Scottish Cosmetic Interventions Expert Group minutes: January 2024
- Published
- 21 January 2025
- Topic
- Health and social care
- Date of meeting
- 29 January 2024
- Date of next meeting
- 25 March 2024
Minutes from the meeting of the group on 29 January 2024.
Attendees and apologies
- Andy Malyon (AM) (Scottish Government (SG) and NHS GG&C) – Chair
- Lorraine Alcock (LA) (SG)
- Lesley Blair MBE (LB) (BABTAC and CIBTAC)
- Sara Davies (SD) (SG)
- Healthcare Improvement Scotland (HIS) Representative
- Tom Gorman (TG) (Glasgow City Council)
- Jenny Hunt (JH) (SG)
- Anne Macleod (AMc) (South Lanarkshire Council)
- Jackie Partridge (JP) (Dermal Clinic & BACN)
- Aberdeenshire Council Representative
- Jo Swanson (JS) (SG)
- Martin Gibb (MG) (Glasgow City Council)
- John Elder (JE) (BCAM)
- Alun Parry (AP) (SG)
Apologies
- Kevin Freeman-Ferguson (Healthcare Improvement Scotland)
- Elaine Hutton (Ayrshire College)
- Annalena Winslow (SG)
Items and actions
Welcome and introductions
AM welcomed everyone to the meeting and reminded attendees to return their declaration of interests form. In response to a query from the Aberdeenshire Council Representative, AM confirmed that only one form per attendee is required, not one for each meeting.
Action Point
Any attendee who has not yet done so to return their completed declaration of interest form to SG.
Agreement of minutes
JP noted the following for correction:
- on page 3 under ‘Aesthetic healthcare professional’: should say “take the good parts”
- on page 4 cryolipolisis: suggested that this should be on the red list
AM confirmed he had been able to access a copy of the British Standard referred to in the action of page 5.
The Aberdeenshire Council Representative suggested ‘matter of evident concern’ would be a more appropriate phrase than ‘proven risks’.
The minutes of the previous meeting on 9 November 2023 were otherwise agreed.
Update from the group
Aesthetic healthcare professional (British Association of Cosmetic Nurses)
JP has submitted a paper to LA on the subject of ventilation in clinics, which is required for comfort purposes. The Aberdeenshire Council Representative confirmed that ventilation should be present in any workplace for health and safety reasons. The HIS Representative stated she will discuss the matter with Kevin Freeman-Ferguson and will report back to the group.
Action Point
HIS Representative to report back on ventilation following discussion with KFF.
BABTAC
LB has had some discussions with the clinical advisory group on supervision, she is trying to speak to doctors and nurses on recommendations for the beauty industry as she is concerned there are too many grey areas.
The working group on IPLs and laser intensity is looking at national standards, which is not LB’s area of expertise so she is waiting for the parameters on what is recommended; she will update the group.
Action Point
LB to update group on the recommendations from the working group on IPL and laser intensity
Scottish Government Health Protection
The team has been discussing EHO implementation guides with AMc; if there are any suggestions for additions AP can take this forward.
They have had a query from Glasgow City College about qualifications and will be speaking to them about this next week.
Local authority implementation guide on skin piercing and tattooing working group
AMc said they will need more of an idea of how legislation will be formed so they can update the implementation guide. The EHO short life working group has asked Scottish Trading Standards for information on the type of complaints they are getting from non-HIS regulated clinics and expect to hear from them by the end of February.
The first stage of the EHO guide has been sent to LA who will circulate for comments – it currently only refers to Botox® and fillers but there are many more treatments to add.
Action Point
LA to circulate draft of EHO guide for comments
TG asked what training could be put in place for EHOs to know what to look for: JP suggested EHOs could do the same training as HIS inspectors. AMc suggested that EHOs may not need to be trained to the same level as an HIS inspector. She suggested that it was not the best use of an officer’s time to look at fine details such audit trails etc where there are more pressing issues present, such as prescribers not being on site for consultations / treatments and therefore there being no clinical oversight.
TG reported that Alison Young and Barbara Carter from MHRA have offered to input to training to give their experience of ‘raiding’ premises and retrieving non-conforming botulinum toxin and other products. The Royal Environmental Health Institute of Scotland have also offered to be involved.
The HIS Representative stated that HIS might not always be the most appropriate organisation to refer to, for example if drugs are obtained by sources that can’t be identified or a clinic does not meet the definition of an independent clinic HIS can’t do anything. AMc confirmed it would be a variety of regulators rather than HIS who would be referred to – but if it was agreed that a health professional should be always present then it would be HIS (noting that HIS does not regulate services provided by all healthcare professionals). The HIS Representative confirmed that HIS inspectors received appropriate training and use aides memoires and tools for inspecting premises, which she can share.
