Regulation and licensing of non-surgical cosmetic procedures: consultation analysis and response

1: Approach to engagement and consultation, and methodology

The consultation on the further regulation and licensing of non-surgical cosmetic procedures (NSCPs) ran from 20 December 2024 – 14 February 2025. Responses were received through the Citizen Space platform from 2075 individuals and 132 organisations. Alongside this consultation the Scottish Government also engaged with a range of stakeholders and benefitted from correspondence from, and conversations with, stakeholders from different parts of the sector. The Minister for Public Health and Women’s Health, Jenni Minto MSP, met with stakeholders and interested MSPs at various points in advance of the consultation period.

This section of the document sets out who the Scottish Government engaged with, and the approach to that engagement, demonstrating that the Scottish Government has heard a range of views, and that the revised proposals set out in Section 3 have benefitted from this wide evidence base. It also discusses how consultation feedback was analysed, including the use of an Artificial Intelligence (AI) tool to support the analysis of free text comments.

This section also outlines the role of the Scottish Cosmetic Interventions Expert Group, who have worked with the Scottish Government before and during the consultation period. More information on the role of the group is set out on page 8.

The findings from this wide-ranging engagement are set out in the next section, which considers both the consultation feedback and responses, and the evidence from the wider engagement outlined in this section.

The evidence collected and views heard during this period will also inform forthcoming impact assessments, which, when published, will contain more information on the impact of the proposals on specific groups. The Scottish Government is continuing to gather some specific information to inform the Children’s Rights and Wellbeing Impact Assessment (CRWIA) and Equalities Impact Assessment (EQIA).

Who responded to the consultation?

We received 2207 responses to the consultation. The greatest number of responses to the consultation were from individuals (2075 / 94%). The remaining responses came from organisations (132 / 6%). Whilst respondents may have discussed their responses with others, it did not appear that there was a formal campaign to provide particular responses, and most responses appear to be unique.

Respondents were asked about their connection to the non-surgical cosmetic procedures industry using a closed question with the following response options:

• I am not involved in the non-surgical cosmetics sector.
• I undertake or am an employee or representative of an organisation that undertakes non-surgical cosmetic procedures in a setting which is regulated by HIS, or another medical setting.
• I undertake or am an employee or representative of an organisation that undertakes non-surgical cosmetic procedures in an unregulated setting such as a beauty salon.

Over half of respondents (1226 / 55%) reported no formal connection to the industry, although some self-identified in comments as recipients of procedures. The remainder identified as being involved in the delivery of non-surgical cosmetic procedures, either as a practitioner, or a representative of an organisation delivering such procedures (or were responding on behalf of an organisation connected to the industry). Of these, more responses were from those in the currently regulated part of the sector (526 / 24%), where procedures are delivered by healthcare professionals or in HIS regulated settings, but there was still significant representation from those involved in the currently unregulated part of the sector, who stand to be most affected by the consultation proposals (367 / 17%).

Who else has engaged with the Scottish Government on this issue?

During and following the consultation there has been an increase in correspondence on this issue from a range of stakeholders, especially those in the currently unregulated part of the non-surgical cosmetic procedures sector. Often correspondents shared valuable information about their businesses, the procedures they undertook, and the potential impact of the consultation proposals. The views and information shared informed the consideration of these issues, and the findings set out in the next section of this paper. The Scottish Government routinely meets with a range of stakeholders and has been engaging with partners and stakeholders on this issue for some time. The Scottish Government arranged additional opportunities to engage, especially with groups who stood to be most affected by the proposals - those from the currently unregulated part of the sector whose voices had been heard less during the development of the consultation proposals.

Healthcare professionals

Scottish Government officials have met with, as well as received correspondence from, individual healthcare professionals as well as representatives from organisations such as the British Association of Medical Aesthetic Nurses (BAMAN), the Nursing & Midwifery Council (NMC), and the British College of Aesthetic Medicine (BCAM), all expressing their views and concerns about the unregulated sector and what regulation should look like. The Minister for Public Health and Women’s Health and Scottish Government officials also met with representatives of the Scottish Medical Aesthetics Safety Group at a Parliamentary Roundtable sponsored by Miles Briggs MSP and attended by cross-party MSPs. These views were also well represented in the consultation by respondents who identified as being part of the sector, working in a clinical or similar setting.

Non-healthcare professional practitioners

The Scottish Government has received a substantial body of correspondence from non-surgical cosmetic procedure practitioners who are not healthcare professionals who, while generally supportive of the need to regulate the sector, are concerned about the negative impact that Scottish Government proposals will have on their businesses. In view of this, the Scottish Government conducted two engagement events (with 71 non-healthcare aesthetic practitioners attending across the two events) in February 2025, to update them on the consultation proposals and to hear their views and concerns. The Scottish Government has also met separately with individual non-healthcare aesthetic practitioners as well as representatives of the recently formed Scottish Aesthetic Safety and Standards Group. A meeting with the Federation of Small Businesses to hear their views on the possible impacts on small businesses resulted in a further discussion with non-healthcare aesthetic practitioner businesses. These views were also well represented in the consultation by respondents who identified as being part of the non-surgical cosmetic procedures sector, working outside the HIS regulated or clinical setting.

Regulators, public bodies, and other administrations

The Scottish Government has engaged with Healthcare Improvement Scotland (HIS), in its role as regulator of independent health care in Scotland, via the Scottish Cosmetic Interventions Expert Group and in separate exchanges, in the development of proposals that certain higher risk procedures be carried out in HIS regulated settings.

