is essential that body piercing procedures are carried out safely, in terms of the equipment that is used, disinfection and sterilisation, and the quality of the jewellery that is used. It is essential that a client who walks into a body piercing studio knows that it is operating to standards that are set by experts. If it is not operating to those standards, there can be serious consequences, as has been reported.
At its national congress this year, the Royal College of Nursing voted unanimously to lobby the Government to regulate body piercing outlets. Earlier this year, a survey in Rochdale revealed that 95 per cent of general practitioners have had to deal with medical complications arising from body piercing. Those range from the scarring of tissue and disfigurement, to damage to internal organs, and the risk of hepatitis, particularly hepatitis C, HIV, cellulitis and wound infections.
It is clear that there is a groundswell of opinion that it is time to introduce more regulation for body piercing outlets. For instance, the City of Westminster Council, with support from other local authorities in London, campaigned for changes to the London Local Authorities Act 1995. Those changes gave local authorities in London discretion to introduce licensing. Most of the local authorities in London have brought in a licensing system.
The environmental health department of the City of Edinburgh Council has drawn up draft licensing conditions for cosmetic skin treatments. It has been helped by the work of a PhD student on the topic.
The Scottish Centre for Infection and Environmental Health, which is a national health service body that is based in Glasgow, has produced a guidance note for local authorities on body and skin piercing. The note sets out standards for good practice and sets out the legal position.
The London group of infection control nurses is working with the London consultants in communicable disease control to develop guidelines for control of infection in tattoo parlours, body piercing studios and acupuncture clinics. The group is developing an audit tool for the inspection of premises to ensure the highest possible standards in disinfection, sterilisation and good practice. In co-operation with piercers and health professionals, the group hopes to publish guidelines in December.
Today the Scottish needs assessment programme published its report, which I believe recommends that there should be more regulation because of the risk of hepatitis C in particular. The Convention of Scottish Local Authorities has made recommendations for amendments to the Civic Government (Scotland) Act 1982 in relation to cosmetic skin treatments. Those include the recommendation that there should be licensing, albeit on a discretionary basis. I suggest that we need to go further than the discretionary provision that exists in London local authorities. Given the facts that are now coming to light about bad practice in some body piercing outlets, it is essential that licensing should be made compulsory.
There is also the issue of the age limit for body piercing. Margaret Ewing will speak on that later, and I support her views on the matter. It would be necessary for the minister to introduce a statutory instrument requiring councils to introduce licensing. In answers that both Margaret and I have received to parliamentary questions to the Scottish Executive, the Executive has expressed willingness to address this issue and to consider a consultation process. However, we do not think that it has got very far with that, and the idea of lodging this motion for a members' business debate was to move the process on a little. I hope that, in his winding-up comments, the minister will give firm details about that consultation process, so that we can make progress on this important issue.
I congratulate Sylvia Jackson on bringing this important motion before the Parliament. She and I have shared concern over this issue for a considerable time. Although I originally lodged an amendment to the motion, after sensible discussion behind the scenes and with the assistance of our ever-helpful parliamentary staff, we agreed that this motion would remain as it stands. I thank Sylvia for that discussion and suggest to members that sensible discussions behind the scenes can often achieve a great deal.
Sylvia Jackson referred to the fact that I was concerned about the age issue. I shall have a joke at my expense—why not, as everybody else tells jokes about me? [Members: "Aw."] My mother adamantly refused me permission to have my ears pierced when I was a teenager, on the ground that "If the good Lord had meant you to have holes in the lobes of your ears, he would have given you them." At approximately the age of 45 I decided to challenge both the good Lord and my mother, all in one day, and had my ears pierced. I am sorry that Tavish Scott has left the chamber, as it was in Lerwick that I made that decision—perhaps on the basis that the good Lord and my mother did not seem to be around in Lerwick.
The attitude to fashion among teenagers and younger children has changed considerably since I was a teenager. Ear piercing has been substantially regulated, and anyone who has read documentation about the practitioners will know that they have always exercised extreme caution and have made it clear that there should always be an adult in the presence of any youngster, even over the age of 16, who considers having his or her ears pierced, on the specific grounds of health and hygiene.
This debate is essentially about body piercing. I first asked a question of the Minister for Health and Community Care in March in connection with the minimum age restrictions for body piercing. That parliamentary question arose following the receipt of a letter from a constituent—the constituents in Moray are extremely literate and keep me busy. The letter says:
"I saw something yesterday I just could not believe, a young child no more than 18 months old with an earring . . . There are some things you never think you would need laws against, because you imagine no one would be that stupid. I think this matter needs urgent review before we start seeing babies with studs in their noses or tattoos on their arms."
