Regulation of non-surgical procedures: equality and Fairer Scotland Duty impact assessment

Background

Policy Aim

Non-surgical procedures are procedures that pierce or penetrate the skin, whether through needles and the use of injectables or through treatments that use heat, cold or light and lasers. These procedures are undertaken for a number of purposes, including for cosmetic purposes, but also for wider wellbeing purposes such as to improve focus and vitality. Non-surgical procedures may be undertaken by a healthcare professional in a clinic or by a non-healthcare practitioner in a salon or similar setting.

Non-healthcare practitioners are not regulated as healthcare professionals are, and this lack of oversight means that it is difficult to know where or by whom services are being provided and how procedures are being performed, and to take the necessary actions if clients are harmed. While healthcare professionals are regulated within their specific professions (medical practitioners, nurses, dentists and so on) it is not clear how that regulation extends to the practice of non-surgical procedures, and there is no overall regulation of these procedures as a whole.

The UK-wide Keogh Review, published in April 2013, identified that there was little regulation of the cosmetic interventions sector and called for a new legislative framework. In response, the Scottish Cosmetic Interventions Expert Group (SCIEG) was set up by Scottish Government. The group’s membership includes healthcare professionals, hair and beauty industry representatives, environmental health officers, and a representative of Colleges Scotland (beauty and aesthetics educationalists). It has provided valuable evidence and insight to the Scottish Government. The SCIEG report of 2015 recommended a phased approach to the regulation of cosmetic procedures in Scotland.

The current policy aim is to introduce regulation whereby some non-surgical procedures must be carried out in premises licensed by a local authority, where this is considered an appropriate means of mitigating their risks, whereas more invasive non-surgical procedures are restricted to a setting regulated by Healthcare Improvement Scotland (HIS) where they will be carried out by, or supervised by, certain healthcare professionals. This will lead to improvements in standards of training, hygiene and safety, and allow for an enforcement regime for those premises and individuals.

We are also proposing an age restriction for non-surgical procedures of 18 years and over. This reflects the potential for lasting damage from non-surgical procedures that are not carried out correctly, and the fact that these procedures are generally not suited to younger skin and bodies which are still developing.

The provision of non-surgical procedures for healthcare purposes is not within the scope of this policy work and will continue to be made available through established NHS or independent healthcare pathways. The policy also avoids those procedures which are more widely considered to be surgical in nature, and where the Scottish Government is not aware they are being undertaken outwith appropriate settings.

Not all elements of the policy will be implemented at once. A Bill will introduce elements of these proposals, whereas other elements will be introduced by a separate order to be made under the Civic Government (Scotland) Act 1982. Further aspects, including the provision of training and qualification standards, supervision standards and the restriction of certain procedures to appropriate healthcare professionals, will be made in future legislation.

Who will it affect?

The main intended outcome of the proposals set out in the response to the public consultation is to improve the safety of non-surgical procedures for everyone. Ensuring non-surgical procedures are only carried out in licenced or regulated premises will significantly reduce harm and will allow authorities to be aware of where and by whom non-surgical procedures are being carried out. It will mean procedures and premises can be inspected and relevant enforcement action taken where necessary. It will also give confidence to clients that services are safe and follow consistent standards.

There will be costs to businesses and practitioners relating to obtaining and renewing licences for premises under the local authority licensing scheme, and for registration with HIS for the national scheme. There may be costs for staff to undertake appropriate training, either once relevant standards are in place or if practitioners move to work from regulated settings that require this training. There may also be costs associated with making improvements to premises and services so that they are able to apply for a licence or registration. These costs may be passed on to customers in higher prices.

Any premises where non-surgical procedures are carried out will need to meet certain standards of hygiene and safety, and be subject to inspection whether by HIS or the local authority. It may be possible for practitioners to work out of their own homes, but only if the space is licensed by the local authority or regulated by HIS and meets the relevant requirements. It will not be possible for non-surgical procedures to be carried out in the client’s home. This may restrict availability of some services to clients, but it will ensure safer provision of procedures.

It will be subject to the discretion of local authorities or HIS whether it is possible for a vehicle to receive a licence or registration in order to provide a mobile non-surgical procedures service, and any vehicle would again need to meet all the relevant requirements. This may further reduce availability, particularly in remote, rural and island areas, but it is not possible to establish how common such services currently are due to their unregulated nature.

What might prevent the desired outcomes being achieved?

It is crucial that there is consistency in standards for non-surgical procedures. This will ensure that practitioners are confident about the regulatory regime in which they are practising, and it will enable regulators to carry out inspection and enforcement fairly and meaningfully.

The Scope of the EQFSDIA

We have considered whether our proposals will affect particular population groups, that is those with protected characteristics under the Equality Act 2010, and also those groups who experience socio-economic disadvantage covered by the Fairer Scotland Duty:

• age, disability, sex, pregnancy and maternity, gender reassignment, sexual orientation, race, religion or belief; and
• people experiencing socio-economic disadvantage or from low socio-economic backgrounds, people with rare and/or long term health conditions, looked after children and young people, refugees and asylum seekers, minority ethnic people, homeless people, people involved in the criminal justice system, people with low literacy/numeracy, carers and people in remote rural and island areas.

Following discussions with a variety of stakeholders, including business owners and third sector organisations, and analysis of public consultation responses, we identified the following groups as potentially being specifically impacted:

• Children and young people, who will be protected from potential harms caused by non-surgical procedures;
• Remote, rural and island communities, where provision of services may already be sparse;
• Transgender people, who may look to non-surgical procedures to enhance their appearance; and
• Women, as the non-surgical procedures industry is largely female-led, but also as the majority of people seeking non-surgical procedures are also women.

An EQIA/FSD questionnaire was sent to the following organisations:

• Age Scotland
• Young Scot
• Inclusion Scotland
• Health and Social Care Alliance Scotland
• Disability Equality Scotland
• LGBT Health and Wellbeing
• LGBT Youth Scotland
• Scottish Trans
• Equality Network
• Engender
• Men Matter Scotland
• Carers Scotland
• Learning Link Scotland
• Interfaith Scotland
• Bliss
• Saheliya (prior to its closure)
• Moving for Change
• The Traveller Movement
• Community Justice Scotland
• Scottish Refugee Council
• The Poverty Alliance
• The Coalition for Racial Equality and Rights
• Crisis
• Shelter Scotland

Only one response was received, from Scottish Trans.