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It’s hard to put the finger on exactly when the aesthetics industry first came into being, but having been insuring the sector for more than 25 years, Hamilton Fraser has been there since the early days.
We have watched the non-surgical side of the industry evolve rapidly since the late 90s and early 00s, with treatments like botulinum toxin injections, dermal fillers, and other minimally invasive techniques becoming increasingly popular.
But one thing that has plagued the sector is the lack of regulation.
Despite the booming demand and rapid expansion of the industry, the regulatory framework has struggled to keep pace, leading to significant concerns about patient safety, the quality of practitioner training, and the ethical marketing of aesthetic services.
The Joint Council for Cosmetic Procedures (JCCP) has long been a partner of Hamilton Fraser, working closely with government and national bodies seeking greater regulation on non-surgical aesthetic treatments and hair restoration surgery in the UK, with the ultimate aim of creating a safer environment for members of the public undergoing non-surgical treatments. As such, we are delighted to be welcoming Professor David Sines, the chair of the JCCP who also chaired the HEE review that took place between 2014 and 2015 on behalf of the government, to give a regulation update and lead a Q&A at The Aesthetics Business Conference on Tuesday 8 October.
Ahead of that, this article delves into the historical developments, key legislative milestones, and future prospects for the regulation of the aesthetics sector in England, where the first steps are being made towards formal regulation and where we are currently waiting for the outcome of the public consultation on licensing of non-surgical cosmetic procedures in England.
The rise of non-surgical aesthetics began in the 1990s with the advent of dermal fillers and botulinum toxin treatments, with Allergan’s Botox being licenced for cosmetic use in the US in 2002 and the UK in 2006. Initially, these procedures were predominantly performed by trained medical professionals, such as plastic surgeons and dermatologists. However, as the popularity of the treatments grew, so did the number of practitioners from non-medical backgrounds entering the field, often with minimal training. This proliferation of unregulated practice led to mounting concerns over patient safety, prompting discussions on the need for regulation.
The first significant step towards addressing these concerns was the Keogh Review, published in April 2013. Commissioned by the Department of Health and spearheaded by Sir Bruce Keogh, the report provided a scathing critique of the state of regulation in the aesthetics industry. It highlighted that individuals seeking non-surgical cosmetic interventions had little more protection than those buying everyday consumer goods, like toothbrushes or ballpoint pens. The report’s findings underscored the urgent need for regulatory reform to protect patients from the risks associated with poorly performed procedures.
In response to the Keogh Report, Health Education England (HEE) was tasked with developing a framework to improve training standards across the non-surgical aesthetics sector. Over the course of 18 months, HEE worked closely with a wide range of stakeholders, including professional regulators, universities, and industry representatives, to develop a set of educational standards aimed at enhancing practitioner competence and patient safety.
The culmination of this effort was the publication of two key reports in November 2015. These reports outlined a structured qualification framework for practitioners, categorising treatments based on their level of risk. For example, high-risk procedures like injectable toxins and dermal fillers were designated as Level 7 treatments, requiring advanced training and the oversight of a qualified prescriber. This framework represented a significant step forward in ensuring that practitioners possessed the necessary skills and knowledge to safely perform these procedures.
However, the implementation of these standards faced several challenges. The qualifications were introduced on a voluntary basis, leading to inconsistent uptake across the industry. Many training providers found loopholes, offering substandard courses that failed to meet the rigorous standards envisioned by HEE. As a result, a large number of practitioners continued to operate with inadequate training, perpetuating the risks highlighted in the Keogh Report.
Recognising the need for a more robust regulatory body, the Joint Council for Cosmetic Practitioners (JCCP) was established in 2017 and formally launched in 2018. The JCCP took ownership of the HEE standards and sought to enforce these through its voluntary register, which was designed to recognise practitioners who met the highest standards of training and practice. The JCCP also played a crucial role in lobbying for more stringent regulation and public protection within the industry.
The JCCP’s efforts were bolstered by the Cosmetic Practice Standards Authority (CPSA), which developed the competency frameworks that underpin the JCCP’s standards. Together, these organisations worked to raise the bar for training and practice within the non-surgical aesthetics sector. Despite these efforts, the voluntary nature of the register meant that many practitioners, particularly those from non-medical backgrounds, remained outside its purview. The same was true of other voluntary registers established following the Keogh review, including Save Face and Treatments You Can Trust.
The JCCP and CPSA Code of Practice and Guidance for Practitioners Who Provide Cosmetic Interventions was developed following a wide-ranging consultation process for those involved in providing cosmetic treatments. This updated and revised version of the guidelines was approved by the CPSA and JCCP in 2020. A third edition was published in March 2023.
In 2021, the JCCP laid out its 10 point plan, setting out the campaigns the JCCP is carrying out and the goals they are seeking to achieve in their aim to create a safer aesthetic industry with mandated qualifications, premises criteria, insurance and other steps relating to the sector, which are:
In July 2021, the All-Party Parliamentary Group (APPG) released its findings and recommendations after conducting a year-long inquiry. The group, established to advocate for the rights of the UK beauty and medical aesthetics industries in Parliament, emphasised the importance of setting minimum educational standards for aesthetics practitioners to enhance patient safety.
The first significant piece of legislation directly affecting the aesthetics industry was the ban on cosmetic injectables for individuals under 18, which came into effect in October 2021. This law marked a turning point in the regulatory landscape, reflecting growing concerns about the ethical implications of administering such treatments to minors. The legislation was the result of concerted efforts by various stakeholders, including industry professionals, advocacy groups, and public campaigns.
Building on this momentum, the Health and Care Act 2022 introduced a comprehensive framework for the future regulation of the non-surgical aesthetics sector. The Act laid the groundwork for a mandatory licensing scheme, which would cover both practitioners and their premises. This licensing scheme, once fully implemented, would represent a major step forward in ensuring that all individuals performing aesthetic procedures meet a consistent standard of training and competence.
2022 also saw the Health and Social Care Select Committee release its report focusing on the impact of body image on mental and physical health. The report includes the Committee's recommendations for regulating non-surgical aesthetic procedures in the UK.
In January 2023, the government confirmed its commitment to this licensing scheme, with plans to implement it by the end of 2026. The scheme is expected to include minimum education standards for practitioners, mandatory hygiene and safety protocols for premises, and ongoing oversight to ensure compliance. This regulatory framework is seen as a critical step towards safeguarding the public from unqualified practitioners and substandard practices.
Consultation on the licensing of non-surgical cosmetic procedures in England opened in September 2023 and closed in October 2023. The industry is still awaiting a response from the Government, and fears started to mount following a change of Government in July 2024.
However, Prof Sines remains confident that a response from the new Labour Government will come soon. He says, “The bottom line is this: none of us have knowledge of when the Government will respond to that first consultation (which closed in October 2023). What was very clear in my mind was that had the Government not announced the election by Rishi Sunak on that particular Thursday, there would have been an announcement by the Conservative Government, which would have resulted in the publication of their consultation response.
“There were 11,800 responses to that consultation. That is powerful! So, with that in mind, I remain confident that the new Government will be in a strong place to validate whatever recommendations the previous administration was going to make.”
You can read our full interview with Professor David Sines here.
While the journey towards comprehensive regulation of the aesthetics industry has been long and complex, recent developments signal a positive direction. Establishing mandatory licensing and the continued efforts of organisations like the JCCP are crucial steps in ensuring that the industry operates to the highest standards of safety and professionalism. As the regulatory landscape continues to evolve, the challenge will be to balance the needs of practitioners with the imperative to protect patients and maintain public trust in the industry.
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