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:I would agree. Further, the documentation about when the vial came out of the fridge and went back in the fridge, and how long it had been open for, is vital when it comes to assessment by HIS of what you are doing and whether you are doing it safely. I do not think that all providers are taking that approach right now. I am sure that some providers are—I will not say, in a blanket way, that everyone is not doing things—but if we do not have regulations, we will not know what we should or should not be doing, and therefore we will not know whether we are following procedure. That is my worry when it comes to watering down HIS standards.

The idea of the blank prescription is that someone can crack on and prescribe, although the person who wrote the prescription does not really know what is happening with it and has not had a discussion about each patient and what is being done. We should look at that, because I am pretty sure that it is not the point of being an independent prescriber, such as a pharmacist, to give out blank prescriptions.

:Amendment 79 seeks to ensure that those who make complaints after receiving non-surgical procedures benefit from a clear set of national guidelines being in place. I do not believe that such an approach would be too onerous, as it would be set out in secondary legislation, and it would allow a very clear line when it came to making complaints.

I have heard it asked, “If we are talking about a single provider, how on earth can you create a complaint along those lines?” However, the situation is the same with single-handed GPs; there still has to be a complaints procedure in place. If someone is not satisfied with the response that they get from the provider in question, there should be clear guidance that sets out exactly how they can complain and that ensures that any such complaints are followed through in a robust way.

I turn to amendments 106 and 118. The committee said in its stage 1 report that it wanted the Scottish Government to ensure that

“all providers are similarly suitably trained and qualified to be able to undertake patient mental health screening and to ensure properly informed consent”.

Amendment 106 seeks to deliver that by ensuring that comprehensive national guidance is in place to assist providers with mental health screening. We are not requiring providers to be fully trained in mental health issues, and they do not need to be psychiatrists, but they need to have some idea of how to do a quick screen. After all, body dysmorphia is estimated to affect one in 50 adults in the United Kingdom; given its impact on body image, there is naturally a high likelihood that those suffering from it might seek a non-surgical procedure, and having that kind of discussion with the appropriate patient or client would provide a safeguard if they were seeking a non-surgical procedure.

Amendment 21, in the name of the minister, rightly defines an injectable non-surgical procedure as something that is done for a cosmetic or “wellbeing purpose”, so that providers are not able to enter this from the side, as it were, and I really support such an approach. Given the minister’s recognition that people seek out procedures to improve their mental health, it is important that we put in place proper guidance in response to that. Although amendment 106 focuses on body dysmorphia, it would just be a starting point, and it would, I believe, allow ministers to create guidance covering any other mental health condition that they felt was appropriate.

I declare an interest as a practising national health service general practitioner.

I will start with amendment 6, and I would like to directly ask the minister about it. I support the idea of clinical trials not being part of the bill, so the amendment makes sense. My only concern is about ensuring that they are real clinical trials, not something that somebody says is a clinical trial. There could be wording in the bill to strengthen the provision—for example, by requiring the trial to have gone through an ethics committee, to ensure that it is a clinical trial that the ethics committee has agreed is acceptable. That is not to say that I will not support amendment 6, but I would like to see a tweak made when we come to stage 3.

Turning to amendment 64, the minister said that this is not the place to debate what does and does not constitute medicine. However, there is no reason why an osteopath should inject somebody; that is simply not part of the job of an osteopath. Whether we agree that osteopaths have any place in science and medicine can be debated at stage 3, but there is no reason for an osteopath to inject anybody, and osteopaths are unable to prescribe medicines. For that reason, I do not see why osteopaths should be in the bill. Chiropractors are different, because they do a lot of work in the NHS. However, given that hyaluronic acid is being injected, I might not move the amendment and might instead bring it back at stage 3.

On Maurice Golden’s and Jeremy Balfour’s amendments, I support the principle behind ensuring that some reasoning be given for why a procedure is being added to the bill, but I do not want a huge amount of extra work to be required to do that, which could slow down the inclusion of new procedures in the bill or make that too cumbersome or difficult. I support the principle, but the issue needs work before it can come back at stage 3.

:There is a lot in this group, as the minister said. I am absolutely sure that there are people providing non-surgical procedures who have neither insurance nor indemnity for their premises, which concerns me. The point of the bill is to make everything safer and to tighten things up. It will be very important to have further discussions on the issue as it is vital that providers have such arrangements in place—it is unacceptable for providers not to be insured.