That letter stimulated my interest. I was grateful that, in response to my question, Susan Deacon said that there would be consultation on the issue of age. I would be grateful if the Deputy Minister for Community Care could advise us how far advanced that consultation process is with our local authorities, the public health interest groups that are involved and others who might have vested interests.
We seek a balanced and sensible approach to the issue. Neither Sylvia Jackson nor I want to infringe on people's liberty to pursue fashion. After all, there is another saying from my youth: "You might as well be deid as out of the fashion." As we all know, fashion is temporary; however, in seeking the adoption of Sylvia Jackson's proposals, we do not want to restrict the fun of being dedicated followers of fashion. We want only to ensure that fashion followers do not fall victim to health risks or take decisions that they might later regret. The young people are most at risk and we want national regulations that provide a sensible and sensitive framework.
I thank Sylvia Jackson for securing a debate on this subject. Body piercing has existed since ancient times and has certainly become far more popular in the past 20 years. Its popularity stems from the fact that it allows people to differentiate and express themselves; to make themselves look attractive to others; and to adorn themselves in a way that my generation would not have appreciated. However, that said, people should have the right to choose the way they dress. Although I do not care for that fashion and do not recommend it, I would certainly fight for an individual's rights to have their body pierced.
There has been much concern about the health risks associated with body piercing. My research on the topic has not been exhaustive, but I have made a significant search for information and discovered that even though there are certain risks from infection, no one is clear about the actual incidence of those infections. The lack of rigour in the research and the fact that the evidence is anecdotal mean that some effort should be made to gather greater evidence on the incidence and type of infections that occur as a result of body piercing.
After such evidence has been gathered, we should bring together practitioners, local authorities, public health authorities and the British Medical Association to consider the appropriate legislation. We feel that any legislation should be light of touch and devolved out to local authorities. If a licensing system were required, local authorities should have some guidelines about the form of such administration.
Body piercing can carry worrying risks, not least the fact that tongue studs can cause problems for casualty wards in administering life-saving practices. Similarly, doctors can have difficulties because they do not know how to remove studs when they give help to people. Furthermore, there are risks of different types of infection, depending on where studs, rings or other adornments are placed—I will not visit some of the places where rings or studs go.
For that reason, when deciding whether to impose an age limit on body piercing we should consider the issue along with the lessons that we have learned from the legal situation on tattooing. For example, I have taken my children to many events and found that the people they have been playing with since they were six have earrings or studs about their body. We must be concerned, as this is a growing practice. As adults have studs, they often think that it is appropriate for children to have them as well. That also should be considered.
Once enough information has been gathered, it would be appropriate for Parliament to act in a considered and limited fashion. Local authorities should have the responsibility for ensuring that the practitioner is of the proper standard. That would provide people with reassurance.
In the Highlands 200 years ago, body piercing meant something much more violent and involved dirks or sgian-dubhs.
Only a week ago, my 16-year-old daughter, who has just dyed her hair purple with yellow highlights, announced that she was going to have her nose pierced—she takes after me, one can tell. I said that I was not sure that that was a good idea and she decided to have her belly button pierced instead.
What always sticks in my gullet is the fact that fashion—by definition—is temporary. Someone with a stud in their tongue or their belly button might find that that is deeply unfashionable five years down the line but there they are, scarred for life.
I congratulate Sylvia Jackson on introducing this important debate and I congratulate Margaret Ewing on her speech. I had no idea that she is more than 45 years old—I thought she was far younger. That has come as a surprise to us all.
There should be a licensing system and it is right that it should be compulsory. Brian Monteith is right: it should be the responsibility of local authorities, but the involvement of the medical profession will be absolutely essential. Perhaps the consultation should include the health boards or some similar bodies—Dr Simpson might want to comment.
I had no idea that it was possible to have one's ears pierced in Lerwick, but I know better now. Should the fashion change for males, I know where I will go.
I congratulate Sylvia Jackson on initiating this debate and recognise Margaret Ewing's involvement in highlighting this matter of public concern.
I signed the motion some time ago. More recently, I picked up a magazine in my dentist's waiting room and happened to read an article on the subject that we are discussing. It certainly took my mind off my teeth.
Realising the implications for individuals and for public health in general, I decided to examine the issues further. As we have heard, body piercing is becoming increasingly popular and is a fashion statement, particularly for young people. For many teenagers, image and peer-group pressure become all important. Often, the body piercing can be done on a whim without any knowledge of the possible dangers or after-effects. It is worrying that it appears that a child of any age can have piercing carried out without parental consent.
