Scottish Cosmetic Interventions Expert Group minutes: November 2023
- Published
- 21 January 2025
- Topic
- Health and social care
- Date of meeting
- 9 November 2023
- Date of next meeting
- 29 January 2024
Minutes from the meeting of the group on 9 November 2023.
Attendees and apologies
- Andy Malyon (AM) (Scottish Government (SG) and NHS GG&C)
- Lorraine Alcock (LA) (SG)
- Emer Appleton (EA) (SG)
- Lesley Blair MBE (LB) (BABTAC and CIBTAC)
- Sara Davies (SD) (SG)
- Kevin Freeman-Ferguson (KF) (Healthcare Improvement Scotland (HIS))
- Tom Gorman (TG) (Glasgow City Council)
- Jenny Hunt (JH) (SG)
- Anne Macleod (AMc) (South Lanarkshire Council)
- Alun Parry (SG)
- Jackie Partridge (Dermal Clinic & BACN)
- Jo Swanson (SG)
- Annalena Winslow (SG)
- Aberdeenshire Council representative
- SCIEG secretariat
Apologies:
- Martin Gibb (Glasgow City Council)
- Elaine Hutton (Ayrshire College)
Items and actions
Welcome and introductions
The Chair welcomed everyone who introduced themselves to the group.
The Chair advised that group members would be required to declare any interests and forms would be sent out for completion.
Action Point
SCIEG secretariat to email declaration of interests form to complete and return to the SG.
Update from SG Safety, Openness and Learning team
LA updated the group on the work already being undertaken by the Safety, Openness and Learning Team. This included:
- progressing legislative work to add any independent services provided by pharmacists and pharmacy technicians to the list of independent healthcare (IHC) services regulated by Healthcare Improvement Scotland (HIS)
- amending and commencing the regulation of Independent Medical Agencies (IMAs (to align with clinics)
- SG currently consulting on increasing the maximum fees that HIS is able to charge to regulate independent healthcare (IHC) services
- LA hopes the above regulations will come into force by June 2024
- SG is also considering the regulation of surgical and non-surgical cosmetic procedures, including consideration of the The Civic Government (Scotland) Act 1982 (Licensing of Skin Piercing and Tattooing) Order 2006
Environmental Health Officers (EHO) Short Life Working Group
AMc and TG are co-chairs of the short life working group (SLWG) which was set up, at the request of Health and Safety Co-ordinating Group (HASCOG), due to concerns about the increasing number and variety of non-surgical cosmetic procedures being carried out by non-medical professionals. Both shared with the meeting that a number of concerns had been raised by the short life working group, including:.
- concerns about a lack of knowledge by providers
- concerns about a lack of evidence of qualification or experience of practitioners
- suggestion that businesses can seem reluctant to share information
- concerns that Prescription Only Medicines (POMs) and other regulated products may be being obtained online and from pharmaceutical warehouses around the UK; EHOs have notified MHRA and awaiting response
Action Point
SD to check with MHRA where information should be directed.
Following the Löfstedt Report EHOs reported that they will not go out unless there is a matter of evident concern. They advised the group that if there is evidence of complaints, local authorities (LAs) can make it a priority.
A prohibition notice is an option in some circumstnces but requires collaboration with many agencies.
Next step is to gather information from the Health and Safety Liaison Group.
The SLWG is looking at next steps.
LB and JP asked if they could join the group and warmly welcomed.
Action Point
AMc/TG agreed to circulate the minutes from these meetings.
Updates from the group
Members were given to opportunity to update what was new for them and their concerns in regards to public safety and cosmetics.
BABTAC
LB has been working with the UK Government regarding legislation for licensing. BABTAC is preparing a report on IPL and laser intensity, which LB will share with the group. LB expressed a view that unregulated providers should not do injectables and she is keen to share this perspective. A short discussion followed on whether IHC clinics record information on people going to these clinics as a result of complications from procedures performed elsewhere.
Action Point
LB to share BABTAC report on IPL and laser intensity with the group.
Scottish Government Health Protection
AP and EA work in SG Health Protection Team and their interests are in the Skin Piercing and Tattooing Order. They are in the very early stages of this role. They work with EHOs and recently met with all and the Minister.
Local authority implementation guide on skin piercing and tattooing working group
The Aberdeenshire Council Representative enquired about the definition of skin piercing in regulations. AP says that he would be very happy to have a conversation with the Aberdeenshire Council Representative regarding the definition. The Aberdeenshire Council Representative also provided details of “Kambotherapy”, and asked whether others in the meeting had had knowledge of this.
Healthcare Improvement Scotland
KFF says that challenges are that some treatments and procedures fall to IHC regulation due to the healthcare professions who provide them. There are some similarities in regards to the willingness of IHC clinics to share information as to non-regulated aesthetic clinics. HIS can be challenged about its enforcement approach and need providers to engage.
