Scottish Cosmetic Interventions Expert Group minutes: October 2024

Minutes from the meeting of the group on 29 October 2024


Attendees and apologies

  • Jenni Minto MSP, Minister for Public and Women’s Health
  • Andy Malyon (AM) (Scottish Government (SG) and NHS GG&C) – Chair
  • Lorraine Alcock (LA) (SG)
  • Lesley Blair MBE (LB) (BABTAC and CIBTAC)
  • John Capiron (JC) (SG)
  • Sara Davies (SD) (SG)
  • John Elder (JE) (BCAM)
  • Kevin Freeman-Ferguson (KFF) (Healthcare Improvement Scotland)
  • Martin Gibb (MG) (Glasgow City Council)
  • Tom Gorman (TG) (Glasgow City Council)
  • Owen Griffiths (OG) (SG)
  • Jenny Hunt (JH) (SG)
  • Anne Macleod (AMac) (South Lanarkshire Council)
  • Alun Parry (AP) (SG)
  • Jackie Partridge (JP) (Dermal Clinic & BACN)
  • Joanna Swanson (JS) (SG)
  • Julie Wales (JW) (Glasgow Clyde College)
  • Annalena Winslow (SG)

Apologies

  • Elaine Hutton (EH)

Items and actions

Welcome and introductions

AM welcomed Jenni Minto MSP, Minister for Public Health and Women’s’ Health and thanked her for being able to join the first half hour of the meeting. SCIEG members outwith the SG were invited to introduce themselves to the Minister.

Minister for Public Health and Womens’ Health

The Minister thanked AM and said that while other commitments had not allowed her to meet SCIEG until now, she was pleased to be able to do so today and was keen to hear their views. She noted that she had met JP at the helpful Parliamentary Roundtable on non-surgical cosmetic procedures (NSCP), which was sponsored by Miles Briggs MSP. The Minister appreciated the work SCIEG had done to date, and continued to do, which included the regulation of independent clinics by Healthcare Improvement Scotland (HIS) that was extended to the pharmacy sector this year. 

The Minister confirmed she was keen to move as quickly as possible to regulate procedures taking place outwith regulated independent healthcare settings and was happy to have announced that a further consultation will be published before the end of 2024. She was also pleased with the cross-party support shown at the debate in the chamber earlier in the month.

Due to the Minister’s limited time with SCIEG, members were invited to send in questions in advance of the meeting.

TG requested a public health campaign regarding high risk NSCPs carried out by non-healthcare professionals and to advise the public to carry out their due diligence and only use aesthetic practitioners who have the relevant experience and qualifications. The Minister firstly thanked TG for his and his fellow environmental health officers’ work in Glasgow in investigating safety concerns raised about certain providers. She said that a campaign was raised at a recent debate in the chamber. Owing to the range of important topics received for health awareness campaigns that affect the people of Scotland, it is important that the SG carefully prioritise the issues to which funding and staff resource are allocated, and continually assess the potential need for these with the close input of clinicians. AW advised that SG could issue comms on this when the public consultation is launched.

Action Point
SG to consider communication messages on NSCP in conjunction with the launch of the public consultation.

LB asked if it was possible for the Minister to issue a statement warning of the risks of NSCPs, which includes questions that people should raise. The Minister said that she was happy to look into this.

Action Point
Minister’s office to look into issuing a statement regarding NSCP risks and questions people should ask.

In response to TG’s question on what the sanctions will be under any proposed licensing of aesthetic practitioners who do not require to be registered with HIS, and e.g. continue to carry out amber/red activities outwith a HIS registered premises, the Minister advised that she could not say what any sanctions will look like. This is still to be worked through,  taking into consideration the public’s response to the consultation. Any enforcement powers will need to be proportionate and take into consideration who will enforce the regulation and the resources available.

JP asked Ms Minto if she could provide a date for a change in primary legislation to allow NSCP regulations to be implemented. Ms Minto said that she wanted to see progress as soon as possible but was unable to give a definitive timeline on any potential regulations as processes will need to be followed. She has committed to publishing the consultation before the end of 2024 and responses to the consultation will help inform what regulation may look like and what is still required to achieve this.

The Minister took the opportunity to ask questions, and commenced by asking for SCIEG members’ views on age restrictions for NSCPs. Several members expressed the view that procedures should be restricted to people aged 18+ which would bring it into parity with England and restrictions on HIS regulated clinics. KFF said that HIS is aware that some healthcare professionals feel that clinical judgement should be used for such decisions.

The Minister also asked for the group’s thoughts on what impact regulation could have on businesses. Views included that patient and public safety is paramount; that beauty therapists should only do what they are trained in however, there was also a counter argument that not all healthcare professionals are properly trained in NSCPs. A balance is required ensuring that competency and qualification is required for all practitioners. Concerns were raised about wider illicit activity that may be taking place in the absence of any regulatory regime.

The Minister thanked SCIEG for the opportunity to join them, for their continued work, engagement and advice to address the gap in regulation and the complexities of NSCPs.

Agreement of minutes

The minutes from the meeting on 27 August 2024, which were shared with the agenda prior to the meeting, were agreed with no amendments.

Previous Action Points

The following updates were provided on the previous action points:

  • LA emailed Glasgow dermatologist regarding contacts for NSCP school education package but has not yet had a response. JE and JP have not been contacted by the dermatologist

Action Point
AP to follow up with Glasgow dermatologist regarding NSCP school education package.

