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Following this, the International Agency for Research on Cancer upgraded its assessment of sunbeds to its highest level of cancer risk. In November last year, the independent Committee on Medical Aspects of Radiation in the Environment-COMARE-also assessed the evidence and concluded that legislation is needed to prevent the commercial use of sunbeds by under-18s. This concurred with the same earlier conclusion from the World Health Organisation and the European Scientific Committee on Consumer Products. The US Food and Drug Administration is considering strengthening its measures on sunbeds.

We now lag behind Belgium, Finland, France, Norway, Portugal, Spain, Sweden, USA, Australia and New Zealand, where specific legislation is already in place to protect under-18s from the dangers of sunbeds. Here in the UK, the Scottish Government's Public Health etc. (Scotland) Act 2008 includes a ban on under-18s using sunbeds. The Health Minister in Northern Ireland announced last week that as soon as possible he would be bringing forward strong legislation on sunbeds. The Secretary of State for Health in England and the Minister for Health and Social Services in Wales are committed to bringing regulations forward straight away when this Bill's passage is successful.

There has been wide consultation on the Bill. In the other place, 215 MPs signed the EDM on under 18 year-olds and sunbeds, showing massive support

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for this Bill from across all parties. This Bill is needed because voluntary regulation has failed. The Bill is proportionate to the problem.

The Sunbed Association has over 1,100 members, including retailers, distributors and salons. Representatives met me to discuss the Bill and have been most helpful trying to clarify issues around regulation of the industry. It has its own code of conduct that is compatible with the Bill and has emailed me to say:

"The Association totally supports the Bill, in terms of a ban on sunbed use by anyone under 18 years, and a ban on unsupervised tanning (unstaffed tanning salons). A minimum age restriction and the need for tanning salons to be manned by trained staff at all times have always been requirements in the Association's Code of Practice. Our Code also requires the provision/display of health and safety information".

The association has sent me this code of practice, which is based on the European standard; it will be most helpful in drawing up guidance on implementation of this Bill. The association raises concerns that the output standard from Europe, which states that the output from a sunbed must not exceed a maximally weighted irradiance of 0.3 watts per square metre, is not universally observed. This standard is a living document which is due for revision from this June, and I know there are ongoing discussions with the industry about this.

I visited a supervised salon in Cardiff recently, owned by a family with teenage children. They do not allow children to use their sunbeds and they welcome legislation as it will support their high standards of practice. Unfortunately, not all salon owners are so responsible. Many tanning salons are unsupervised or operate on only the most cursory checks, if any, on young people before letting them use the sunbeds. Cancer Research UK commissioned a piece of focus group research with under-18s in 2009. The following quotes are shocking, but far from unique:

"I just walked in and she was, like, 'Have you got your coins for the machine?' and that was that",

from Stoke-on-Trent;

"They didn't ask my age because we went with my friend's sister",

from Bushey;

"I think they're just not bothered about the money and they're under-age too",

from Newcastle.

Research commissioned by CRUK found that more than a quarter of a million children have used sunbeds in England. Among 15 to 17 year-old girls, sunbed use was particularly high, especially in Liverpool and Sunderland, where half of the girls in this age category use sunbeds and 18 per cent of young people who have not used a sunbed would consider doing so in the future. Voluntary regulation of tanning salons has clearly failed.

Professor Lesley Rhodes at Manchester University tells me they are now seeing a rapid rise in melanoma in young people and severe photodamage to skin collagen, which causes premature ageing, in early adulthood. Professor Paula Grey, director of public health in Liverpool-the city with the big problem-in welcoming the Bill and highlighting their upward trend in malignant melanoma, wrote:



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"In Liverpool the voluntary code has not worked. The evidence from local surveys and questionnaires highlights that, in many salons, there is a lack of skin typing, no advice on goggles, no warnings of overuse and no age restrictions on under-16s. In Liverpool, 49 per cent of young people between the ages of 14 to 17 years are using sunbeds. Thirty per cent of young people are using them more than three times a week and this equates to 150 sessions per year-eight times the World Health Organisation's recommended adult exposure limit".

The COMARE report concluded that poor compliance is found against a variety of control measures where strict legislative controls do not exist. COMARE and WHO are clear about the proportionality of stricter controls on sunbed salons. Local authorities already visit sunbed salons but at present they do not have the powers to ensure that salons are operating responsibly. The Bill would redress the balance and give them powers to ensure that under-18s are not using sunbeds and, further to the introduction of associated regulations, to ensure that a number of other good practice guidelines are adhered to. The key point is that the legislation will not place a major additional burden on local authorities in terms of extra workload as these businesses are already being inspected. Rather, it will ensure that current working is more effective and safeguard the health of young people.

