12 January 2021


Response to the APPG on Beauty, Aesthetics and Wellbeing: Inquiry into non-surgical cosmetic procedures


Which of these non-surgical cosmetic procedures are being carried out, where, by whom, with what qualifications, and with what clinical oversight?

Non-surgical cosmetic interventions are currently unregulated in the UK. This is of significant concern to reputable providers in the cosmetic interventions sector and represents a threat to public health. At present, there are no guidelines that state the need for any form of clinical qualification for those that carry out non-surgical procedures, which – given the continuing rise in popularity in non-surgical cosmetic interventions and the complex medical nature of such procedures – compromises patient safety and must be urgently acted upon by the UK Government.

At Transform Hospital Group, we carry out a range of non-surgical interventions, including botulinum toxins or similar anti-wrinkle injectables, dermal fillers and polydioxanone at our industry-leading facilities. Transform Hospital Group operates specialist hospitals in Manchester and Birmingham, alongside a national network of 23 industry-leading clinics. All of Transform Hospital Group’s facilities are regulated by the Care Quality Commission (CQC) in England, the Healthcare Inspectorate Wales (HIW) and Healthcare Improvement Scotland (HIS). Surgeons and doctors working with Transform Hospital Group are all registered with the General Medical Council and all nurse prescribers are registered with the Nursing and Midwifery Council.

What regulatory measures currently exist in relation to who should be able to carry out what procedures and where, under what conditions? Is the current framework adequate or are further regulatory measures needed?

Non-surgical cosmetic interventions are unregulated in the UK. This means that there is:

  • No guarantee that the location in which a medical aesthetics procedure is being carried out is subject to infection control protocols. This is particularly pertinent in the current environment amid the COVID-19 pandemic.
  • No requirement for the individual undertaking the procedure to evidence training or professional competency, or how to manage adverse clinical events, should they occur.

As a leading, responsible provider of cosmetic interventions, all of Transform Hospital Group’s practitioners undergo rigorous training specific to the non-surgical procedures they undertake. All Transform Hospital Group practitioners must pass competency assessments to ensure that they have the necessary skills and knowledge that are crucial to delivering high standards of patient care. Furthermore, they also undergo regular ‘trade testing’ for medical aesthetics competency, during which an expert observes and assesses their competence.  

In the first instance, Transform Hospital Group is calling for industry-wide minimum standards to be introduced, to regulate the location in which non-surgical cosmetic procedures can take place and standardise the qualifications of those administering such procedures. This should be enacted quickly through secondary legislation, as outlined below, and will be a crucial first step towards achieving patient safety in the non-surgical cosmetic industry.

Ultimately, however, Transform Hospital Group is calling for the regulation of non-surgical procedures to be brought in line with the surgical cosmetic industry, and it should be clearly defined in law that non-surgical cosmetic procedures are medical procedures and should be regulated as such.

As an initial step, Transform Hospital Group urges the APPG to consider the current legislation in place that governs the tattooing and body piercing industry and compare that to the unregulated non-surgical cosmetic interventions sector. Under the Local Government (Miscellaneous Provisions) Act 1982, as amended by the Local Government Act 2003[1], local authorities are responsible for regulating and monitoring businesses offering cosmetic body piercing, permanent tattooing, semi-permanent skin colouring and electrolysis.

The Local Government (Miscellaneous Provisions) Act 1982 states:

“A person shall not in any area in which this section is in force carry on the business—

  1. of tattooing;
  2. of semi-permanent skin-colouring;
  3. of cosmetic piercing; or
  4. of electrolysis,

unless he is registered by the local authority for the area under this section.”[2]

 

Transform Hospital Group believes it is a dangerous affront to patient safety and public health that premises where non-surgical cosmetic procedures take place are unregulated, whilst tattoo parlours are subject to local authority oversight, particularly given that even graver health risks may occur through the injection of pharmaceutical products and medical devices, often by individuals without clinical qualifications.

Transform Hospital Group is calling for the immediate amendment to the Local Government Act 2003 to ensure that the non-surgical cosmetic interventions sector is brought into line with regulations for tattooing and body piercings, making it a criminal offence for a premises offering non-surgical cosmetic interventions to trade without local authority licencing. This will ensure that minimum standards for patient safety are met and that providers and practitioners are held to account, particularly amid the heightened need for appropriate levels of clinical standards during the COVID-19 pandemic.