Aesthetic healthcare professional (British Association of Cosmetic Nurses)
JP said that she felt that, as a healthcare professional, it is unfair that that they are regulated and have to pay costs for such regulation while there is lack of regulation for others.
She hopes that the SG will take the good parts from the UK consultation however she raised concerns about the ‘green’ group outlined in the consultation. JP would appreciate if the group could meet with the minister.
Update on Proposals for Regulation of Non-Surgical Cosmetics
LA advised that, following the consultation in 2020, the then Cabinet Secretary, Humza Yousaf, agreed that the priority was to consider legislation to restrict who can administer dermal fillers. However, with the continued growth of non-surgical cosmetic procedures SG felt that it would be more appropriate to broaden the scope of non-surgical cosmetic procedures to be considered for regulation in Scotland. This proposal was agreed by the new Cabinet Secretary for Health and Social Care.
SG will also consider which procedures may fall for licensing under amendments to the Skin Piercing and Tattooing Order.
SD advised dermal fillers were unlikely to become prescription-only.
Discussion on non-surgical cosmetic procedures
The group used the UK Government’s (UKG) consultation on the licensing of non surgical cosmetic procedures (specifically the red, amber and green categories) as a starting point for discussion on the procedures that may be considered in any future Scottish consultation.
Red – procedures with the highest risk of complications (and should be carried out by qualified and regulated healthcare professionals). The various views expressed by the group included:
- any procedures requiring POMs should fall under the red category
- some procedures including thread lifting procedures, hair restoration, breast augmentation, dermal microcoring should be classified as ‘surgical’ procedures and should not be provided by those not qualified to do so
- professional regulation is a factor and healthcare professionals must work within their scope of competence
- only services provided by specific healthcare professionals are regulated by HIS
- can we say ‘suitably qualified’ when describing healthcare professionals carrying out red procedures
- we will need to be clear on definitions, e.g. for the ‘peel’ procedures
Green – procedures with the lowest risk of complications (and all practitioners could carry out the procedures where they meet agreed standards). The various views expressed by the group included:
- procedures within this category would fall within the remit of EHOs
- 'no-needle’ fillers should be banned completely
- micropigmentation (semi-permanent make up) and microblading are covered under the Skin Piercing and Tattooing Order
- needs to be a check on what procedures are already covered by the Order
- practitioners should have regulated qualifications (e.g. via Scottish Qualifications Authority (SQA) or Ofqual) for the procedures
- should IPL be in the green list and if so, practitioners need to be qualified
- regulated IHC providers are required to have appropriate procedures in place for laser and IPL - see UK Government guidance on lasers, intense light source systems and LEDs
- should photo rejuvenation be within green group and would we need a definition
Amber – procedures with medium risk of complications (aesthetic practitioners must have oversight by a named regulated healthcare professional who has gained an accredited qualification to prescribe, administer and supervise aesthetic procedures). The various views expressed by the group included:
- what is defines ‘oversight’
- what should be the appropriate level of supervision
- need to agree definitions, e.g. for ‘suitably qualified’ or ‘appropriately qualified’, ‘consultation’ and ‘procedure’
- HIS has guidance for IHC providers regarding the need for qualified and competent staff
- there will be healthcare professionals and prescribers whose IHC services are not regulated by HIS by virtue of their healthcare profession
- would welcome aesthetics as a clinical specialty however this is beyond the remit of this group
- the combination of two or more procedures’ (currently in the amber list) does not necessarily move them into a riskier category. There are some combinations used by beauty therapists which remain in the green category
- radiofrequency treatments, cryolipolisis, high frequency focused ultrasound (HIFU) should be moved to the green category
- procedures requiring POMs should be moved to the red category
- a meeting with SQA would be helpful to discuss qualifications in the sector
- BABTAC is preparing a report on IPL and Lasers intensity, which LB will share with the group
- the next meeting of the group could discuss training requirements once the BABTAC report is received
Other views included:
- a training licence, which the Welsh Government is proposing, is a good idea
- restricting non-surgical cosmetic procedures in Scotland to over 18s
- enforcement tools are required for HIS and EHOs. SD provided the link to the old Health Education England standards
Action Point
SG to invite SQA to meet and attend part of the next meeting.
Action Point
JP will send AM details regarding British Standards (for aesthetics)
Close – next steps
AM thanked everyone for joining and for their contributions to the meeting.
The group agreed that the next meeting should be in January or February to discuss educational framework.
Action Point
SCIEG secretariat to send out date for next meeting.
List of action points
1. SCIEG secretariat to email declaration of interests form to complete and return to the SG.
2. SD to check with MHRA where information should be directed.
3. AMc/TG agreed to circulate the minutes from SLWG meetings.
4. LB to share BABTAC report with the group once available.
5. SG to invite SQA to meet and attend part of the next meeting.
6. JP will send AM details regarding British Standards (for aesthetics).
7. SCIEG secretariat to send out date for next meeting.
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