Mike Clifford, partner at law firm Weightmans, considers whether England’s plans to reform cosmetic regulation will deliver meaningful change or expose the limits of the CQC’s capacity.
Regulation of non-surgical cosmetic procedures in England is both overdue and welcome. For years, the aesthetics sector has expanded in a regulatory vacuum – commercially successful, but insufficiently regulated, leading, at times, to real harm.
Worth an estimated £3.6 billion and delivering, among other treatments, around 900,000 Botox injections each year, it has outgrown the limited frameworks designed to keep patients safe. The result is an uneasy mix of professionalism and opportunism: responsible providers working alongside cosmetic cowboys operating with minimal training/oversight.
After years of calls for reform from clinicians, insurers and patient advocates, the government has now promised to act in England. This summer’s announcement marked a long-awaited shift, setting out a tiered regulatory framework that would continue to place the highest-risk procedures under Care Quality Commission (CQC) oversight and bring lower-risk treatments, such as Botox and fillers, into a new local authority licensing system. Nearly 12,000 people responded to the government’s consultation, a clear sign that public confidence depends on credible enforcement.
It puts England on course to catch up with the other nations. Scotland has proposed a similar three-tier licensing regime to be put in place in the current Parliamentary session, and, in November last year, Wales introduced a new licensing scheme for premises conducting non-surgical cosmetic procedures like tattoos and electrolysis.
Regulation in principle
On paper, these reforms are a step in the right direction. They could professionalise the sector, curb unsafe practice and restore trust. But the government’s plan depends heavily on the CQC, a regulator that is already in flux.
Under the 10 Year Health Plan, the CQC is being reformed to become more “intelligence-led”, with AI tools, data dashboards and remote monitoring. In theory, this could make oversight faster and more responsive. In practice, the CQC is still working through inspection backlogs, IT failures and staffing shortages, while also addressing criticism that its processes can feel rigid, opaque and overly punitive. Adding to its remit, the oversight of a fast-moving commercial sector like aesthetics risks stretching the organisation beyond its limits.
The CQC’s challenge is not only operational but cultural. The shift toward data-driven inspection has prompted concerns that empathy and sector understanding are being lost. Providers across healthcare have voiced frustration that inspections can feel procedural rather than collaborative – a problem that could easily worsen when applied to an entirely new industry.
The aesthetics market is unlike traditional healthcare: it spans high-street clinics, salons and mobile practitioners, all operating with varying degrees of medical training/supervision. Effective regulation will require nuance, sector-specific expertise and strong communication. These are qualities that will require the evolution of the CQCs model and will be challenging for an organisation already under a lot of strain. Without investment in training and culture, enforcement risks becoming inconsistent or adversarial.
A test for local authorities, providers and insurers
Local authorities will carry responsibility for licensing lower-risk procedures, creating another potential bottleneck. Councils already face significant funding and staffing pressures, and establishing new inspection systems will require sustained support. Without it, oversight could vary dramatically between regions – a postcode lottery in safety standards that would erode the credibility of the entire framework.
For providers, compliance will demand time and money. Clinics will need to upgrade premises, enhance governance and ensure practitioners meet new licensing and training thresholds. Dentists, pharmacists and opticians who offer aesthetic treatments will have to check their indemnity arrangements carefully, as traditional policies may not cover cosmetic work.
For insurers, the implications are complex but potentially positive. In the short term, policies will need recalibration to reflect the new risk tiers. Over time, however, effective regulation should reduce claims from unsafe or unlicensed practice. Much will depend on the consistency of enforcement – if the CQC and local authorities lack capacity, insurers could remain exposed to the same risks under a different regulatory label.
Ambition must be matched by delivery
The broader opportunity is reputational. Providers and insurers that align early with the new rules can position themselves as leaders in a more professionalised market, helping to restore confidence in an industry long undermined by cowboy practices. For an aesthetics sector driven by patient trust, credibility will become a key differentiator.
But ambition must be matched by delivery. The CQC needs the resource, expertise and cultural reform required to regulate fairly and proportionately, while local authorities must be funded and equipped to apply the new licensing system consistently across the country. Without this, regulation risks being ambitious in scope but hollow in impact.
If implemented effectively, these reforms could finally bring order and professionalism to an industry that has too often been left to its own devices. If not, England risks replacing one kind of inconsistency with another – a regulatory framework that looks strong on paper but fails to deliver the cultural reset the sector needs.
