Response to Non-surgical Procedures Bill call for views

Part 1 of the Bill: Non-surgical procedures

Question 1. In your view, what impact will the Bill have on: 

a. People wishing to access non-surgical procedures detailed in Schedule 1?

Summary of our key points

• The Bill seeks to guard against circumstances where a procedure in a regulated environment could still be performed by someone who is not qualified to do so or where a qualified practitioner could practice in an unsafe environment. Consumer Scotland broadly supports the provisions and welcomes the intention to protect consumers who wish to access non-surgical procedures from harm. All consumers should be able to trust that any procedure they choose to have is carried out in a safe environment, and by a practitioner who is qualified to perform that procedure.
• Information: We recommend that the Scottish Government amends the Bill to allow Scottish Ministers to set out, by Regulations or Statutory Guidance, the information that should be provided to help consumers understand the impact of their treatment, how they can obtain redress if things go wrong, and how they can access low-cost finance if needed. We also encourage the Scottish Government to work with ASA and CAP to explore how clear and appropriate guidance can be provided to ensure advertisements are accurate, fair and legal once the Bill comes into force.
• Accountability and Redress: We recommend that requirements for professional registration, indemnity and insurance and signposting to professional regulatory and complaints bodies should be set out in secondary regulations.
• Enforcement: We welcome the penalties set out in the Bill and the additional powers enabling Healthcare Improvement Scotland (HIS) to search premises and prevent incidences of consumer harm. It will be important that HIS is appropriately resourced to undertake this.

We set out below our analysis of the potential impact of the Bill for particular groups of consumers, specifically:

• Young consumers
• Rural and island consumers
• Consumers in vulnerable circumstances

Young consumers

Non-surgical cosmetic procedures can be invasive in nature and there is evidence that some procedures can present significant long-terms risks to the mental and physical health of consumers. For example, a recent survey of consumers who had experienced complications following cosmetic Botulinum Toxin injections found that 7 out of 10 were experiencing lasting effects.[1] While anxiety, pain and headaches/migraines were most commonly reported, consumers also reported experiencing emotional, psychological and financial harm. Given these risks, we welcome the proposal to introduce age restrictions to protect consumers who are under 18.

By making it an offence to treat consumers under the age of 18, the proposals provide the same protection for young people against potential detriment from fillers as has existed in England and Wales since the introduction of the Botulinum Toxin and Cosmetic Fillers (Children) Act in 2021.[2] This will protect under 18s in Scotland. We welcome this, as the Chartered Trading Standards Institute (CTSI) has highlighted that the current variance in age limitations across the UK is leading to “young people crossing the border to have procedures carried out.”[3]

Rural and island consumers

Consumers in smaller geographical markets such as rural and island communities may already have poorer access to non-surgical medical procedures than those in more urban settings. The Scottish Government accepts that the proposed regulatory regime may decrease competition in certain areas, and may have the effect of increasing costs for businesses due to the potential need for non-healthcare practitioner led businesses to employ prescribing healthcare professionals, register with HIS, undertake further training and possibly make alterations to their premises to comply with HIS standards. They may also experience a potential loss of revenue from not being able to offer certain procedures if they do not take these steps. It is unclear whether such effects may result in price increases for consumers, or whether the model of delivery may change to accommodate new requirements. However, we consider it important that all consumers in Scotland are equally protected from harms and we agree with the Scottish Government’s assessment that “it is not possible to make exceptions or alternatives for island communities. Non-surgical procedures must be licensed or regulated in a consistent way across the country, so that the regime is fair and straightforward for providers, and for local authorities and HIS, who must administer it”.[4]

While non-surgical cosmetic procedures are not public services, we consider that this Bill will provide the necessary accountability to ensure that services available to all consumers in Scotland, including our remote, rural and island communities, are safe and of high quality.

