Regulation of non-surgical procedures: island communities impact assessment consideration

Island Communities Impact Assessment Consideration: Regulation of non-surgical procedures

Step One – Develop a clear understanding of your objectives

Non-surgical procedures include cosmetic procedures such as dermal fillers, chemical peels, Botox^®, laser treatments and some ‘lifestyle’ or ‘wellbeing’ procedures such as vitamin infusions. They are often carried out by healthcare professionals or skilled non-healthcare practitioners, but they can also be undertaken by practitioners who are not sufficiently trained or experienced, in unhygienic environments, using unsuitable products. In some circumstances this can lead to harm, which in some cases can be long-lasting and significant.

The Scottish Government propose that non-surgical procedures should only take place either in an independent clinic or other healthcare setting regulated by Healthcare Improvement Scotland (HIS), or in a business premises that is licensed by the local authority. Under this proposal practitioners in a licensed premises would be able to carry out lower risk, less invasive procedures, with more invasive, higher risk procedures which required the input of a healthcare professional carried out only in a HIS regulated setting, either by an appropriate healthcare professional or under their supervision.

It should be noted that this policy does not relate to non-surgical procedures that are required for healthcare purposes – where there is a medical need this will continue to be met, as now, through recognised healthcare pathways.

The licensing and regulation of non-surgical procedures is intended to apply equally across the whole of Scotland in order to protect the population consistently. However, it may have particular impacts on island communities which, under local authority licensing or Healthcare Improvement Scotland (HIS) regulation, may not have access to the same level of service provision ie. fewer clinics or salons which are able to offer licensed or regulated procedures.

Due to the nature of the issues which the policy aims to address, it is not possible to make exceptions or alternatives for island communities. Non-surgical procedures must be licensed or regulated in a consistent way across the country, so that the regime is fair and straightforward for both providers, and for local authorities and HIS, who must administer it. For example, while mobile services may be a preferred option for business owners and customers in island areas, these services must still be suitable for carrying out the procedures concerned. Under the government’s proposals it will not be possible to offer any non-surgical procedures in hospitality venues or customer’s homes, and it would be for the local authority or HIS to assess if a vehicle could be licensed or registered for this purpose.

It is important to recognise that in small, widely dispersed communities such as those found in islands where service provision is low, the requirement that procedures take place in premises licenced by the local authority or regulated by HIS may limit services further and make it difficult for clients to get the procedures they want in a convenient location. This may mean individuals having to travel further to obtain procedures, which may add to costs. It may lead to a rise in underground (illegal) or unregulated practices, which in turn may lead to increased workload for local authorities and HIS.

Step Two – Gather your data and identify your stakeholders

There are currently four HIS-regulated clinics offering non-surgical procedures in islands, two in Lerwick and two in Stornoway. However aside from these clinics, due to its unregulated nature it is not possible to estimate exactly how many other businesses are currently providing non-surgical procedures in island communities.

Since it is environmental health officer (EHO) teams who currently deal with complaints about non-surgical procedure services in salons and other settings, we contacted those in island local authorities to ask if they could help give an indication of service provision in islands. We received two responses, both stating that this is difficult to quantify partly due to its unregulated nature.

We also contacted the Scottish Islands Federation (SIF) who said that information about local services was difficult to capture as it was often ad-hoc, for example practitioners coming across from the mainland and advertising in local newsletters or social media pages.

Step Three – Consultation

We have been aware throughout development of the policy in relation to regulation of non-surgical procedures that there may be a heightened impact on island communities with regard to the accessibility of services in small and isolated areas where customer base does not support the same level of competitive service provision as would be the case in urban mainland areas. As discussed above, it has not been possible to gain insight into true levels of service provision in islands, nor has it been possible to establish contacts to facilitate a dedicated consultation exercise into the impacts our proposals will have on island communities.

We have however, obtained feedback through other engagement that has been carried out:

• The Scottish Government ran a public consultation on our proposals from December 2024 to February 2025. As part of this we asked: “What are your views on how the introduction of licensing and regulation of the non‑surgical cosmetics sector in Scotland might affect access to safe, high‑quality services in island communities?”. (‘Cosmetic’ here included some lifestyle/wellbeing procedures.) Respondents were not required to state their geographical location. There were 793 responses to this question.
  • 25% of these welcomed the improvements to services that regulation would bring, while 20% felt it would bring fair access to services and safety in island communities.
  • 10% of respondents recognised the likely effect on island communities, with for example licence fees proving prohibitive for smaller businesses and a lack of healthcare practitioners for supervision and prescribing.
  • A range of suggestions were put forward to mitigate these, for instance allowing visiting practitioners to offer services in healthcare premises, reducing licence fees in island settings, subsidised accommodation for visiting practitioners and flexible compliance measures such as allowing remote consultations and mobile services.
• In February 2025 we ran two workshops (one in-person, one online) for non-healthcare professionals operating businesses which provided non-surgical procedures, to gather evidence for a Business and Regulatory Impact Assessment (BRIA). Again those who attended were not required to state their geographical location. A total of 71 individuals attended both sessions. While the discussion focused mainly on general issues relating to training and the categorisation of non-surgical procedures, concerns were raised that services in island communities might find it difficult to access a prescriber and/or healthcare professionals for those procedures which (as proposed in the consultation) required healthcare professionals oversight or prescription-only medications. Attendees suggested these aspects of the service could perhaps be done remotely.
• SIF commented that equity of cost for businesses on islands must be a consideration as in some other instances. For example, the cost for Energy Performance Certificates for short term let licences are typically considerably higher on islands than in mainland areas.
• In response to our public consultation, the Federation of Small Businesses (FSB) told us that members who currently pay fees to HIS for the provision of healthcare services such as dentistry on the mainland sometimes visit remote, rural and island communities to offer services there, but this can come at a cost as they must pay further fees to HIS in order to do so. FSB’s members have told them that HIS fees are disproportionate to small businesses, and we also heard this from attendees at our BRIA workshops.
• The representative from one island council which we contacted indicated that their EHOs would be content to be involved in any licensing arrangement for non-surgical procedures, as they currently are for existing licensing schemes such as private water supplies, as long as costs were fully recovered by licensing fees.
• At a roundtable in September 2025 hosted by Colin Beattie MSP we heard further from business owners and representatives of business owners in rural communities (who felt they would face similar issues to island communities) who were concerned about the availability of suitably trained healthcare professionals to support them. While currently this is not an issue where the healthcare professional is needed solely to prescribe any necessary products, they may not have availability to be present for all face-to-face consultations and oversight of the procedures themselves, and therefore the business might not be able to continue to offer these services.