I am sure that many parents have been horrified when their child has appeared home with their ears, nose, navel or whatever pierced. They will be even more horrified to learn that the people doing the piercing are not subject to formal regulation or licensing and that anyone can set up a business that enables them to stab holes in the population and insert pieces of metal in our children. I imagine that, as I did, the general public believe such practices to be regulated. Too late, many will realise that that is not the case and will be left to deal with the consequences.
There are many horrific stories of piercing gone wrong—we have heard about blood poisoning, scarring and paralysed tongues. More common problems involve infections, allergies and rejected jewellery. In some cases, the metal becomes embedded in the skin and has to be surgically removed. I talked to a GP recently, who told me that many young people baulk at the idea of having the jewellery removed and think that antibiotics can sort it out. They do not realise the seriousness of the problems.
Many health risks could be avoided if piercing were regulated and proper after-care carried out. Anyone going for a piercing should be asked about their medical history, since some conditions could make the procedure dangerous. Sylvia Jackson mentioned the survey of GPs in Rochdale that shows that dealing with the effects of piercings that have gone wrong is an unacceptable cost to society.
The use of piercing guns needs to be investigated. I know that we do not have time to do the subject justice today, so I will simply point out that the design of those guns is based on a piece of equipment that was invented for cattle tagging. They cannot be sterilised effectively because they melt when they are run through an autoclave.
I am not calling for the banning of body piercing—there is no doubt that people have a responsibility for their own health and actions—but they can act responsibly when having body piercing carried out only if they are aware of the issues and the possible consequences. In particular, action must be taken to safeguard children. This is a public health issue and a child protection issue. Parliament must take urgent action. We need a requirement for parental consent to be introduced to help protect young people, and some form of regulation and licensing of body piercing studios.
This is not about stopping body piercing, but about ensuring that reputable piercers carry out piercing safely and hygienically and that the full facts about the risk and possible consequences of it are made available to the public.
I congratulate Sylvia Jackson on securing a debate on this topic. My major concerns are about the infections that can occur in association with the process of piercing. Hepatitis C is not a particularly well understood disease, and HIV and hepatitis C were not talked about at all 20 to 25 years ago. If they existed, we do not know where they came from—that is still a matter for debate.
In view of that experience, it is appropriate to ask what other diseases we do not yet know about. Appropriate sterilisation of needles is fundamental. Simple, old-fashioned disinfection with a wipe is not enough. It is vital that either new equipment or a fresh needle is used on each occasion, or that there is an effective system of sterilisation, which can be applied appropriately to equipment—I will not repeat the point that Elaine Smith made on that. That applies to tattooing and acupuncture as much as it applies to body piercing.
The other question is that of informed consent. Young people are quite entitled to make a fashion statement, such as body piercing. Equally, those who inflict—or assist to achieve—body piercing have a responsibility to ensure that the consent that they receive is informed. It is therefore appropriate for there to be indications of the possible consequences of body piercing.
No general practitioner would undertake minor surgery without telling a patient that, for example, a skin operation to remove a blemish carries the risk of infection and of scarring, particularly keloid scarring, which has a red, heaped-up effect, and which tends to occur more frequently among one or two ethnic groups. People need to be informed of such things before they undergo the procedure.
A combination of proper regulation, ensuring informed consent and ensuring, through the licensing process, that the establishments that carry out body piercing have effective sterilisation measures, is important.
I too congratulate Dr Jackson on her motion. I do not believe that this matter should be left to local authorities; there is a need for a national regulatory framework, which should be set by the Department of Health.
The minister may recall that I have regularly raised the issue of hepatitis C. He will be aware that the Scottish Centre for Infection and Environmental Health has estimated that 8,000 people in Scotland suffer from hepatitis C. Unfortunately, there is a little asterisk by that figure to indicate that there is a footnote—which says that it is probably a severalfold underestimate. We simply do not know the situation, but the former general manager of Fife Health Board described it as a time bomb; Interferon or combination therapies can cost up to £10,000 per patient per year. Perhaps the minister can update me on that.
I know that the Minister for Health and Community Care has remitted this issue to the Scottish Executive's special policy unit, which is an indication that she is as anxious about it as I am. Can the minister tell me what the upturn in the HIV figures is?
The Executive has first to get a policy out of the policy unit. It has existed for several months, but this is an urgent matter that requires to be addressed. We do not want suddenly to discover that a huge number of hepatitis C sufferers are not getting treatment. I hesitate to say, "another SQA," but the minister will take my point: we need action.
We also need education, so that there is much wider awareness of hepatitis C, not just among drugs misusers, but among other people who could be affected, for example through body piercing.
