Licensing and further regulation of non-surgical procedures: business and regulatory impact assessment

Section 2: Engagement and information gathering

Engagement approach

The Scottish Government has adopted a comprehensive and inclusive approach to engagement regarding the regulation of non-surgical procedures including consultations undertaken in 2020 and 2024/25. The Scottish Government has ensured that the views of a wide range of stakeholders, including healthcare professionals, industry representatives, regulatory bodies, business owners and members of the public, have been listened to and reflected in the iterative development of the proposals.

Different groups of stakeholders have been involved at different stages through policy development, but the Scottish Government is confident that the proposals outlined in the response to the 2024/25 consultation have benefitted from the fullest range of views. This impact assessment has additionally benefitted from a specific survey on those proposals. Changes have been made to the approach as a result of this and ongoing feedback.

Two separate consultation processes brought in a range of views, and the Scottish Government has also undertaken specific activity to bring in any views or expertise that has been underrepresented at previous stages of policy development.

A common theme throughout the development of policy has been the paucity of hard data on, for instance, the size of the current sector, and the volume of procedures being undertaken. These limitations are acknowledged in this, and in other impact assessments. The Scottish Government is open to new data or new information, and is prepared to revise elements of this impact assessment and consider the impact of any new information on its position.

To identify the information required to make informed policy proposals the Scottish Government has relied on a mix of formal consultation and surveys, larger-scale events and small-scale engagements, speaking to specific experts and reviewing significant amounts of correspondence from people working in all parts of the sector. This has enabled a mixture of evidence to be collected, ranging from broad public views to specialist clinical information about the risks of procedures, and information from businesses about models of practice. More about the approach to engagement was discussed in the response to the 2024/25 consultation.

The Scottish Government considers that the approach to engagement has been appropriate and will continue to engage with a variety of stakeholders as the Bill progresses, as a licensing Order is developed, and as future steps (as outlined in Section 5) are taken.

Internal Scottish Government engagement/ engagement with wider Public Sector

Internal Scottish Government engagement

Extensive engagement has taken place with a variety of relevant internal Scottish Government stakeholders and subject matter experts, with a focus on seeking expertise on matters such as trade and business, criminal justice, professional regulation, public health, pharmacy and medicines, and existing regimes in relation to skin piercing and tattooing. This was undertaken to inform developing proposals and ensure that the proposed licensing and regulation of procedures was undertaken in such a way as it harmonised with wider policy priorities and avoided any unintended consequences.

Scottish Government officials also attended meetings of the Regulatory Review Group to present emerging proposals, and feedback has been received as published on the group’s webpage. The Regulatory Review Group’s remit is to examine and identify implementation challenges and appropriate mitigations of regulation. Their advice to Scottish Government informed the development of policy and will continue to inform the approach to implementation, especially in respect of the balance between legislation and non-legislative standards which may be set in guidance.

Advice was also received from the Directorate for International Trade and Investment and related areas to ensure that the proposals would not represent a restriction in the trade of goods and services, or undermine inward and internal investment in Scotland, matters which are considered in more detail in Section 4 of this Impact Assessment.

UK/ Devolved Administrations

The Scottish Government has maintained regular official level engagement with the UK Government, in particular the Department for Health and Social Care (“DHSC”), and with the relevant departments of the other administrations. The UK Government has been developing equivalent proposals for England, and discussions with DHSC have included discussion of the consultation undertaken by the UK Government, elements of which informed initial proposals that were included in the Scottish Government’s own consultation proposals.

Health is a devolved area and given the distinct regulatory landscapes in each country of the United Kingdom, these discussions were not intended to achieve a single or common approach to non-surgical procedures. The Scottish Government is aware that there is a risk that differences in regulation in England and Scotland could lead to confusion for clients and practitioners (especially those operated near the border) or provide an incentive to travel between Scotland and the rest of the UK for procedures. The Scottish Government will work with the UK Government to identify any such potential effects and consider if they can be avoided. Discussions will continue as the UK Government advances its proposals, and if the other UK administrations develop proposals in this area. Discussions will consider the effect of any divergence and ensure mutual learning.

