Public Health (Wales) Bill – cosmetic and therapeutic procedures

11 June 2015

Article by Victoria Paris, National Assembly for Wales Research Service

This post is one of a series following the introduction of the Public Health (Wales) Bill on Monday 8 June. Further articles on each of the Bill’s proposals are being published throughout the week.

Image from Flickr by Reg Natarajan. Licensed under Creative Commons.

Image from Flickr by Reg Natarajan. Licensed under Creative Commons.

A number of cosmetic and therapeutic procedures, for example body piercing and tattooing, are becoming more and more popular.  However, there are associated health risks with these type of procedures if they are carried out in an unhygienic fashion. 

Improper and unhygienic practices may result in localised skin infections, the spread of infectious diseases, or the transmission of diseases such as blood-borne viruses.  For example, just recently (May 2015) a tattoo and piercing parlour in Newport was at the centre of a health scare, with hundreds of customers being invited to have precautionary tests, after five customers who had piercings at the parlour all suffered serious skin infections.

Currently in order to ensure infection control arrangements are adequate and effectively carried out, there is a registration scheme and some regulatory controls.  However, registration is not currently mandatory and the enforcement of provisions are often inconsistent.

The recently introduced Public Health (Wales) Bill sets out a series of specific proposals in priority areas of public health including provisions in the area of cosmetic and therapeutic procedures (referred to as special procedures in the Bill).  These special procedures include acupuncture, body piercing, electrolysis and tattooing; however, the Bill also provides Welsh Ministers with the power to amend the list of special procedures through secondary legislation.  The Bill’s aim is to ensure that where special procedures are provided in Wales, they are carried out in a manner which is not potentially harmful to health or well-being.

With regard to special procedures the Bill includes provision for the following:

Creating a mandatory licensing scheme for practitioners and businesses carrying out special procedures in Wales

In order for an individual to perform any of the special procedures they must be licensed and the premises, or vehicle from which they operate, approved.  It will be an offence for a practitioner to conduct any special procedures without a licence or to perform any procedures from premises or vehicles that are not approved.  Through regulations the Welsh Ministers will set licensing criteria and mandatory licensing conditions to ensure that standards of practice and enforcement of special procedures are consistent throughout Wales.  Local authorities will be responsible for enforcing the licensing requirements and for keeping a public register current.  Practitioners will also be required to provide pre- and post-procedure consultations to ensure that people are fully aware of the risks associated with the procedure and how to self-administer any required aftercare.

In the Welsh Government’s White Paper consultation the majority of respondents supported the establishment of a national special procedures register in Wales.  Respondents believed that a register would:

  • help identify safe premises which meet a certain standard;
  • help individuals to make informed choices about who to go to for a particular procedure;
  • ensure consistency of approach across Wales and remove the existing registration and byelaws process; and
  • benefit practitioners who work at different places around Wales.

However, a number of respondents were opposed to the introduction of a register, stating that:

  • there are no/few problems with the current system;
  • resources required to enforce a register may divert funds from other priority services; and
  • a register could lead to additional and onerous bureaucracy, especially for small businesses.

A number of respondents also felt that acupuncturists who are members of the British Acupuncture Council and pharmacists and chartered physiotherapists practising acupuncture should be exempt from the register as they are already appropriately trained and practice to strict Codes of Practice and Ethics.  Similar views were expressed with regard to electrolysis.

The Bill as introduced does provide exemptions to some requirements, for example members of a specific profession, such as doctors, will not be required to have a licence to practice special procedures, unless regulations provide otherwise.

Introducing a ban on the intimate piercing of people under 16 years old

There are a number of issues with regard to intimate piercing of children and young people.  Due to young people being less likely to have the experience or knowledge of how to clean or maintain an intimate piercing, complications, such as infections, are more prevalent and as young people continue to grow during their teenage years an intimate piercing could result in further complications as their body develops.  The intimate piercing of children and young people could also be considered a child protection issue.  As stated in the Explanatory Memorandum:

By undergoing the procedure, young people may be putting themselves in a vulnerable position by placing themselves in situations in which their ‘intimate’ areas are exposed to, touched and pierced by an adult who may be previously unknown to them.

Currently in Wales there is no age restriction for any body piercing.  If a young person is capable of understanding the nature of the act to be done then they can give valid consent.  Due to the nature of the procedures and the intimate areas involved some criminal legislation, for example the Sexual Offence Act 2003, may be relevant, however an intimate piercing is not automatically a sexual assault or criminal offence.

The Bill defines an intimate piercing as the perforation of the skin or mucous membrane of the anus, breast (including the nipple and areola), buttock, natal cleft, penis (including the foreskin), perineum, pubic mound, scrotum or vulva.

The purpose of the provisions in the Bill to prohibit, in Wales, the intimate piercing of a person who is under the age of 16 is to protect children and young people from the potential health harms of an intimate piercing and to avoid circumstances where they are placed in potentially vulnerable situations.  The Bill will also provide greater clarity and consistency in the law.

The Bill also makes it an offence for a person in Wales to make arrangements to perform an intimate piercing on a person who is under the age of 16, so even if a young person had not undergone an intimate piercing the making of arrangements for the procedure would be classed as an offence.

The Bill does provide a ‘due diligence’ defence for a person who offers to perform or performs the intimate piercing if they have taken reasonable steps to ensure that the person requesting the piercing was aged 16 or over, such as checking their age.  A person under the age of 16 providing their consent or consent given by a guardian or parent on their behalf will not be a classed as a defence.

Local authorities will have a duty to undertake enforcement action in relation to the provisions, including bringing forward prosecutions and investigating complaints, and appointing ‘authorised officers’ for these purposes.

Currently many practitioners choose not to perform intimate piercings on young people under the age of 18 and the Bill will not affect the ability of practitioners to continue this policy.