I too commend Sylvia Jackson for giving us this opportunity to discuss this important matter that covers a number of procedures from the relatively innocuous electrolysis and ear piercing to the piercing of parts of the anatomy that many of us, such as Brian Monteith and Elaine Smith, find it hair-raising to contemplate. Personally, I am with Margaret Ewing's mother on the matter, but I cannot speak for everyone in the chamber and in any case others' views may not be obvious at first glance.
Several concerns have been raised, and from different angles, many of them to do with young people—which is right as they tend to be the ones who are interested in this kind of fashion. Parents and their concerns about their children have also been mentioned a number of times. Like Jamie Stone, I have personal experience of this issue. There is understandable worry about the environment in which skin piercing is carried out and about the standards of hygiene being observed.
Sylvia Jackson rightly drew attention to the potential health risks of body piercing in particular. Usually, problems are local and trivial and arise from wound infections, although Richard Simpson pointed out that while we believe that to be true we do not know. Piercing can also result in serious blood-borne viral infections, such as hepatitis B or C. I do not think that I will have time to address Keith Raffan's specific points about HIV and hepatitis C, but that is not to treat them as unimportant. Sylvia Jackson mentioned the SNAP report, which will be published today. It may provide information on the concerns raised by Keith Raffan.
Will the minister respond to me in writing?
That seems an entirely reasonable request and I undertake to do so. Our knowledge is developing. We will get back to Keith Raffan, who I know takes a proper interest in the matter.
I will say a little about some of the background. Tattooing, particularly of young people, has been mentioned. The Tattooing of Minors Act 1969 makes it an offence to tattoo young persons under 18 years of age. An age limit is in place but, except in Edinburgh, as Sylvia Jackson explained, Scottish local authorities do not have specific powers to regulate skin piercing businesses. Some local authorities have taken an active interest in such businesses. As Sylvia Jackson said, that is reflected in the fact that the Scottish Centre for Infection and Environmental Health has recently produced a guidance note in response to inquiries from councils.
We should not, as Brian Monteith said, assume that those who provide skin piercing services are universally irresponsible. At the UK level, the European Professional Piercers Association and the Association of Professional Piercers have produced guidelines for their members and would have to be included in any consultation arising from our concerns.
Sylvia Jackson outlined the legal position in England and Wales, which I will not take the time to repeat. The UK Government has concluded that primary legislation should be introduced in England and Wales to give local authorities outside London specific regulatory powers. However, parliamentary time at Westminster has not yet been found.
Consent is a difficult issue, as many parents are content for their children to have their ears pierced and parents will differ from each other and from their children in their belief of what is acceptable at particular ages. The Age of Legal Capacity (Scotland) Act 1991 states that a child under 16 does not have the legal capacity to enter into a transaction unless specifically allowed by statute, so there is some protection, at least in insisting on consent from the parent. One of the two associations to which I referred says that procedures should not be carried out on anyone under the age of 16 without parental consent. The other says they should not be carried out on anyone under the age of 18. I appreciate that that falls short of some of the concerns that have been expressed this evening.
In closing, I return to the key issue raised by Sylvia Jackson: the need to address the possible health risks of body piercing. The Executive recognises the need to assess the effectiveness and adequacy of current arrangements and to consider what different arrangements may be necessary. We are committed to conducting a consultation exercise. I confess that the commitment on that was made some time ago and that this evening's debate has allowed me to return to it. I instructed officials today to prepare the consultation exercise as soon as possible and to set it in motion before the end of the year, at the very latest. I will give Parliament a timetable for it in due course and information on how it will be carried out.
In his instructions to his officials, will the minister include a request for organisations such as the British Medical Association to provide evidence on the health risks? If there is to be legislation, it would be helpful to have information making a case for it so that people will understand the need for it.
I am happy to take up that suggestion. We will also include councils in the consultation, as they would have to implement any controls needed to provide safeguards. We will also have to address whether there should be exactly the same regulatory regime everywhere in Scotland.
I am concerned that the minister has indicated that a members' business motion six months after a commitment was given to investigate the situation is required before it is acted on. I hope that does not mean that we have to have a members' business motion every time such a commitment is given. We are looking for a very clear time scale for the consultation and the likelihood of implementation of any recommendations.
I take the point—I made my comment as a confession. Given that I instructed the preparation of the consultation today, it would be wrong to make an immediate pronouncement on how long it will take, but when we have a clear idea on that we will inform Parliament.
As several members have said, our consideration of the issue must take place against the background of an increasing fashion for skin piercing. We are rightly concerned and we must ensure that skin piercing is carried out in a safe and hygienic manner. I assure Sylvia Jackson that the debate has moved the matter forward.
Meeting closed at 17:38.