UK Internal Market Act 2020

Engagement with the UK Government’s Department for Business and Trade has also taken place to support consideration of the impact of UK legislation on emerging proposals, and how they relate to the UK Internal Market. The UK Internal Market Act 2020 (UKIMA) was introduced with the stated intention of ensuring the smooth functioning of trade and professional services across the four nations of the UK following the UK’s exit from the European Union.

UKIMA was passed without the consent of any devolved legislature, and the Scottish Government position in relation to UKIMA is set out in a position paper published as part of the ongoing statutory review of the Act being undertaken by the UK Government in 2025 (Internal Market Act 2020: position paper - gov.scot).

The Scottish Government worked with the UK Government to support consideration of whether the UKIMA presented a challenge to emerging proposals and especially proposals to require practitioners of non-surgical procedures to meet specific training and qualification standards, and for certain procedures to be undertaken by certain healthcare professionals.

The Scottish Government is confident that the Bill introduced to the Scottish Parliament is effective, enforceable and is not in breach of any aspect of UKIMA. The UK Government has confirmed that it was not the intention of UKIMA to prevent any part of the United Kingdom from putting in place proportionate measures to protect public safety. The Scottish Government is continuing its consideration of these issues insofar as they may relate to the exercise of powers in the Bill, or the proposed practitioner licence in secondary legislation to give effect to elements of the proposals relating to training standards, supervision and the restriction of some procedures to appropriate healthcare professionals. This issue is also discussed in Section 4 “UK, EU and International Regulatory Alignment and Obligations” and Section 5 insofar as it relates to the proposed implementation of the Scottish Government proposals.

Wider Public Sector

The proposals have been informed by discussions with a number of parts of the wider public sector. Collaboration with Healthcare Improvement Scotland (HIS), which currently oversees the regulation of certain clinics providing non-surgical procedures has been crucial in identifying gaps in the existing regulatory framework and in determining how future models might be effectively implemented across a diverse and evolving sector.

Additionally, the Scottish Government has considered the perspectives of other relevant regulatory bodies, including local authority environmental health officers (EHOs) who are responsible for licensing under the Civic Government (Scotland) Act 1982, and professional regulators for healthcare practitioners. Input from these organisations has helped shape the regulatory proposals to ensure alignment with current practice, avoid duplication, and address enforcement considerations.

Engagement with HIS and EHOs has been carried out partly through the Scottish Cosmetic Interventions Expert Group (SCIEG), but has been supplemented with separate discussions, and specific discussions with COSLA.

Finally, the Scottish Government is in ongoing discussions with Business Gateway and Skills Development Scotland on the support and advice available for businesses affected by legislation.

International

The Scottish Government has not engaged specifically with government organisations outwith the UK, but has undertaken some consideration of other regulatory models. Regulatory modes vary between nations, so direct comparisons are challenging. The Scottish Government does note correspondence it has received and reports that this industry is less regulated here than in other comparable (EU) nations. In particular, in many countries, procedures that are currently entirely unregulated in Scotland, such as injectable procedures, are restricted to healthcare professionals or healthcare settings, dependent on the structure of regulation in a given country.

Business/ Third Sector engagement

The Scottish Government has received substantial engagement from businesses in this sector. The Scottish Government undertook targeted engagement with businesses in the sector from the regulated and, substantially, the unregulated part of the sector, and through the SCIEG group, which included participation from both healthcare professionals who were involved in the industry, and insurers and educators representing the hair and beauty industry and wider non-healthcare led part of the sector.

During the period of the 2024/25 consultation (described below) two engagement events were held specifically for businesses from the non-healthcare led part of the sector, and around seventy individuals signed up for the two events. One was an in-person event held in Glasgow during the working day, and the other was an online event held in the evening. In advance of, and following, these meetings the Scottish Government received extensive correspondence from businesses in this part of the sector, as well as continuing to receive representation from medical professionals and healthcare led businesses. The voices of business owners could therefore be considered as the proposals were developed.

This engagement built upon evidence gathered through the public consultation and was further enhanced by an additional survey, specifically designed to assess the impact of the updated policy proposals on businesses. The aim was to ensure this Business and Regulatory Impact Assessment was robust and evidence based.

