Scottish Cosmetic Interventions Expert Group minutes: August 2024

Attendees and apologies

Andy Malyon (AM) (Scottish Government (SG) and NHS GG&C) – Chair

Lorraine Alcock (LA) (SG)

Healthcare Improvement Scotland (HIS) representative

Sara Davies (SD) (SG)

John Elder (JE) (BCAM)

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)

Donna O’Boyle (DO) (SG)

Jackie Partridge (JP) (Dermal Clinic & BACN)

Joanna Swanson (JS) (SG)

Julie Wales (JW) (Glasgow Clyde College)

Annalena Winslow (SG)

SG official

Apologies:

Lesley Blair MBE (LB) (BABTAC and CIBTAC)

Kevin Freeman-Ferguson (Healthcare Improvement Scotland)

Elaine Hutton (EH)

Alun Parry (AP) (SG)

Items and actions

Welcome and introductions

AM welcomed everyone to the meeting and introduced OG. OG told the Group that he had just joined the SG Safety, Openness and Learning team and he will be focussing on legislation more generally across the team. OG’s experience in the processes is that timelines can be variable with periods of apparent quietness followed by busy periods but as far as possible we will keep SCIEG informed of any forthcoming activity.

Agreement of minutes

The minutes from the meeting on 28 May, 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 confirmed that, having received consents or otherwise to release personal details, the agreed minutes of SCIEG meetings will be published, with details published or redacted, in the next few weeks.

SG Official confirmed that Declarations of Interests had been received from everyone who attended previous meetings however, they will be required for anyone new joining the meetings.

SG met with Directors of Public Health who advised that they were unable to commit resources at this time to developing public messaging on undertaking checks prior to undergoing any non-surgical cosmetic procedures. SG will consider other options.

John Elder continues to provide medical expertise to EHOs.

LA provided JP and JE as contacts to the Glasgow dermatologist who is developing a school education package on non-surgical cosmetic procedures however the dermatologist has not been in contact with them. LA will follow this up.

Action Point
LA to follow up Glasgow dermatologist regarding non-surgical cosmetic procedures school education package.

AM advised that he contacted NHS Education for Scotland (NES) to develop training for A&E departments on the management of dermal filler complications. This has been picked up by the education lead for emergency medicine at NES. A course on head and neck trauma is being developed which is planned to include dissolution of fillers. It is hoped that a first course will be available for the end of the year or Spring 2025.

TG asked whether hospital A and E departments stock Hyaluronidase to dissolve dermal fillers. AM advised that it should be available somewhere in the hospital.

TG stated that he had two cases where Hyaluronidase had been prescribed to practitioners and he reported these to the General Pharmaceutical Council (GPhC). TG will send details to HIS Representative.

LA thanked everyone who contributed further information in regards to the procedures list. 

Scottish Government update

LA advised that SG has continued to engage with stakeholders across the industry. SG has also liaised with the UK Government (UKG) however, there has been no update regarding their consultation nor the new government’s intention in regards to licensing in England. SG will also need to consider reserved matters (e.g. medicines regulations, medical devices, professional regulation), the UK Internal Market Act and European Convention on Human Rights (ECHR) when considering any potential regulation.

Update and Discussion on Procedures 

Taking the stakeholder engagement into consideration, SG’s current proposal is to revert to categorising procedures as Red, Amber and Green and this is what we are planning to seek the public’s views on.  

The proposal currently being developed is that Red and Amber procedures (higher and medium risk procedures respectively) would only be able to be carried out in a HIS registered and regulated independent clinic with the Red (high risk) procedures to be performed by doctors, nurses (and potentially dentists) only. Amber (medium risk) procedures would be carried out by suitably qualified healthcare and non healthcare professionals with oversight of a prescriber.  

It is proposed that Green (low risk) procedures, which excludes injectables, would be carried out in licensed premises by suitably qualified practitioners.  

A set level of training would be required for all categories.

Members reviewed the list of procedures and their proposed categories (Red, Amber, Green).

JP said that IPL should require cover by Laser Protection Officer and core knowledge of lasers.

JP asked that it be recorded that she would prefer that Cryolipolisis be in the Red category.  JW considers it should be Amber.

AM and JP agreed that Photorejuvenation should be moved from Green to Amber as this could be inadvertently used on skin cancers. AM feels that any ‘decisions to treat’ procedures, such as Cryotherapy, should be in the Red category.  