Consumers in vulnerable circumstances

As regulatory changes may lead to cost increases for businesses, this may present affordability challenges for some consumers. Consumers have experienced significant price increases across many goods and services in recent years while a number of surveys show that consumers are under financial strain, with many having to cut back on essential services.[5] We suggest that the effect on competition and pricing in rural areas should be monitored and taken into account in wider Scottish Government policy activity seeking to monitor and address the cost of living in rural communities.

One potential consequence of rising prices may be an increase in demand to pay for treatment in instalments or via external credit. We consider that providers should signpost consumers to sources of free financial advice and support, prior to entering into a contract. While the FCA Consumer Duty does not impose a specific duty on firms to do this, it does contain best practice guidance on identifying consumers with characteristics of vulnerability.[6] We are aware that some providers offer credit (lenders) or are Introducer Appointed Representatives (credit brokers). They are subject to FCA regulations in these roles and are already required to provide consumers with timely and clear information to help them make good financial decisions about what financial product is right for them, taking their individual circumstances into account.[7]

b. The level of risk to people who wish to access these procedures? 

The proposals in the Bill aim to reduce the possibility of consumer harm, however medical procedures inherently carry a degree of risk. In the interest of the consumer principles of safety and redress, it is important that:

• consumers are protected against harm when they choose to undergo cosmetic procedures,
• they can make informed choices about where to have procedures undertaken, and who by, and
• they are able to seek resolution if things do go wrong.

Consumers must be able to make informed choices

Practitioners and clinics should provide consumers with information around procedures, risks, after care instructions, success rates and qualifications of staff along with any other necessary information to enable consumers to make a well-considered decision. This information should be provided in a timely, clear and accessible way.

The Bill currently does not place a duty on practitioners and clinics to provide this information. This is a gap in the legislation and the Bill would be strengthened by its inclusion. We recommend that the Scottish Government amends the Bill to allow Scottish Ministers to specify by Regulations or Statutory Guidance the types of information that should be provided to consumers.

Earlier this year, CTSI highlighted issues it had observed in relation to online sales of cheap unsafe fillers to consumers.[8] It is important that consumers are protected against advertisements that may be false, misleading, or seek to pressurise consumers into undertaking procedures they might otherwise not have.

In recent years, the Committee of Advertising Practice (CAP), which writes the Advertising Codes enforced by the Advertising Standards Authority (ASA), has issued and updated guidance around the advertisement of such procedures. Guidance states that “Marketers of all non-surgical procedures should ensure that their ads are responsible, and they hold evidence for all claims of efficacy, do not exploit insecurities or portray offensive stereotypes and should not trivialise the procedure.”[9] CAP has also warned that “marketers need to take particular care with their wording [and] make sure they don’t rush consumers into a decision.”[10] We encourage the Scottish Government to work with ASA and CAP to explore how clear and appropriate guidance can be provided to ensure advertisements are accurate, fair, and legal once the Bill comes into force.

Information about qualified practitioners and clinics should also be easily accessible to consumers to help them make informed decisions. The HIS website already includes a publicly accessible register of HIS-regulated clinics, including contact details, services the clinic has registered to provide, and inspection reports. The Scottish Government should work with HIS to explore how this can be made more accessible to consumers. In addition, the online information provided by clinics should be expanded to include the registration numbers of all practitioners delivering procedures at the premises, or clarify that they work under supervision of a regulated health care professional, to increase transparency and clarity for consumers.

The effects of the Bill must be monitored

Regulation making powers will allow data about businesses offering non-surgical procedures to be captured by local authorities or HIS. This means that future monitoring will be possible, for example of the type of services offered, the location of businesses and the types of healthcare professional being employed by otherwise non-healthcare businesses.

Development of future policy and targeting of any enforcement activity in this area would also benefit from insights into how well informed consumers are when they undergo procedures. This includes assessing their understanding of the direct and medium to long term risks associated with their procedure, awareness of alternatives, use of information sources, how they decide where to go for their procedures, and how aware they are of their rights.