Local authority environmental health officers, who have an important role in addressing concerns about public safety within the currently unregulated sector, have pressed for the introduction of regulations and therefore engaged with the Scottish Government, through ad hoc meetings, an environmental health officer led short life working group on aesthetics/non-surgical cosmetic procedures and through the Scottish Cosmetic Interventions Expert Group, on what regulations could look like.

Officials from the Scottish Government also engage regularly with counterparts from the UK Government, especially the Department of Health and Social Care and relevant departments of other devolved administrations to update each other on proposals, if any, to regulate the sector. Engagement also took place with the Medicines and Healthcare products Regulatory Agency regarding medicines used in non-surgical cosmetic procedures, including Botox^®, as they have UK-wide responsibility for compliance with the regulatory requirements that govern the manufacture, distribution, retail sale/supply and advertisement of medicinal products. Police Scotland have also been engaged with on issues around non-surgical cosmetics settings.

Other engagement

Scottish Government has also engaged with, and sought views from organisations which include:

• Beauty organisations including the National Hair and Beauty Federation and British Beauty Council.
• Professional Standards Authority and its accredited voluntary registers, Joint Council for Cosmetic Practitioners and Save Face. Both organisations have advised governments on the regulation of the sector.
• Scottish Trans regarding the use of non-surgical cosmetic procedures by trans people and the possible impact of regulations.
• Scottish Qualifications Authority and, separately, Glasgow Caledonian University regarding qualifications or options to develop qualifications for the sector.

Scottish Cosmetic Interventions Expert Group

Work on proposals to regulate non-surgical cosmetic procedures has been guided by advice from the Scottish Cosmetic Interventions Expert Group, whose membership includes representatives of healthcare professionals and non-healthcare practitioners working in or alongside the sector, educators, HIS, and local authority environmental health officers.

The Scottish Cosmetic Interventions Expert Group was set up in 2014 to explore the need for introducing regulation to cosmetic procedures following the publication of the Keogh Review in April 2013, which noted that little regulation of non-surgical cosmetic procedures already existed, and that there was a call for this amongst those working within the sector.

Following the group’s July 2015 report recommendations, independent clinics where services, including non-surgical cosmetic procedures, are provided by a medical practitioner, dental practitioner, registered nurse, registered midwife, or dental care professional have been regulated by HIS since 1 April 2016. HIS regulation of independent health care services provided by pharmacists and pharmacy technicians which are not provided under the terms of an NHS contract or from pharmacy premises registered with the General Pharmaceutical Council was also commenced on 19 June 2024.

Use of Artificial Intelligence (AI) in analysis

The Scottish Government used the UK Government Incubator for Artificial Intelligence’s Consult tool to carry out qualitative analysis of responses to the free text questions in this consultation. Consult AI uses artificial intelligence to streamline the process of analysing qualitative consultation responses. It aims to efficiently synthesize large volumes of responses, enabling quicker identification of key themes and trends.

The use of the tool was a pilot, representing the first time that Consult was used to support a live consultation. The UK Government has published an evaluation report which provides more detail on the tool and an assessment of its use on this consultation. The use of the tool was aligned with the Scottish Government’s AI strategy for trustworthy, ethical, and inclusive use of these tools.

The rationale for using the Consult tool to support the qualitative analysis process for this consultation was to reduce the staff time spent on analysis, so more time could be focused on what policy work needed to be undertaken, and to avoid the cost of externally commissioning this service.

How was the Consult tool used?

The tool supported qualitative analysis (analysis of the free text questions) in two main stages. Firstly, generating a list of themes for each question based on responses and then, classifying each written response to one or more of the themes.

The team worked with the Incubator team to refine and agree the list of themes for each question. Starting with a long list generated by Consult, the policy team was able to add to the list of themes and modify, split, or combine themes, to produce a short list of themes. The purpose of this check was to ensure that the themes were relevant to the policy questions, and at times to identify fewer common themes from the AI-generated long list that officials felt were particularly important. For each question, a final list was agreed to be used in the assessment of findings.

The policy team undertook a 100% check (every response was read by a member of the team) of the mapping of all responses to the themes, for quality assurance purposes, making modifications where it was felt that the mapping was not quite correct. The purpose of this check was to ensure that the AI tool had accurately assigned the themes, and that the results would therefore reflect the feedback received.

Data protection

The responses to the consultation were shared with the UK Government in accordance with the Scottish Government’s privacy notice, and under an agreement with the Incubator for AI signed by the relevant Scottish Government Information Asset Owner. Any personal and identifying information provided by respondents such as name, business name, or connection to the sector was not shared. Data in free text boxes was checked by the policy team to remove personal and identifying data from those fields. The Incubator for AI team provided assurance that, although the Consult tool makes use of Microsoft’s Azure OpenAI Service, that service is independent from OpenAI’s public services (such as ChatGPT), and the responses input in the Consult tool and their processing remain within Microsoft's Azure secure cloud infrastructure, are deleted after processing and are not used to train the underlying Large Language Model (LLM). An LLM is a computer program trained to generate human language by learning patterns from huge amounts of text data. It can answer questions, write content, or have conversations. It does so by simply predicting what words should come next, so although a LLM can sound human and appear to “understand” questions or follow a train of “reasoning” before it provides an answer, it does not. The data itself will be stored securely and deleted six months after the initial data share. These precautions are based on established practice when using third party or external analysis.