Regulating Cosmetic Surgery: Following the Scottish approach?

Nine out of ten cosmetic procedures in the UK are non-surgical treatments. Sir Bruce Keogh identified in his 2013 review that non-surgical treatments were “almost entirely unregulated”. Over the last decade, there has been a considerable increase in demand for such treatment – it is a multi-billion pound industry, fuelled in part by social media images and influencers. The injection of toxins and lip enhancement procedures are invasive and carry complications that can have major and irreversible effects on health. There is little or no public protection and there has been a continuous call to increase patient safety in recent years.

Regulation of cosmetic procedures

There is currently little or no regulation in place to protect the public.

• Practitioners. There is nothing to prevent an unqualified practitioner from offering non-surgical procedures.
• Premises. The Care Quality Commission regulates private clinics and hospitals in England that provide cosmetic surgery. However, it does not cover those premises that provide only non-surgical procedures.
• Products. Devices and equipment marketed for non-medical purposes were to be included in the EU Medical Devices Regulation as from May 2020. However, following Brexit, it is not now clear what assessment criteria will be used in both the UK and EU member states.
• Young People. Access to cosmetic procedures by young people is not covered by statutory controls, although minimum age limits of 18 apply for procedures such as tattooing and sunbed use.

Scottish consultation

In Scotland, there has been a requirement since 1 April 2016 for all independent clinics to register their services with Healthcare Improvement Scotland where such services are provided by dental professionals, doctors, nurses and midwives. However, this regulation does not apply to anyone other than these registered practitioners. This means that for non-surgical treatments that pierce or penetrate the skin, like dermal fillers or lip enhancements, anyone can currently administer such procedures.

On 17 January 2020, the Scottish Government launched a consultation regarding non-surgical cosmetic procedures. The aim of the consultation is to seek views on the need for further statutory regulation, to ensure that anyone providing such procedures, that pierce or penetrate the skin, is competent and appropriately trained.

Ministers want to bring non-health practitioners under existing legislation, which would require them to obtain a licence to perform these treatments in unregulated premises, such as beauty salons. Such a licensing regime would be the first in the UK.

Professor David Sines CBE, Chair of the Joint Council for Cosmetic Practitioners, an organization that seeks to regulate the non-surgical cosmetic industry to protect the public and promote excellence in practice says ‘oversight by suitably trained healthcare professionals and regulation by Government is required to ensure that practitioners are appropriately trained, insured and work from safe premises. Current enforcement and regulatory regulations remain insufficient to protect the public and as such I consider that statutory regulation is required to enable enforcement officers working within the environmental health profession to undertake to inspect and apply sanctions. Primary legislation is required to ensure that all practitioners who undertake to deliver such higher risk procedures should be registered with a statutory regulatory body and that Government should require that all aesthetic practitioners are appropriately trained and insured’.

It is hoped by many in the industry that the Scottish consultation may persuade the Government to follow suit having previously argued that it does not want to cause undue financial difficulties for reputable small businesses, that a blanket ban on non-medical professionals could be difficult to enforce and could drive unregulated providers underground.

The consultation closes on 30 April 2020.