Consumers must be able to undergo procedures safely

Where procedures go wrong, this can cause very significant harm for consumers. The first known death in the UK as a result of a non-surgical procedure occurred in England in September 2024, following a ‘Brazilian Butt Lift’ (BBL). The British Association of Aesthetic Plastic Surgeons (BAAPS) has emphasised that injectable fillers should only be administered by medically trained clinicians.[11]

When procedures are not undertaken correctly this can result in the need for corrective treatment and can cause significant distress and mental health problems. A 2023 UK study explored the types of issues consumers had experienced following a Botox injection for cosmetic purposes.[12] While 8 out of 10 participants reported having experienced issues – mostly anxiety – following their Botox treatment, 7 out of 10 had experienced long-lasting adverse effects. It also found that 78% of consumers who subsequently contacted their practitioners were refused help to address their complications. The most commonly reported issues were anxiety, pain, and headaches/migraines. Participants also reported financial costs running to thousands of pounds to address the issue or having to take time off work. They also reported very low awareness around industry regulation.

In addition to the harm caused to consumers, corrective treatment or other support for those affected is often provided through the NHS. A report by Save Face into non-surgical BBL and breast augmentation complaints found that 98% of consumers who had complications were then treated by NHS services,[13] while CTSI has also highlighted the pressure being put on NHS resources due to treating infections and life-threatening complications resulting from non-surgical procedures that had gone wrong.[14]

Unlicensed premises

We welcome the Bill’s intention to prevent the performance of non-surgical cosmetic procedures in unlicensed premises. The CTSI has previously highlighted problems with procedures being carried out in unlicensed premises. Although procedures are defined as non-surgical, consumers can be exposed to harmful bacteria and viruses if the procedure is being performed in an unhygienic setting or using unsterile materials. One of the most egregious cases reported in the media concerned the hospitalisation of two consumers with bacterial infections following non-surgical BBLs carried out in a backroom of a hair salon in Northern Ireland. The procedures had been advertised on Facebook and were carried out by a beautician with no medical qualifications.[15]

The Bill mainly limits permitted premises to those regulated by HIS (independent hospitals or clinics) or by the NHS (certain GP and dental practices which provide NHS services and registered pharmacies). HIS and NHS regulated premises are regularly inspected to ensure compliance with high hygiene and safety standards and managed by regulated healthcare professionals and we therefore welcome these provisions in the Bill.

Professional Standards

The Royal College of Surgeons in England has warned that “complications such as infection, nerve damage and even blindness have been reported” following complications arising from non-surgical procedures.[16] A number of respondents to the Scottish Government’s consultation on regulation of the sector earlier this year, including the response from the British Association of Medical Aesthetic nurses[17], highlighted the risks of consumer harm presented by such procedures being provided by unqualified practitioners. The Women and Equalities Committee at Westminster has also heard evidence about these problems in recent months as part of their Inquiry into the health impacts of breast implants and other cosmetic procedures.[18] In view of these risks, it is important that only regulated professionals with medical and anatomical knowledge perform such procedures.

We agree with the Scottish Government’ that “the training and knowledge required to undertake the procedure safely is sufficiently complex that the appropriate training is unlikely to be available and accessible to non-healthcare professionals, and/or needs to be accompanied by broad-based core pharmacological or anatomical knowledge most likely to be held by those with a healthcare background.” [19]

We also welcome the Bill allowing Scottish Ministers to specify detailed requirements in relation to non-surgical procedures, practitioners, training and qualifications, and enforcement through future secondary legislation.

It is important that a UK-wide approach is taken to this issue to ensure equal protection for consumers across the UK. We understand that the Scottish Government is currently examining whether the activities being regulated by the Bill can be defined as a “practising profession”. This is relevant because under Part 3 of the UK Internal Market Act, a profession that can be subject to a qualifications system should be “an occupation or trade and any subdivision of, or distinct specialism within, a profession”.[20] While qualification requirements and restrictions under this Bill can only be enforced in relation to providers based in Scotland, a consistent, UK-wide approach is necessary to ensure the effectiveness of this regulatory regime, to help minimise the risk of consumers travelling to areas which may have weaker regulatory safeguards. Factors which may increase this risk would include differing age restrictions, which this Bill seeks to eliminate, or significant price differences based on the requirement for a medical professional to be present or to supervise procedures. We encourage the Scottish Government to continue to work with the UK Government to deliver a coordinated approach in the interests of consumers.