This additional survey was sent to participants from the public consultation who had identified themselves as owners, managers, or employees of businesses providing non-surgical cosmetic procedures and who consented to be contacted further. In total this survey was sent to 665 recipients. The survey was not publicly advertised as it was targeting businesses rather than anyone wanting to comment, though the link was shared among some interested parties. Ultimately, 591 responses were received, providing a substantial evidence base for the assessment.

Respondents represented a diverse cross-section of the sector:

• Clinics or settings currently regulated by HIS
• Salons or clinics not regulated by HIS but led by healthcare professionals
• Salons or clinics not regulated by HIS and not led by healthcare professionals
• Other categories, including training providers, clients, associates, and businesses supplying or manufacturing products.

This categorisation allowed for nuanced analysis of how the revised proposals would differently affect businesses, depending on their current regulatory status and operating model.

The survey provided both quantitative and qualitative evidence regarding anticipated business impacts. While not all responses contained detailed financial data, the breadth of perspectives, including from businesses inside and outside Scotland, helped identify key issues and themes. In addition to direct survey responses, further feedback was gathered from businesses outside the survey, including those who volunteered financial information.

Engagement extended beyond direct providers of cosmetic procedures to include training providers, pharmacies supplying the sector, and manufacturers. The “ripple effect” was noted, with concerns about decreasing demand for training as regulatory uncertainty grew, and the impact on business viability was considered in the analysis.

The engagement process highlighted a range of impacts, both positive and negative, and reflected a diverse set of experiences and views across the sector. Importantly, it surfaced sectoral concerns such as economic viability, fairness, emotional impact, and the risk of shifting activity to unregulated providers. This evidence informed the policy development process, ensuring that the Scottish Government’s proposals were grounded in understanding of real-world business experiences and concerns.

A fuller write-up of the responses to the additional survey to businesses is annexed to this impact assessment.

Public consultation

The Scottish Government undertook a public consultation that ran from 20 December 2024 to 14 February 2025, which received 2,207 responses, as well as leading to an increase in correspondence and media attention to the issue. Of the responses, 2,075 were from individuals and 132 were from organisations. Of the total responses, 526 indicated they were involved in a regulated setting (such as working within HIS registered clinics or other medical environments), while 367 indicated they worked in unregulated settings such as beauty salons. This granular approach allowed the government to capture the perspectives of both regulated and unregulated providers, as well as to identify potential challenges and opportunities unique to each part of the sector.

The consultation outlined a set of proposals for the regulation of non-surgical cosmetic procedures, through a combination of a licensing scheme and restriction of certain procedures to regulated settings and/or certain appropriate healthcare professionals. The consultation also covered the role of local authorities and HIS in inspection and enforcement. The consultation proposed the allocation of specific procedures to three groups, to differentiate in what setting procedures should be carried out and by whom, standards for hygiene, training and insurance, and age restrictions.

The responses showed broad support for action to make the sector safer. This included support for a licensing scheme for some procedures (called Group 1 procedures), and the restriction of some procedures only to appropriate healthcare professionals (called Group 3 procedures). Scottish Government proposed a middle group of procedures (called Group 2) that was proposed should be restricted to HIS regulated or clinical settings, but could be carried out by non-healthcare professionals. Views on Group 2 were split. Most respondents believed that the majority of the procedures in the proposed group should either be restricted to healthcare professionals (with Group 3) or be available in licensed premises (with Group 1).

There was strong support for many of the practical aspects of proposals made. This included the requirement for a dual licensing system (for premises and practitioners) for lower risk procedures taking place outwith a HIS regulated setting, and for local authorities and HIS to have appropriate powers to enforce their proposals. There was also strong agreement that non-surgical cosmetic procedures should only be carried out on people aged 18 and over.

Responses to the consultation from all respondents who gave permission have been published on the citizen space website. The Scottish Government response to, and updated proposals following, the consultation has been published and the response can be found here.

Other stakeholders

The key stakeholders for the Scottish Government in relation to this piece of work are those who are currently involved in the industry, those who have raised concerns or can provide evidence of the harms and challenges to public safety that policy in this area seeks to address, and those who are involved in the sector as regulators, including local authorities, HIS and professional regulators. Engagement with these groups is detailed above.