I should make it clear that this Bill would not prevent adults using sunbeds, but the responsible side of the industry agrees that sunbed salons should be supervised to protect children and that providing information to sunbed users should not be optional; adults need to be able to make informed choices about decisions that affect their health. Under-18s are not allowed to buy alcohol or knives, so the Bill would bring the age at which one can use commercial sunbeds in line with other age restrictions across the UK. It is practical and ensures clarity of message.

In conclusion, the Bill would protect our children; it is necessary, workable and enforceable; it could save lives. I commend it to the House.

2.41 pm

Baroness Barker: My Lords, I congratulate the noble Baroness, Lady Finlay, on this typically thoroughly-researched, targeted and focused legislation for which she is rightly known. On a day when it is snowing in Scotland, I was preparing for this debate and I thought about my Scottish childhood-I freely admit it-when beachwear consisted of Aran jumpers because it was so cold. However, it was not so many years ago that friends of mine suffered badly from sunburn in Aberdeen, which was previously unheard of. So the background to the Bill is one in which our climate is changing, which adds some weight to the debate. We on these Benches welcome and support the Bill. Like all legislation, it could perhaps do with some revision but, as a first step, it is a sound basis on which to proceed.

In my research for the Bill I was glad to see a paper from the British Association of Dermatologists; its acronym is BAD but, from its briefing, it seems a very good organisation. It is absolutely unequivocal in calling for a ban on coin-operated and unmanned sunbeds. Its reason for doing so is that the evidence base is so strong. In this House in recent times we have debated different measures to tackle the issue of cancer

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prevention and sometimes we have disputed the evidence, but this time the evidence from this country is clear and unequivocal.

The British Association of Dermatologists makes a good point when it indicates that many people are completely unaware of the risks of these machines-indeed, some people labour under the impression that they are beneficial to health-and it cites the moves in Scotland towards licensed premises and licensed machines as being of benefit. It is right that local authorities should be given powers to ensure that there is compliance with a licensing regime and that standards are met. There is a responsible end of the industry which deserves to be supported. As the noble Baroness said, a great many people go about their business in a perfectly reasonable and honest way and we would not wish to prevent them doing so.

I was particularly taken by a study in Northern Ireland. I know that the Bill applies in England and Wales but, although I am not keen on legislation which seeks to go into other jurisdictions and choose examples of how one might selectively go about doing things, it seems to me that this study is highly relevant and very valuable. It was conducted by a team led by Mr Art O'Hagan and studied 322 tanning salons in Northern Ireland over an eight-week period in July and August 2007. It came up with some remarkable findings. Over a quarter of the premises used type 4 sunbeds, which are for medical and not cosmetic use, and it is possible that many others were using sunbeds which emitted UV rays way in excess of those. Most of the salon owners-62 per cent-did not know what level of radiation was being emitted by their machines; 39 per cent of the premises reported that they did not regularly test their devices and did not know when the last inspection had been; and in 71 per cent of tanning salons the operating manuals for the beds were not available and there was no reliable oversight of the machines. Faulty machines can produce very high levels of radiation, cause burning of the skin and potentially lead to skin cancer.

It is interesting that in one-fifth of the tanning salons, the customers' skin type was not discussed with them. Of the indigenous population of Northern Ireland who felt that they had very dark skin, 40 per cent were skin types I and II-light-skinned people who are particularly at risk. People with skin types V and VI-dark Asian or black skinned-are much less open to damage from UV rays. If you combine badly managed enterprises with people who do not know their own risk factors, you could end up with a potentially lethal situation.

Worryingly, the study found that in 38 per cent of cases people were charged for using protective eye goggles. We know that these machines can cause severe damage to eyes and, particularly, cataracts. All in all, the findings from Northern Ireland are very relevant to England and Wales.

Other studies, such as the one carried out at the Ninewells Hospital in Dundee which was a precursor to some of the Scottish measures, have also found that the levels of UVB radiation from machines were increasing; the machines are becoming much stronger than they were in the past.



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I said that I do not like cherry picking from other jurisdictions but in America, William James, the president of the American Academy of Dermatology, said that his group has seen a startling increase in skin cancer among women in their teens and twenties. He went on to say:

"What was formerly considered a disease of older men is ballooning in young women, the very target audience and the number one customer of the tanning industry".

My colleagues in Liverpool, where we know there is a particular problem, are very supportive of the Bill. Ron Gould, a Liberal Democrat councillor, has been working for a number of years to try to bring about exactly the sort of measures contained in the Bill. He wishes to see them on a statutory basis so that local authorities can go after unlicensed premises which are acting unsafely and target particularly vulnerable groups within the city's population. There are more than 300 premises with sunbeds in Liverpool and across the Mersey on the Wirral, and an outbreak of dermatological problems at some of them is becoming very serious.