We also recognise that the regulation and licensing of medical products such as botulinum toxin (also known by brand name “Botox”) is reserved to the UK Government under the Human Medicines Regulations 2012.[21] Botox is a Prescription-Only Medicine meaning it can only be prescribed by a qualified prescriber such as a doctor. It can however be administered by anyone. While this Bill regulates where non-cosmetic procedures can take place, it cannot regulate who can supply or administer products like Botox, and a legislative caveat remains. This summer, the Medicines and Healthcare Products Regulatory Agency (MHRA) reported a spike in reported complications such as facial paralysis, linked to illegal Botox products in England.[22] Regulation of exactly who can supply or administer such products is needed to prevent such malpractice. It is our understanding that the UK Government intends to introduce legislation to better regulate access to non-surgical medical procedures in 2026. We recommend that the Scottish Government engages with the UK Government to ensure that this caveat is resolved with clear regulations around who can supply or administer Botox.

In relation to standards, the Professional Standards Authority has accredited two registers in this market: Save Face for clinics, doctors, nurses, dentists, and prescribing pharmacists who offer non-surgical cosmetic treatments and the JCCP register which can be used by all practitioners in cosmetic treatment.[23] Both are voluntary registers. We encourage the Scottish Government to continue to monitor this market once the Bill is in force. As part of this monitoring it may be useful to consider whether there is a need for mandatory registration of unregistered staff, for example beauticians, who may be administering procedures under the supervision or direction of regulated health care professionals in order to maintain standards and mitigate risk for consumers. Policy development in this area should be informed by advice from the relevant regulatory bodies.

The Scottish Government may also wish to consider incorporating the British Standards Institute’s standards for non-surgical treatments into future regulations, requiring practitioners to adopt and comply with these.[24]

If professional standards are adopted, members should display their accreditation in communications and on physical premises. There may be a potential risk of fake certificates being displayed and it is important that enforcement advice is taken to mitigate this risk.

Consumers must be able to obtain redress when something does go wrong

Even with improved regulations and standards, the risks associated with undergoing the types of procedures covered by the Bill cannot be eliminated. There must be systems in place to enable consumers to secure redress if their procedure causes them harm. We recommend two specific requirements to achieve this:

• It should be mandatory for providers to have insurance and indemnity arrangements in place. Regulated health care professionals such as doctors are already obliged to take out separate indemnity insurance for their private practice.[25] However, the Bill proposes that unregistered staff supervised or managed by regulated health care professionals will also be able to perform procedures. It is important to ensure that those procedures that are performed by unregistered staff are also subject to some form of indemnity insurance. Given the cost that is generally associated with this type of insurance, it may not be affordable for unregistered staff to take out such insurance personally. The Scottish Government should engage with stakeholders to establish what such a requirement should look like, i.e. if similar protections can be taken out through the clinic or otherwise.
• Providers should have a duty to issue consumers with information about how they can secure redress if there is a problem with their procedure. Due to ongoing technological, medical, and regulatory developments in this sector, we consider that details about the information that should be provided should be contained in regulations rather than being on the face of the Bill.

c. Local businesses and individual practitioners? 

Consumer Scotland has considered these proposals from the perspective of consumers. However, it is in the interest of consumers that small businesses are motivated and able to take the required steps to meet the new requirements upon them. The Scottish Government should ensure that clear plans are in place to signpost businesses to sources of support, accessible guidance, and potential funding to help meet the new regulations.

Many providers are small or micro businesses and the additional training, licensing, and supervision requirements may result in increased costs to small businesses.

d. Organisations and staff who currently operate within a premises that meets the definition of permitted premises? 

Consumer Scotland has considered these proposals from the perspective of consumers.

