Scottish Cosmetic Interventions Expert Group Report July 2015

Annex 6: Equality Impact Assessment initial scope

The SCIEG secretariat developed a scope for an Equality Impact Assessment at the beginning of the process which will be continued following the acceptance of any recommendations. The report that follows was from the initial scope.

Draft Equality Impact Assessment scope for Cosmetic Interventions

Summary & Request

A workshop was held on 19 May 2014 to run a screening analysis for an equality impact assessment (EQIA) on the work proposed for cosmetic interventions regulation. The attenders are noted in Appendix 1. The aim was to check initial impacts and consider where any gaps in knowledge and the evidence base are to ameliorate or remove any negative impacts and spread the positive impacts of the policies being developed.

We request the review of the EQIA scope and welcome any volunteers

Background

A screening EQIA was proposed by the Scottish Health Council member of the Scottish Cosmetics Interventions Expert Group (SCIEG) and supported by them in finding relevant attenders. A summary of the current situation (Appendix 2) was laid out for the workshop attenders together with a brief background on the work in Scotland reflecting our experience with the PiP breast implant device removal and the Department of Health's response^[21] to the Keogh Report on the Regulation of Cosmetic Interventions from April 2013^[22].

The volume of procedures are predominantly in the non-surgical field and include 5 main areas: dermal fillers, botulinum toxin, lasers and intense pulsed light; chemical peels and hair restoration surgery. These account for 9 out of 10 cosmetic interventions and are worth 75 per cent of the market in total. The screening process started with this area, before considering the potential impacts on the equality fields of both cosmetic surgical interventions and information / redress requirements.

This report will be shared with the workshop attenders, the SCIEG groups and evidence will be sought for the specific areas. As the work continues and questionnaires and policies get framed, the workshop attenders will be asked again for their input.

Assessment

The assessment found the majority of impacts require further information to reduce any negative impacts and through a new and varied public information campaign, many of the impacts will be positive. Regulation is useful if carefully managed and implications on services for both providers and users carefully considered. Questions were asked on how other European countries run services and how would a non-surgical cosmetic service provider set-up in Scotland. The effect of alcohol on all ages to change risk behaviours was noted and to ameliorate this, a paperwork of consent, consideration of capacity and and possible 7 day waiting period must be necessary. The screening assessments are shown below.

Non surgical cosmetic interventions ie botox, dermal fillers, lasers, chemical peels

Characteristic	Impact (+/-)	Data gaps identified and action taken
AGE	Teenagers - ensure capacity	If age restrictive (not ideal) make sure not too restrictive. Ensure policy supports care of vulnerable people; do not require too many hoops for consumers; ensure follow-up arrangements can be in place and followed. Careful not to replicate NHS system only
DISABILITY	People with mental ill health - ensure not excluded nor exploited	Ensure policy supports care of vulnerable people; ensure follow-up arrangements can be in place and followed.
SEX	No impact for non-surgical interventions
PREGNANCY AND MATERNITY	Information/ safety	Part-time workers keeping competency to standard could be an issue

Characteristic	Impact (+/-)	Data gaps identified and action taken
GENDER REASSIGNMENT	Nil
SEXUAL ORIENTATION	Nil
RACE	Providers should provide information on skin colour / types and procedures to different ethnicities	Skin lightening Hair removal Tailored information
RELIGION OR BELIEF	Animal fat or pork substances in products	Better labelling across EU

Non surgical cosmetic interventions ie botox, dermal fillers, lasers, chemical peels continued

Characteristic	Impact (+/-)	Data gaps identified and action taken
Criminal Justice	Lasers for hair removal	Check with the Scottish Prison Service Beauticians in women's' prisons ?
Homelessness	Access to follow-up if no address / no postal receipts
Language or social origin	Information available in correct format (language, sign if deaf etc)
Poverty / social deprivation	Removal of 2 for 1 deals and free deals from training colleges working with trainee beauticians will impact of people with less disposable income

General comments

Careful not to replicate NHS system in terms of how to enable people to access services as the adult exceptional aesthetic protocol for the NHS is also to reassure services will be targeted and provides a filtering system.

However an approval system must be in place in the independent sector as well as the protocol in the NHS as the rationale is the same in terms of allowing a period of reflection, freedom from undue pressure on consumers and careful safe medical and health interventions.

Ensure the European dimension is considered.

Surgical procedures, information and redress.

Characteristic	Impact (+/-)	Data gaps identified and action taken
AGE	Literacy levels
DISABILITY	Literacy levels	Information of use to individual
SEX	Impact for surgical services for certain groups, particularly male to female transgender	Also in general be wary of impacting badly on NHS current contracts to the independent sector in some boards. Awareness raising campaigns need to be in different outlets ie gyms for men possibly, and not only concentrating on women.
PREGNANCY AND MATERNITY
GENDER REASSIGNMENT	Cosmetic tattooing not mentioned so far and uncertain whether always included in NHS services	Genital laser hair removal not always available - can be subcontracted by NHS to independent sector so be wary of unintended impacts
SEXUAL ORIENTATION
RACE		Information in language that is required is provided by provider and provider should not assuming English "will do".
RELIGION OR BELIEF		Information to providers and consumers on female genital cosmetic surgery and boundaries and consent, capacity and capability to reduce coercion.
Criminal Justice
Homelessness
Language or social origin
Poverty / social deprivation

Appendix 1: Attenders to the cosmetic interventions equality impact assessment screening workshop 19 May 2014

Rosemary Hill, Participation Network Manager, Scottish Health Council

Leeze Lawrence, transperson, documentary film-maker

James Morton, Scottish Transgender Alliance manager

Vittal Katikireddi, registrar in public health, Scottish government

Sara Davies, consultant in public health, Scottish government

Terry O'Kelly, senior surgeon, Scottish government

Appendix 2: Regulation of Cosmetic interventions

Developments in 4 areas:

1 Surgical interventions - cosmetic surgery

• Standards & training for cosmetic surgery
• Inspection of cosmetic surgery providers, including clinics
• Patient information / decision aids / consent formats

2 Non-surgical interventions (botulinum toxin, dermal fillers, chemical peels, lasers & lights)

• Training for
  • The practice
  • The supervision
• Considering legislation on controls of cosmetic interventions & regulators of healthcare professionals codes of practice
• Credentialing

3 Ensuring safe products

• EU Medical Devices Directive & EU General Product Safety Directive
• EU register of medical devices & unique device identifier
• Pilot breast implant registry
• Improved reporting of suspected devices failures to MHRA

4 Responsible information, resolution & redress

• Patient information / decision aids / consent formats
• Socially acceptable advertising & Committee on Adverting Practice new guidance
• Follow-up care promoted / Medical Directors required
• Complaints on independent healthcare to the Parliamentary & Healthservice Ombudsman
• Professional indemnity
• Device manufacturer risk pools
• NHS recouping costs