The evidence base is sufficiently strong for us to accept the Bill; it may not be perfect but it is a good way to proceed. It does not, for example, limit the access of children and young people to private sunbeds-that is outwith its ambit-but it makes a start. I have one reservation. We are placing yet another duty on local authorities, albeit not one of the biggest. The duty will also fall disproportionately on different local authorities. I therefore ask the Minister whether the department might work with those local authorities in which there is a particular incidence and prevalence of the problem not only to assist them with ensuring that there is compliance but in funding targeted awareness campaigns. One thing that is becoming very apparent is that we do not just have the broad headlines on health and illnesses associated with this; we are getting very good at mapping to a high level the incidence of this in the most vulnerable communities.

All in all, this is a good piece of legislation and I am very pleased to lend support from these Benches.

2.51 pm

Earl Howe: My Lords, I begin by saying that I have nothing but praise for the noble Baroness, Lady Finlay, for bringing forward this Bill today and for introducing it so powerfully and so well. In adding my strong support for all that she has said, I declare an interest as chairman of RAFT, the Restoration of Appearance and Function Trust, a medical research charity which for many years has been carrying out ground-breaking research into the prevention and treatment of skin cancer. The work of RAFT, which incidentally runs much wider than just skin cancer research, is unique in the medical research world, and I am proud to be associated with it. The entire board of trustees at RAFT is, needless to say, behind this Bill to a man and woman.

Whenever we regulate to prohibit an activity we have to ask ourselves two key questions. The first question is whether the case for prohibition is based on good scientific evidence of actual harm being done; and the second is whether the aims underlying

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the regulation could be achieved equally effectively by other means. I am absolutely clear that this Bill passes both tests. The science behind it is now indisputable; we know that melanoma is now the most common cancer in young people aged 15 to 34 and that it kills more than 2,000 people every year. Its incidence is doubling every 10 years. Although women are more likely to contract it, men are more likely to die from it. Its incidence is associated with affluence, and is highest in south-west England, though it is also high in much of Scotland, Ireland and southern England, perhaps because of the high numbers of fair-skinned people in those areas.

We also know that sunbeds contribute to the annual death toll from skin cancer. The International Agency for Research on Cancer recently stated that there is, "no doubt sunbeds cause cancer", upgrading sunbeds to be definitely "carcinogenic to humans", with a 75 per cent increased risk in melanoma in people who started using sunbeds regularly before the age of 35. The new assessment puts sunbeds on a par with smoking or exposure to asbestos. Sunbeds emit high-intensity radiation over a short time, which is predominantly UVA. Those intensities can be equivalent to or higher than midday Mediterranean sunlight. A study last year by DeAnn Lazovich et al, based at the Division of Epidemiology and Community Health in the United States, concluded:

"Melanoma risk was particularly pronounced among users of high intensity ... devices and high pressure ... devices. Risk increased as the total years ..., total hours ... or total sessions increased ... Conclusions-Because prevalence of exposure was high and detailed lifetime information about indoor tanning use and potential confounders were collected, this study overcomes many of the limitations of earlier reports. Our results provide strong evidence that indoor tanning is a risk factor for melanoma".

In a large cohort study conducted by the Karolinska Institute into indoor tanning and melanoma risk, the authors conclude:

"Solarium use in early adulthood and midlife increased the risk of melanoma in this large cohort study".

Sharply increased numbers of melanoma cases in Iceland have been associated strongly with sunbed use in a recent international study, which concludes:

"It is highly plausible that the high prevalence of sunbed use contributed to the sharp increase in incidence of melanoma in Iceland, especially of trunk melanoma".

While it is right for me to add that the three papers I have mentioned have not yet been peer reviewed, they were all presented at the 7th world melanoma conference in Vienna last year. All of them confirm what Cancer Research UK and the WHO have been saying for a considerable time on the basis of quite separate evidence. The recent COMARE report has added to that evidence. The bald fact is that the use of sunbeds by those under the age of 35 significantly increases the risk of developing skin cancer later on. In England, more than a quarter of a million children have used sunbeds. In some areas of the country, as we have heard, sunbed usage among teenage girls is extremely high, at around 50 per cent. It is clear that a lot of this usage is completely unsupervised, with coin-operated machines being accessible in some tanning salons without any restrictions or questions being asked. One should say here that members of the Sunbed Association take a responsible approach and abide by a very clear code of practice on

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these matters. However, members of the Sunbed Association account for only 20 per cent or so of all sunbed outlets; the rest are not subject to any controls at all.