I agree with the minister on the high-risk groups and I will not move amendments 81 and 103. Further discussions are needed, but I will not press amendment 77.

Amendment 77, by agreement, withdrawn.

:Given what was said, this is an issue on which further discussions are required, so I will not move the amendment.

Amendment 81 not moved.

Section 5—Power to make further provision about non-surgical procedures

Amendment 83 not moved.

:It is a difficult one, because the minister said that she would come on to discuss the issue that my amendment addresses prior to the vote being taken. Given that I do not know what the minister is going to say, I will move the amendment.

Amendment 104 moved—[Sandesh Gulhane].

:Amendment 104 seems rather sensible in setting out that, within a year of the bill coming into force, ministers must review how the enforcement provisions are working in practice. Such a review would include looking at the number of fines, whether multiple fines were being issued to the same practitioner, whether enforcement powers were providing enough of a deterrent and whether the level of fine should be modified as a result. We might find, for example, that behaviours that incur the maximum fine keep occurring, because they seem to be in the providers’ interest. This is, as I have said, a sensible amendment, the purpose of which is to look at whether we are getting things right when it comes to fines.

:Thank you. I did not want to interrupt what you were saying, because it is vital that we can ensure that under-18s do not get into this. When we introduce a new form of ID, providers might, in good faith, be duped by false documentation. In considering the secondary legislation, will the minister set out help for providers with new forms of ID that they might not have seen before?

:Amendment 77 would require providers to have insurance and indemnity. Responsible providers already do so. It is perfectly reasonable to require providers to have insurance for their premises and indemnity for themselves.

With amendment 78, I am seeking to ensure that there is an informed consent process for prospective patients. Informed consent is not as straightforward as saying to someone, “Oh—I see you’ve come here for Botox. Let’s crack on.” It involves discussing the potential risks and side-effects. There is even a place for a cooling-off period to ensure that the person who is seeking the procedure receives appropriate levels of information.

Amendments 81 and 103 deal with a really important issue. They were recommended by the Scottish Medical Aesthetics Safety Group. I believe that they would close a loophole that currently exists in the bill. There are only nine botulinum toxin type A products authorised for use in the UK by the MHRA. The patient safety instructions that accompany those products clearly state that they can be administered only by healthcare professionals, not by members of the public.

I am concerned that, as it is currently drafted, the bill will not prevent members of the public from administering botulinum type A, which means that it ignores the manufacturer’s safety instructions and undermines the MHRA’s rigorous risk assessment and licensing requirements. My amendments 81 and 103 seek to close that loophole in the interests of public safety by ensuring that only regulated healthcare professionals can administer botulinum type A.

Amendments 92, 95 and 87 seek to define those people who are qualified to conduct such procedures unsupervised. Amendment 95 seeks to define a licensed medical doctor as

“a person registered with the General Medical Council”.

Amendment 87 is a consequential amendment that would remove the need for ministers to make regulations about supervision, as that issue is covered by amendment 92.

I apologise—I have a lot of amendments. With amendment 95, I am seeking to provide a definition that ensures that an advanced medical practitioner is able to act independently. It is important that we do not have a loophole whereby someone can train to be a dental nurse, for example, which does not require a long period of training, simply to get into the field of aesthetics. People who have experience and who are able to prescribe should be able to act independently when it comes to the clinic that they run.

I also want to look at the meaning of “supervision”. It is important that that word is defined. Ideally, I would like a definition to be provided in the bill, because I think that it is vital that it is clear to everyone what is meant by “supervision”, to avoid any legal challenges or situations in which people say that they are supervising when they are online in the Bahamas, rather than actually there in the clinic.

Amendments 99 and 120 are probing amendments. I am looking for guidance to be provided on higher-risk clients. I discussed the issue with the minister; it was raised by Cleft Lip and Palate Action. Essentially, I want to ensure that patients who are at a higher risk are looked after by practitioners who have the appropriate skills to deal with high-risk patients. However, I will not move those amendments.

I move amendment 77.

:Again, in order to have further discussions with the minister, I will not move the amendment.

Amendment 103 not moved.

Amendment 27 moved—[Gillian Mackay]—and agreed to.

Section 12, as amended, agreed to.

Section 13 agreed to.

After section 13