JP prefers that HIFU be in the Amber category as it can cause damage although JW says that it is performed safely in a local salon.

There were some differing views on Botox and any other procedures requiring prescription-only medicines. JP felt that Botox should only be performed by a prescriber while others felt that it can be delivered by a suitably trained person, under the oversight of a prescriber.  

JW raised concerns that Botox may be driven underground if not in the Amber category and AMac added that consideration needs to be given to UKG’s and Welsh Government’s proposals on non-surgical procedures to avoid cross-border tourism.  

JP felt that reverting to an Amber list muddies the water and JE reminded the group that the UKG list of procedures and categories is only a starting, not final, list and felt that SG’s lists should not solely be based on UKG’s consultation list. LA confirmed that the procedure list is still under consideration and not solely based on UKG proposals. LA also pointed out that the revised SG Red list is more extensive than the original UKG’s. LA confirmed that SG will  need to consult on the procedures.

There were discussions regarding available data on risk and harm to support the categorising of procedures into the lists. Most agreed that there was only anecdotal evidence available.  However, since the last meeting, SCIEG members have provided SG with details of possible harm/risks for each listed procedure.

There were also discussions about regulated independent clinics in Scotland and concerns were raised that such clinics can be opened or managed by non-healthcare professionals. However HIS Representative pointed out that if minimum qualifications for non-surgical procedures are set under any proposed regulations, practitioners of these procedures would need to meet the qualifications to comply with Regulation 12 of The Healthcare Improvement Scotland (Requirements as to Independent Health Care Services) Regulations 2011 and it will be the responsibility of the provider to ensure this. AM said that approved training for the sector would not be one-day courses such as currently offered however, we cannot expect practitioners to meet that training requirement immediately (i.e. following any potential new regulations).

Some members expressed concern about “training” being a one day course/self-certified. AM reassured that our expectation is that we could set a properly rigorous standard for training requirements and SCIEG would continue to discuss the level of training itself in more detail.

AM sought agreement for injectables (specifically botulinum toxin and dermal fillers) that it would be reasonable for these to be delivered by someone trained to at least NVQ level 7 in the context of a HIS regulated clinic with the oversight of a doctor or nurse prescriber who is physically on site. This was agreed.

Age restrictions for Procedures

The merits of setting an age restriction were discussed and, if so, at what age it should be applied. AM stated that laws for consent in Scotland differed to England. The current different age restrictions in Scotland for various things were raised, such as buying alcohol (18); getting married (16); the age of legal capacity (16); getting a tattoo (18); getting treatment in a HIS clinic (18). The majority considered that age restrictions are necessary and need to be clear across the UK. SD noted that laws must be enforceable and caveated the professional and practitioner responsibilities and code of practice to be vital whilst accepting the majority view.

AMac asked if we should also consider a minimum age for practitioners however, it was felt that any proposed mandatory qualifications would mean that any practitioner would be at least 18 by the time they were qualified.

AOB

Post-surgery lymphatic massage

TG asked whether post-surgery lymphatic massage should be included on the list of procedures to be regulated. Glasgow City Council had recently prohibited a practitioner from performing the procedure under the HSAW Act due to lack of consultation and on infection control grounds. TG says that he has received different advice from different organisations on the matter.

Groups to consider training for procedures

LA said that she would like to set up smaller working groups to consider training for the different groups (Red, Amber, Green). LA suggests JW and LB to join the group to look at training for the Green procedures and JP and JE to join the group looking at training for the Red procedures. A further group will be invited to consider training for the Amber procedures.   LA will get in touch to set up meetings for the groups.

Action Point 
LA to invite JW and LB and JP and JE to join groups to consider training for Green and Red procedures respectively

Public consultation

LA said that next steps will be to prepare a public consultation. SCIEG members may be asked to comment on the draft consultation however, due to the timescales, members may be given a short time to respond.

Next Meeting

The next meeting will be in approximately 8 weeks. SCIEG secretariat/LA will send a calendar invitation. 

Action Point
SCIEG secretariat/LA to send calendar invitation for the next meeting.

List of Action Points

1.    LA to follow up Glasgow dermatologist regarding non-surgical cosmetic procedures school education package.
2.    LA to invite JW and LB and JP and JE to join groups to consider training for Green and Red procedures respectively.
3.    SCIEG secretariat/LA to send calendar invitation for the next meeting.