This is the point at which we have to look at regulation as being the only answer. Self-regulation and guidance simply have not worked, as the noble Baroness, Lady Finlay, said, because too many businesses operate outside it. Such self-regulation as there is in the sunbed industry is not for the most part subject to independent supervision. The Bill before us therefore takes what I believe is a proportionate approach by focusing on the risks to young people, in whom there is clear evidence of actual harm now being done, and in whom the most harm is done by sunbed usage, and by homing in on young people's access to commercial tanning salons. As we have heard, however, the regulation-making powers in the Bill would enable appropriate restrictions to be extended in due course to the hire or purchase of sunbeds by young people. It would be helpful to hear from the Minister whether the Government intend to consult on implementing measures in this context.

As we debate this Bill today, it is not possible for us to say whether we shall be able to scrutinise it in detail in Committee, because of the possibility that Parliament may be dissolved during the next couple of weeks. In these circumstances, I hope I may be allowed to ask one or two Committee-type questions relating to Clause 5 of the Bill and the power to require information to be provided to sunbed users. I welcome the clause, but seek guidance on its practical implications. Regulations under the clause could bring advertisements by sunbed operators either wholly or partially under statutory control, rather than being subject to control by the Advertising Standards Authority as they are at present. That concerns me, because advertising controls are one area of non-statutory regulation that is working well.

All the media channels that are currently being used by sunbed operators are subject either to the Committee of Advertising Practice's code, known as the CAP code, or the Broadcast Committee of Advertising Practice's radio advertising standards code, which are both adjudicated upon by the ASA. The CAP code will shortly be extended to other business websites and other online space. These codes reflect the provisions of the Consumer Protection from Unfair Trading Regulations 2008, including those on misleading or aggressive advertising. An advertisement may be considered misleading either by containing false information or else by omitting pertinent information. The codes also contain rules that advertising should not be a cause of harm, and there will shortly be additional rules relating to social responsibility. On top of that, under the current system there is proactive daily monitoring of advertisements in all relevant media to check on their compliance with the codes.

Both the Government and the Office of Fair Trading regard the ASA as the "established means" for enforcing the consumer protection regulations. Will the Government therefore consider issuing guidance to the Sunbed Association to make compliance with the CAP code a requirement of their own code in respect of on-premises

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advertising material as a means of helping sunbed operators comply with the legislation? For non-broadcast advertising, I am aware that there is a wealth of free advice available to businesses from the Committee of Advertising Practice, which would make this an attractive way forward for the industry. Broadcast advertising of sunbeds is in a different category, but there is no reason why radio advertisements should not be made subject to advance mandatory clearance by the Radio Advertising Clearance Centre.

With regard to the age restriction contained in the Bill, does the Minister acknowledge that the advertising codes are already capable of reflecting the law where access to products is restricted by age, which suggests that they could do so equally well and equally effectively in this context? What consultation will the department engage in to clarify the role of those responsible for regulating advertisements in this area?

On the face of things, part of Clause 5 looks otiose in that the existing advertising codes effectively prohibit sunbed operators from making claims about unproven health benefits in their advertisements. Am I right about that?

I end by expressing the hope that the Bill reaches the statute book. As a means of protecting the young, especially those from deprived backgrounds, it is a public health measure of the greatest importance. The provisions of the Bill enjoy the support of the BMA, the Local Government Association and the Chartered Institute of Environmental Health, and they have been subject to consultation. I believe that the Bill will enjoy wide public acceptance. I therefore wish the noble Baroness, Lady Finlay, all success after today in taking it forward to its parliamentary conclusion.

3.02 pm

The Parliamentary Under-Secretary of State, Department of Health (Baroness Thornton): My Lords, I welcome the opening remarks of the noble Baroness, Lady Finlay, and I am delighted that she is taking this Bill through your Lordships' House. I am happy to be speaking to it today and I repeat that the Government support it.

The Bill is about tackling a public health issue and protecting young people. As a result of this Bill, people will have a greater awareness of the risks of using sunbeds and of sun damage generally. It seeks to prevent under-18 year-olds from using sunbeds by making it a criminal offence for sunbed businesses to offer them sunbeds. There are also provisions that set the scene for future regulation of sunbed use. The Government have already made clear our commitment to consult on the further regulations as soon as possible after the Bill passes.

I join the noble Baroness in thanking Julie Morgan MP and Siân James MP for their work in getting the Bill through another place where it was clear that it had cross-party support. I am pleased to see that this is reflected in your Lordships' House today. Quite simply, the Bill could save lives.

The noble Baroness has already outlined the scientific evidence and other noble Lords have given us the benefit of research. I do not intend to repeat all that,

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but it clearly shows that the evidence is there that sunbeds are a health risk when misused, and the risks are greater for young people. That is why there is a case for legislation.


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