In addition, Transform Hospital Group call for legislation to go further and forbid the delivery of non-surgical cosmetic interventions outside of a local authority licenced premises, putting an end to the practice of so-called “mobile practitioners” - regardless of their qualification or level of clinical competence - delivering non-surgical cosmetic procedures in private residences. Moreover, any individual conducting non-surgical interventions should be required to hold a licence to perform procedures, achieved through accreditation at V300 level.

Transform Hospital Group firmly believes that legislation that establishes a licencing regime for premises, accompanied by a standardised qualifications threshold for practitioners, would be a crucial initial step towards raising standards within the medical aesthetics industry, which will increase accountability amongst practitioners and ensure that patient health and wellbeing is safeguarded.  

This should be considered as an initial step towards achieving comprehensive patient safety in the non-surgical cosmetic industry, and should be introduced as soon as possible. Ultimately, however, regulations for these procedures should mirror those that are in place for surgical procedures and there should be clarity that all cosmetic procedures – whether they be non-surgical or surgical – are clinical procedures. This will ensure that there are comprehensive safeguards for patients in place, meaning that all practitioners that carry out such procedures are clinically qualified and responsible, risk management is always considered, and procedures are carried out in clinical settings.

It should be noted that the regulatory bodies required to achieve this level of comprehensive regulation already exist, with the CQC in England, the HIS in Scotland and the HIW in Wales. Transform Hospital Group therefore calls on the APPG to recognise non-surgical cosmetic procedures as clinical procedures, and recommend to Government that they be regulated as such.

Not only would this mean that patient safety becomes the top priority for practitioners carrying out non-surgical cosmetic procedures, but it will also ensure that a comprehensive informed consent process is in place for patients wishing to have such procedures carried out. This will empower individuals to make well informed decisions about the outcomes of such procedures and risks that they carry, in the knowledge that procedures will take place in a clinical setting by a trained medical practitioner.

Should there be a legal age limit for undertaking specified non-surgical cosmetic procedures?

Transform Hospital Group does not offer non-surgical cosmetic interventions to anyone below the age of 18. Drawing comparisons again to the tattooing industry, the Tattooing of Minors Act 1969 makes it an offence to permanently tattoo individuals under the age of 18. This is due to the permanent nature of tattooing and the need for those wishing to have such procedures carried out to be fully informed about the risks and nature of the procedure. No such statutory restrictions apply for non-surgical cosmetic interventions that need the same level of education around risks.

To that end, Transform Hospital Group is calling for legislation to be put in place to make it illegal for providers or practitioners to deliver non-surgical cosmetic interventions to under-18s, across the UK.

Summary of recommendations

In summary, Transform Hospital Group is calling for the following measures to be introduced in order to protect patient safety and ensure basic levels of clinical standards are met across the non-surgical cosmetic interventions industry:

  • In the first instance, Transform Hospital Group is calling for secondary legislation to amend the Local Government Act 2003 to ensure that non-surgical cosmetic interventions are brought into line with regulations for tattooing and body piercings, making it a criminal offence for a premises offering non-surgical cosmetic interventions to trade without local authority licencing. Further, legislation should also forbid the delivery of non-surgical cosmetic interventions outside of licenced premises. Finally, as a minimum requirement, all individuals that conduct non-surgical interventions to be required to hold a licence to perform procedures, achieved through accreditation at V300 level.
  • Ultimately, however, Transform Hospital Group is calling for the regulation of non-surgical cosmetic procedures and for there to be clarity that all cosmetic procedures – whether they be non-surgical or surgical – are clinical procedures. This will ensure that there are comprehensive safeguards for patients in place, meaning that all practitioners that carry out such procedures are clinically qualified, and they are carried out in clinical settings.
  • Transform Hospital Group is calling for legislation to be put in place to make it is illegal for providers or practitioners to deliver non-surgical cosmetic interventions to under-18s, across the UK.

 

Contact

Freddie Creed

On behalf of Transform Hospital Group

Freddie.Creed@fticonsulting.com

 

[1] Local Government Act 2003

[2] Local Government (Miscellaneous Provisions) Act 1982

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