Step Four – Assessment

The main factor in island communities, which will be similar in remote and rural mainland areas, is the current scarcity of service provision due in part to small dispersed communities, including access to healthcare professionals and prescribers, which will be exacerbated by the requirements of the proposed licensing and regulation schemes.

As will be the case across Scotland, businesses which are not currently regulated by HIS will be required to obtain a local authority licence or register with HIS. This will require the payment of a licence or registration fee, and may require investment for training of staff or employment of appropriately qualified staff, and/or for improvements to hygiene and safety of premises and equipment. Lack of appropriate skilled staff in island settings may be an issue, and the cost of licences may add to overall business costs, especially if licence fees need to cover operational costs for EHOs who may need to travel large distances to cover all businesses.

However, it may be possible to mitigate some of the effects of these proposals. For example, practitioners who require the services of a healthcare professional for supervision or a prescriber for the use of prescription-only medicines may be able to schedule their clients in such a way that any appointment requiring a prescriber or healthcare professional are scheduled on certain days of the week or month when they can be present in the area, thus avoiding the need for their attendance every day or at ad-hoc times. The Scottish Government will explore opportunities through Business Gateway and Skills Development Scotland to provide advice and support to businesses to help them undertake any transition or change to their business model as the proposals are implemented.

Remote prescribing is not likely to be possible as it goes against guidance issued by professional regulators such as the General Medical Council and the Nursing and Midwifery Council.

Licence fees will be a matter for discussion with the relevant local authorities. HIS registration fees are set by HIS on an annual basis, with the maximum fee level set in regulations.

It should be noted that non-surgical procedures are not a public service and are made available to members of the public on a private business basis (as mentioned above any requirement for such procedures which are medically necessary will not be affected by these proposals and will continue to be available via relevant medical pathways).

While the majority of these services are provided safely and successfully by skilled and experienced practitioners, there is a growing body of anecdotal and documented evidence of harms that can arise when procedures are performed by people who are not properly trained or experienced, using products and in settings which are unsafe. Harms can be long-lasting, and in some extreme cases have resulted in death. The Scottish Government has a duty to ensure that the public are not exposed to harms such as these. While measures must be proportionate, they must also be consistent across Scotland so that practitioners are clear on their responsibilities and consumers can trust that any procedures they choose to have are safe and performed to a good standard. Importantly, it would not be acceptable to have a situation where people in island and remote/rural mainland communities had less protection than people in other areas.

Excluding those for medical purposes, which are not within he scope of these proposals, non-surgical procedures are elective procedures undertaken for aesthetic purposes – that is, it is the client’s own choice to undergo these procedures. They are not carried out in NHS settings, and so their availability is led by the private business market.

Due to its unregulated nature it is not possible to estimate the size of this market in island communities, but it is likely to be limited compared to urban mainland settings. However this will be partly because the client base is also smaller, with island populations being small. It is also not possible to estimate rates of participation.

There are no other factors to suggest that expectation, needs or outcomes would differ.

The proposals for regulation of non-surgical procedures are intended to make the sector safer for all, providing a scheme to enable the establishment and monitoring of consistent standards of training, hygiene and safety across the whole of Scotland. While it may be the case that costs for businesses will rise due to the need to ensure licensing requirements are met, and some practitioners in licensed premises will no longer be able to undertake some procedures that will need to be carried out in HIS-regulated clinics, this will be the case everywhere, not just in island settings.

As mentioned above a separate BRIA addressing the impact on businesses will be published. It is possible that the impact may be to some degree greater, but not significantly so. The ultimate objective is to ensure public safety.

In the Scottish Government’s opinion the policy is not likely to have an effect on an island community which is significantly different from its effect on other communities (including other island communities).

Step Five – Preparing your ICIA

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Step Six – Making adjustments to your work

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Step Seven – Publishing your ICIA

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This ICIA screening and decision not to proceed with a full ICIA has been supported by the Islands Team on 9 May 2025, and is approved by:

Name: Lynne Nicol

Position: Deputy Director, Healthcare Quality and Improvement

Signature: Lynne Nicol

Date completed: 11 June 2025