Action Point
HIS Representative to share details of training, aides memoires and audit tools.
JE stressed that someone must take responsibility for cases where medicines are imported without a licence or administered without a prescription as it is breaking the law.
JP asked if EHOs will look only at high level issues or will they address audit trails, duty of candour etc, as otherwise it is discriminatory to healthcare professionals if EHOs don’t investigate non healthcare clinics to the same degree as HIS do. AMc confirmed it is only top line, but they need SG to address this. In order to serve a health and safety prohibition notice in a premises, EHO’s have to demonstrate that there is a risk of serious personal injury. In previous conversations with the MHRA, representatives have said that they could not provide expert evidence that there was a risk of serious personal injury involved in the use of unlicenced drugs. TG confirmed that the Procurator Fiscal will only look at use of unlicenced Botox® if there is serious harm or death as a result. If there is no set course of training for the people carrying out these procedures how can EHOs assess if they are competent?
JP stressed she is in complete disagreement with what is happening in non-regulated clinics, without manpower, training and legislation there is a double standard.
Scottish Government
LA advised that her team are working on secondary legislation to add pharmacists and pharmacy assistants to the definition of independent clinics, and it is hoped it will come in by summer 2024.
Working on the green/amber/red procedures list will allow the team to take forward legislation on regulation.
Discussion on procedures
LA stated that the list presented here is one suggestion based on what procedures could be carried out in specific types of premises, with input from LB, JE and JP.
There was some discussion over procedures being carried out in people’s homes, and it was agreed this needed more thought at a future point.
The following points were made in relation to the green list:
- cryolipolysis – different modalities have different requirements; some manufacturers use the term for things that are not actually cryolipolysis – this should be moved to the amber/red list
- there should not be a barrier to appropriately qualified people carrying out treatments and healthcare professionals should have the same qualifications as non-healthcare professionals
- legislation can specify appropriate levels or instances of use of certain treatments
- what is being treated matters e.g. using IPL on a lesion that turns out to be a melanoma; responsibility has to lie with the person who administers the treatment
- HIFU needs care as it’s difficult to know how deeply it is penetrating
LA clarified that the red/amber list would be restricted to clinics with medical oversight, where a healthcare professional in charge of the clinic could decide who would be trained to perform certain procedures; this is slightly different to the rest of the UK.
The following points were discussed:
- the definition of ‘oversight’: is it enough to have a healthcare professional in the building while procedures are carried out? Should ‘direct oversight’ instead be ‘professional responsibility for service provision’
- training and qualifications: approved training for those carrying out procedures will be necessary. The healthcare professionals with oversight responsibility would have to have appropriate qualification relating to the procedures they oversee
- professional standards: it is harder to assess if people work to professional standards, this is currently an issue even with regulation. One healthcare professional with oversight of a non healthcare professional team carries more risk than a team of healthcare professionals doing all the treatments
- there is a need to consider how novel treatments will be dealt with
- prescribing: those who prescribe should perform or apply the treatments they prescribe rather than delegating to others
It was agreed by the group that all treatments on the red/amber list should be carried out by a healthcare professional with the exception of platelet-rich plasma therapy (excluding Biofillers which should be on the red list as it requires a local anaesthetic), and non-ablative lasers, which will require oversight, although a decision to treat by a healthcare professional may still be required for the latter.
The group agreed that ‘no needle’ fillers should be banned. MG suggested mesotherapy may have to be considered further in relation to this. Regulation should cover the use of all types of laser treatment, whether on the green or amber/red list.
The combination of two or more technologies was discussed. Hybrid devices which perform a combination have received a CE mark are fine for use but some need to be led by a healthcare professional. LB will let the group know more about the procedures carried out by hybrid devices.
Action point
LB to send group information on treatments carried out by hybrid devices
Close
AM confirmed that the next steps are to look in more detail at hybrid devices, and to consider treatments carried out in the home. LA thanked participants for their time and work.
List of action points
1. Any attendee who has not yet done so to return their completed declaration of interest form to SG.
2. HIS Representative to report back on ventilation following discussion with KFF
3. LB to update group on the recommendations from the working group on IPL and laser intensity
4. LA to circulate draft of EHO guide for comments
5. HIS Representative to share details of training, aides memoires and audit tools for EHOs
6. LB to send group information on treatments carried out by hybrid devices.
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