Cosmetic consultations: not just about Botox!

This is Blog no 40

The Government has launched a consultation about a licensing scheme for ‘non-surgical’ cosmetic procedures.

In the media, it is being universally referred to as the Botox consultation, but iInevitably it prompts a discussion about those consultations we regard as ‘cosmetic’

At the outset, it is maybe worth questioning whether, in a less male-dominated political system, we would have had to wait until 2023 before being consulted on an issue that has caused serious concern for many years. Ditto for a range of women’s health issues that have only recently attracted the attention they have deserved.

On the face of it (sorry!), this seems a sensible and straightforward use of consultation. Pressure mounts to tighten up the regulation of practices that leads to an alarming range of disappointing outcomes and complaints. Eventually the Government agrees and legislates ( via the Health & Care Act 2022, Section 180) and at some point, clearly, it is wise to gather stakeholder views about setting up a satisfactory system.

Parliament has done its job, and in recent years, campaigning groups have used the usual parliamentary processes to investigate what the Chief Medical Officer called the ‘wild west’ that is the UK Cosmetics industry. Two years ago, it became illegal to apply these invasive procedures to under-18s, and the main thrust of the current proposals is to reach a consensus about the degree of risk attached to a long list of treatments that should be covered in a new licensing regime, to be run by local authorities in England.

The announcement seems to have been greeted positively, and consultation can be expected to do its job of helping officials and Ministers iron out the details. It sounds like a text-book sequence of rational policy-making doesn’t it?

Except that there is another way to look at it.

For those familiar with running campaigns on public health – or indeed other causes, the British state can be an almighty difficult adversary. Recently reading Isabel Hardman’s masterful account of the NHS in Fighting for Life, one becomes aware of the efforts needed to persuade Ministers that Governments bear some responsibility when things go wrong. Its account of the thalidomde scandal is now so lost in history that new generations have heard little or nothing about it. In my own brief political career around 1978-79 I encountered bureaucracy’s reluctance to concede any ground when arguing the case for slate-quarrymen in North Wales coughing themselves to early deaths from silicosis.

And it still goes on. Closely related to the cosmetic industry’s woes and fresher in the memory was the campaign to re-examine the use of breast implants. As we write today, we are still prevaricating over what happened to haemophiliacs. Successive scandals from maternity services and social care continue to shock even if they no longer surprise. Those who see something going wrong have many battles to fight and hurdles to cross before persuading the State to respond.

So, from time to time, as the wheels of policy-making grind on, and a helpful consultation emerges as a legitimate and broadly acceptable step along the journey, one questions whether it becomes part of the problem rather than a path to a solution. Those voices who despair at the time it has taken to address the Botox issue, and who claim that the proposed regulation is too little, and overdue, are largely silent today. So also, are those who fear that yet another business for cash-strapped. poorly-scrutinised local authorities to regulate may lead to more half-hearted and ineffective administration. For critics, there should have been a ‘how best to tackle this emerging issue’ several years ago. But maybe better to go along with action at last – rather than risk even further delay.

When we talk of consultations being ‘cosmetic’ we often imply a degree of deception – something designed to look better than it really might be. There are plenty of these, unfortunately – often when the headline subject-matter suggests a wider public debate than the detailed scope of the exercise allows. Sometimes it is so blatant that Ministers are caught out in the Courts, as when a consultation promoted as being about the content of the National Planning Policy Statement turned out to have been intended only about the form of the document (The 2019 Claire Stephenson case).

The Botox consultation is not one of these. It is a respectable attempt to gather views that will, almost certainly influence the emerging regulatory framework. And its purpose is clearly to demonstrate that a range of views will be considered. Nothing cosmetic about that.

What is less impressive is the relative lack of context, making the reader think this is a bit of routine bureaucratic tidying-up with no particular urgency, whereas, in fact it needs to have been a more proactive and faster response to a matter of well-founded public concern for some years.

Maybe not the first time Botox has been held to be too little; too late?

Rhion H Jones LL.B

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