Written evidence submitted by Transform Hospital Group Limited (OSB0040)

This document sets out Transform Hospital Group’s evidence submission to the Draft Online Safety Bill (Joint Committee)’s inquiry, to support and inform the work of the Committee before it reports to Parliament in December 2021.

About Transform Hospital Group: what we do and the values that define us

Transform Hospital Group is an independent healthcare and wellbeing services organisation and the UK’s leading provider of cosmetic interventions – both surgical and non-surgical – and weight-loss solutions. We operate two state-of-the-art hospitals – Burcot Hall in Birmingham and The Pines in Manchester – in addition to a nationwide network of clinics which cover most major towns and cities across the UK.

An absolute commitment to patient safety, clinical excellence and corporate responsibility underpins everything we do and is core to our identity as a healthcare services provider. Transform Hospital Group has been proud to support the NHS during the COVID-19 pandemic, supporting the delivery of elective care for NHS patients by making our hospitals in Birmingham and Manchester available to local NHS trusts; playing our part in supporting the nation’s response to the crisis at a critical time for public health services and our local communities.

Reasons for responding to this inquiry

This proposed legislation comes at a timely moment for online advertisers. We welcome its proposals in the context of a rapidly evolving, globalised and technology-led consumer culture.

It is this culture that defines and is currently shaping the cosmetic interventions sector specifically. As an engaged and socially responsible healthcare provider, THG operates with a clear-minded awareness that the cosmetic interventions sector is exposed to a fluid and often unpredictable cultural environment. This landscape is characterised by a range of factors, including a dramatic upsurge in the popularity of gamified reality television, trends in the beauty and fashion industries, the rise of social media influencers, and the way that young people in particular use, share and engage with content on image-based social media platforms.

This has coincided with growing evidence that suggests a link between the use of social media platforms and an upsurge in issues relating to mental health conditions such as body dysmorphic disorder, particularly amongst young people.

As a market leader in the sector, we recognise our responsibility to adopt an extremely thoughtful, considered and nuanced approach to the way in which we engage patients and respond to this environment – through our marketing activity, our patient interaction, the surgeon and nurse-led consultation processes and in the delivery of aftercare.

We recognise and embrace the imperative to remain forensically aware of the external dynamics that may condition the motivations of our patients, and thus adopt a holistic and compassionate approach to patient safety and wellbeing throughout the patient journey.

We also recognise the constantly evolving nature of the online operating environment, however it is clear that digital service providers are currently failing to enact a robust and considered duty of care for their users. It cannot be solely left to advertisers to ensure responsible practice online, and it is within this context that we welcome the Draft Online Safety Bill.

The timing of this inquiry follows a recent Transform Hospital Group intervention surrounding advertising practice in the cosmetic interventions sector. The nature of this intervention, along with the regulatory proposals put forward by the company, will be of interest to the Committee as it considers the broader context of the Draft Online safety Bill.

Regulatory considerations  

Transform Hospital Group believes that existing standards governing the advertising of cosmetic interventions are broadly fit for purpose as it relates to providing effective oversight of cosmetic interventions advertising for their intended adult audience. However, we have identified an opportunity for a series of targeted amendments to the existing guidelines as it relates to restricting the exposure of under-18s.

We are firm in our belief that any marketing activities specific to the cosmetic interventions we deliver are only suitable for, and should be solely viewed by, adults, and must be developed sensitively and appropriately. We therefore take extremely seriously our responsibility to ensure our own marketing activities are focused on our intended audience and do not target under-18s, directly or indirectly.

As a result of changing media consumption habits, prolific usage of image-based social media platforms – and in light of recently published data showing an increase in mental health conditions amongst young people following successive COVID-19 lockdowns – we have specific concerns that under-18s are particularly exposed to the cultural environment referred to above, which may inform perceptions of their own body image, sometimes with negative consequences for their mental health and self-esteem. We therefore believe that a response is required to adapt the regulatory environment to reduce the potential exposure of under-18s to cosmetic interventions marketing materials, which are intended solely for an adult audience.

In support of work currently being undertaken relating to cosmetic interventions advertising, which is being carried out by the Advertising Standards Authority, Transform Hospital Group has recommended the introduction of targeted measures specific to under-18s, which we believe would serve to further strengthen existing regulation and guidelines and ensure that they remain aligned with rapidly evolving dynamics surrounding the cosmetic interventions sector. We therefore recommend that the ASA considers and moves to implement:

We believe that the introduction of these measures would mark an important step towards ensuring that the marketing of cosmetic interventions, which is designed exclusively for an adult audience, does not inadvertently reach or influence under-18s.


The role of digital service providers

Due to the rise of new digital service platforms, and new modes of consuming and engaging with content, it has become increasingly challenging for advertisers to ensure that their marketing materials do not reach specific audiences, in this case under 18s – particularly on social media platforms.  

Concurrently, the proliferation of harmful content online, and the causal effect that this has had on mental health issues amongst young people in particular, demonstrates that digital service platforms are currently failing to deliver on their duty of care to their users. 

There is no ‘quick fix’ for this challenge, but there is a current void in accountability for social media platforms and they must do more to prevent users from viewing and engaging with inappropriate content. Platforms must also do more to support advertisers in restricting and filtering content for under-18s especially. 

That is why we welcome the proposed imposition of a duty of care on digital service providers to moderate user-generated content in a way that prevents users, specifically children, from being exposed to illegal, harmful and/or inappropriate content online.

As such, the legislation must have specific and clear mechanisms in place to define the parameters of digital service providers’ duty of care, what it should entail and how it will be enforced.

As a responsible and engaged organisation, we want to take steps to respond to the challenges of the constantly evolving digital operating environment. Our intervention and response to these challenges is representative of that intention, and we will continue to support regulators and policy makers in this regard. 

Our internal protocols

As a demonstration of our desire to set a benchmark for responsible practice, we have recently launched a range of further internal policies and protocols in relation to our advertising activity, focused on restricting the extent to which under-18s may view or engage with our marketing content. Therefore, effective immediately, Transform Hospital Group has:

Concluding remarks

Transform Hospital Group thanks the Committee for their review of this legislation, and would welcome the opportunity to meet with members to discuss our perspectives and proposals.


17 September 2021