Time for reform

T he Health and Care Act, which received Royal Assent in April, came into force on July 1, 2022. It will have a major impact across the NHS in England and will see the establishment of a new health and care infrastructure designed to create an environment of co-operation and collaboration between the NHS, local government and other partners. Several existing organisations are being abolished and a number of new organisations are being created and it’s difficult to exaggerate the degree to which this complex piece of legislation will impact all our lives.

The Act follows several years of change by stealth in the health and care system and it reflects a growing feeling that the last major health reorganisation – the so-called Lansley reforms of 2012 – were no longer appropriate for a health service in the 2020s. In simple terms the Health and Care Act replaces a regime of competition with a regime of co-operation and it grants the Secretary of State for Health wide-ranging authority over the NHS.

But alongside these national health reforms, there are some less widely publicised clauses, including one that will have a profound impact on the nonsurgical aesthetic sector. It introduces a new licensing system for practitioners who provide a range of more invasive nonsurgical cosmetic procedures, such as the injection of toxins and fillers that prohibits any individual in England from carrying out specified cosmetic procedures unless they have a personal licence. It also prohibits any person from using or permitting the use of premises in England “for the carrying out of specified cosmetic procedures” unless they have a premises licence.

WHAT NEXT?

The scope and details of these new licensing schemes for aesthetic procedures will be determined by ministers following a period of engagement and public consultation. The consultation on which procedures are to be covered by the new licensing scheme is likely to begin in the autumn of this year (2022) with the consultation on the licensing of premises to follow in the early part of next year (2023).

The Joint Council for Cosmetic Procedures (JCCP) is working with its many partner organisations, including the Cosmetic Practice Standards Authority (CPSA), the Chartered Institute of Environmental Health and the British Beauty Council to design and promote new licensing schemes that are fair and equitable.

These schemes will include common cosmetic treatments offered on the high street that can cause serious harm to individuals if not carried out correctly and in a safe environment. At present there is no consistent system of licensing or regulation in England and no legally required training or qualification requirements for practitioners offering these treatments.

The JCCP believes the scheme must at least cover injectable toxins, dermal fillers, vitamin infusions, platelet-rich plasma replacement therapy, thread lifts, cyrolipolysis, invasive chemical peels, a range of laser and light procedures and hair restoration surgery.

In recent years we have witnessed a dramatic increase in the number of harmful complications arising from such procedures, many of which have been the result of sub-standard treatment administered by inappropriately qualified and poorly trained practitioners. We are also seeing gross misrepresentation of the benefits of treatment, not least on social media and other online platforms. At the heart of the problem is a serious lack of independent information and advice for the public and the simple fact that this is an area that requires regulation.

We now need to make sure the new licensing schemes fully safeguard people who have invasive cosmetic treatments and that they introduce consistent standards – including hygiene and safety standards for premises – that individuals carrying out non-surgical cosmetic procedures will all have to meet.

The government has described this clause in the Health and Care Act as the next step on the road to effective regulation of non-surgical cosmetic procedures (and hair restoration surgery) in England. It follows other recent legislation making it illegal to administer such treatments to under 18s and banning adverts on all forms of media including social media, influencer advertising and traditional advertising for injectable toxin and filler cosmetic procedures that target under 18s.

CONTINUING JOURNEY

The new licensing regimes are massive steps in the right direction, but they are only part of the picture. The JCCP has published a tenpoint plan that is necessary if we are to make the aesthetics sector as safe for patients as it can possibly be. The plan calls for:

• Statutory regulation to ensure that only practitioners who meet the required standards for safe and effective practice can practise legally.

• National, mandatory education and training standards for all practitioners in these fields.

• Clear, transparent information from service providers on risks, benefits, costs, qualifications, and insurance.

• Aclear, legal definition of what constitutes a ‘medical’ procedure, a ‘medically-related’ service and a ‘cosmetic’ treatment.

• Robust standards and regulation for the safe, ethical and professional prescribing of medications and preparations.

• The need for the Government to make dermal fillers prescription-only devices.

• Tighter controls on advertising and social media posts to prevent the promotion of unsafe, unethical and exaggerated messaging about products, education, training and service provision.

• Anationally agreed process for the reporting and analysis of complications and adverse incidents.

• Alegal requirement that all cosmetic non-surgical and hair restoration surgical practitioners should hold an appropriate level of medical indemnity insurance to provide a proper redress scheme for service users.

• Nationally agreed standards for the licensing and regulation of premises and treatment procedures.

• Acampaign to raise public awareness of the benefits and risks associated with nonsurgical treatments and hair restoration surgery.

LEAP FORWARD

While many practitioners within the aesthetics sector follow good practice when it comes to patient safety, far too many people have been left physically scarred and emotionally damaged after sub-standard cosmetic procedures.

The new clause in the Health and Care Act is an important leap forward in the field of patient safety but we must also press on with other potential reforms, such as the work being undertaken by the Medicines and Healthcare products Regulatory Agency designed to bring certain devices, such as dermal fillers without a medical purpose, into the scope of medical device regulations. Similarly, we regard the work currently being undertaken by Parliamentarians as part of the ‘Online Safety Bill’ to provide greater protection to members of the public who use social media to be a further essential requirement in our quest to enhance public protection and patient safety.

DR MARTYN KING is a GMC registered doctor and the director of Cosmedic Skin Clinic, Cosmedic Online and Cosmedic Pharmacy. He is a recognised expert in the field of cosmetic medicine, a national and international accredited trainer and Key Opinion Leader. He has published multiple journal articles and is a respected conference speaker and demonstrator and the medical director of the Aesthetics Complications Expert Group, vice-chair of the Joint Council of Cosmetic Practitioners, a member of the British College of Aesthetic Medicine and board member for the British Association of Sclerotherapists. He has completed a Master’s Degree with Distinction in non-surgical aesthetic practice and won the Outstanding Achievement award in the Aesthetic Awards in 2019.