The remaining action points have been completed.

Scottish Government (SG) update

LA provided the following update:

  • OG met and is presenting to Regulatory Review Group on proposals to regulate NSCP and its potential impact on businesses. As with all consultations and new regulations, a Business Regulatory Impact Assessment (BRIA) will need to be done
  • LA thanked those who joined the Red, Amber, Green sub-groups (now Groups 1,2,3) to discuss the procedures for each group
  • the consultation questions have been moulded with input from the Business Review Group and other policy areas. The consultation is nearing completion
  • There has been no further update from the UK Government regarding their consultation and proposals for England
  • LA said that SG had received the JCCP recommendations on future standards and qualifications and JCCP Guidance on Buttock augmentation & other body contouring procedures and is sharing it with SCIEG for information
  • TG asked if there would a lead in date for businesses to adhere to any proposed new regulations. LA said that there would but the details are still to be worked up. AM added that we would need to allow time for practitioners to undertake any required formal training
  • JE said that any illegal activities will need to stop but AM pointed out that it is already illegal and should be acted upon now by the relevant authorities

Models of licensing 

OG led a discussion on a potential model of licensing which it is proposed:

  • will operate similarly to existing schemes under the Civic Government (Scotland) Act 1982 (Licensing of Skin Piercing and Tattooing) Order 2006
  • will cover low risk procedures such as microneedling and laser hair removal
  • will not include higher risk procedures or procedures requiring prescription-only medicines (for the procedure or to treat complications)

Options include requirement for:

  • premises licences
  • practitioner licences
  • practitioner and premises licences (preference)
  • single operators to have a single (premises) licences
  • self-employed (working within another premises) to hold their own (practitioner) licence 

Aside from businesses requiring to meet certain standards (e.g. hygiene etc) to be granted a premises licences, licences will focus on procedures that practitioners must be qualified to perform.

Views expressed and questions raised by the group included:

  • both premises and practitioner licences are the best way forward as long as procedures that practitioners are qualified to perform are included on personal licences and approved licensed practitioners are listed on the premises licences
  • responses to the consultation will help inform the next steps
  • is it OK to have a personal licence for NSCP but not for tattooing
  • will HIS-regulated services also need a licence if they perform the low risk procedures? An exemption already exists for procedures covered by the Skin Piercing and Tattooing Order
  • there needs to be parity regarding qualifications required for healthcare and non-healthcare practitioners performing low risk procedures
  • will personal licences be required for performing the higher risk procedures in a HIS regulated clinic? What will be required for unregulated practitioners working in a HIS setting
  • OG says that he does not envisage a dual model for a HIS regulated setting, but remains important that training standards applied equally in both regulated and licensed settings
  • KFF said that there was differentiation between a HIS regulated clinic and hospital with surgical procedures expected in a theatre setting

Consultation questions overview and discussion

OG outlined the format of and shared a presentation regarding draft consultation questions for discussion. The presentation covered:

  • the proposed grouping of procedures (group 1 – less invasive and less risky procedures carried out under Local Authority licence; gGroup 2 – procedures carried out in HIS regulated premises; group 3 – procedures carried out by doctor or nurse prescriber)
  • proposed Local Authority licensing arrangements
  • HIS regulation of healthcare professionals providing NSCPs
  • proposal of age restrictions for NSCPs
  • mandatory Equalities Monitoring – impact on people with protected characteristics; Fairer Duties Scotland; Island communities; UN Convention on the Rights of the Child

The Group discussion included:

  • there is a legal requirement for independent healthcare services provided by specified healthcare professionals to register with HIS
  • HIS do not register or regulate mixed dental practices (i.e. practices providing NHS contracted as well as independent services)
  • similarly HIS do not regulate GPs with NHS General Medical Services contracts
  • BABTAC do not insure beauty therapists for any procedures in proposed groups 2 and 3. Insurance only fit for purpose for trained beauty therapists. Insurance sometimes covers when people are unhappy with the treatment
  • under a licensing scheme, it would probably be a police matter if someone does not have a licence. Local Authorities may also perhaps serve a prohibition notice
  • a national register or database for all licensed premises and practitioners would require resources. Could any new licensing fees be used to fund a national database? AM said that this could be considered but data sharing between Local Authorities could be a better option
  • should there be separate age restrictions for procedures on intimate areas? Wales bans this for acupuncture, body piercing, electrolysis and tattooing. Age restrictions are already in statute for HIS regulation of independent healthcare – OG will give further thought to this

Action Point
KFF and OG to discuss HIS regulations

AOB

The consultation will be published by the end of the year.
LA advised that SCIEG members will see the final version, for information, before it is published.
There was agreement for SCIEG to reconvene again following the consultation.

Action Point
JC to send calendar invitation for the next meeting in first quarter of 2025.

List of Action Points

1.    SG to consider communication messages on NSCP in conjunction with the launch of the public consultation.
2.    Minister’s office to look into issuing a statement regarding NSCP risks and questions people should ask.
3.    AP to follow up with Glasgow dermatologist regarding NSCP school education package.
4.    KFF and OG to discuss HIS regulations
5.    JC to send calendar invitation for the next meeting in first quarter of 2025..
 

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