2. What are your views on inspection, offences and enforcement powers set out in the Bill? For example, do you think they are fair and appropriate?

The Bill will ensure that procedures regulated by the Bill are only carried out in permitted premises. It will also be an offence for a person to provide a procedure to a person who is under the age of 18. The proposed penalties in the Bill, and enforcement powers, are likely to have a deterrent effect in HIS regulated settings, operated by those with professional registrations. We consider that this will help to protect consumers from harm. HIS publishes inspection reports on its website and consumers should be encouraged to access these reports.[26] We also consider the penalties for non-compliance of up to £5,000 are proportionate.

We would welcome further information on how the Scottish Government and regulators intend for compliance in these settings being monitored and on how potentially illegal practices should be reported to the relevant authorities by either consumers or professionals.

We recognise that HIS-regulated settings and regulated health care professionals can be expected to display a high level of compliance, so as not to risk professional or reputational consequences. However, the most egregious breaches, such as at home ‘Botox parties’ and illegal backroom practices in non-regulated settings will likely be much more difficult to enforce. We therefore welcome the powers of entry, search, and seizure (section 7) which will allow HIS to act on suspicions that non-surgical procedures are being provided illegally and prevent incidences of consumer harm.

It will be important for HIS to have sufficient resources to be able to take the required enforcement actions. If the new regulations are difficult to enforce in practice, there may be a risk of unintended consequences, such as procedures continuing to be provided outside of the regulations but with less public information about these, presenting a potentially even higher level of risk for consumers.

We note that Scottish Government intends to lay an order under the Civic Government (Scotland) Act 1982 before the end of this Parliament to establish a licensing scheme for lower risk procedures. Any extension of Local Authority licensing duties to include non-surgical cosmetic procedures should be subject to specific consultation with Local Authority representatives, to ensure that the scheme is workable, and that sufficient resourcing is in place to support staffing, training, administration, and enforcement of the scheme.

3. Do you have any further comments about Part 1 of the Bill?

Background

Consumer Scotland is the statutory body for consumers in Scotland.[27] Established by the Consumer Scotland Act 2020 we are accountable to the Scottish Parliament.[28] The Act provides a definition of consumers which includes individual consumers and small businesses that purchase, use or receive products or services.

Our purpose is to improve outcomes for current and future consumers and our strategic objectives are:

• to enhance understanding and awareness of consumer issues by strengthening the evidence base
• to serve the needs and aspirations of current and future consumers by inspiring and influencing the public, private and third sectors
• to enable the active participation of consumers in a fairer economy by improving access to information and support.

Consumer Scotland uses data, research and analysis to inform our work on the key issues facing consumers in Scotland. In conjunction with that evidence base we seek a consumer perspective through the application of the consumer principles of access, choice, safety, information, fairness, representation, and redress. We welcome the opportunity to respond to this Call for Views and have done so from this perspective.[29]

We work across the private, public and third sectors and currently have a particular focus on three consumer challenges: affordability, climate change mitigation and adaptation, and consumers in vulnerable circumstances.

Consumer Scotland has previously responded to the Consultation on Amendments to the Regulation of Independent Health Care, which revolved around pharmacy, and in February 2025 to the Scottish Government consultation on regulation of non-surgical cosmetic procedures which sought to inform the proposals for a licensing regime and age restrictions.[30]

Consumer Duty

The Consumer Duty applies to relevant public authorities in Scotland, including HIS and local authorities, who must consider the impact on consumers in Scotland when they make strategic decisions, along with the desirability of reducing harm to consumers. Following extensive consultation, Consumer Scotland has issued guidance on how public bodies can apply the duty. During implementation stage, the Scottish Government should consider how the Consumer Duty will impact on strategic decision-making by public authorities that are relevant bodies in the Bill, i.e. with regard to the implementation of new enforcement powers.

Part 2 of the Bill: Certification of death and authorisation of cremation

As certification of death and authorisation of cremation are not consumer matters, Consumer Scotland has not considered Part 2 of the Bill.