Why safeguarding matters
Why safeguarding is an important issue for patients and practitioners, especially when it comes to intimate health.
Safeguarding involves protecting a person's health, wellbeing, and rights to be free from harm, abuse, and neglect. This is all-encompassing, and examples include financial, physical, psychological, sexual, self neglect, modern slavery, domestic and / or exploitation.
Safeguarding is vital in aesthetics to protect both patients and practitioners. As the aesthetics sector expands into sensitive areas such as menopause care, gaps in safeguarding policies and training are becoming increasingly apparent.
In 2024, Hamilton Fraser announced a partnership with Menopause in Practice (MiP) to support women in getting the right advice through the clinics they are accessing and make sure that menopause care is provided safely and ethically, especially when it comes to intimate health treatments that involve examining and treating a woman’s vulva and/or vagina internally and externally.
“Safeguarding is essential because if you get this wrong, you won't have a business! It's really about protecting your patients, which is non-negotiable. In any medical field, safeguarding is mandatory – whether for adults or children.
As practitioners, we're responsible for recognising potential abuse and understanding what to do about it. This isn't just in a clinical setting but also in identifying if a patient is in danger outside the clinic. Protecting patients and making sure of their safety is key to maintaining trust and avoiding legal issues.”
Practitioners often encounter vulnerable patients, making awareness of physical, psychological, and financial abuse critical. From understanding early signs of distress to handling complex cases of self neglect, safeguarding requires vigilance and a deep sense of responsibility.
Kimberley Cairns, integrative psychologist and trustee of the Joint Council for Cosmetic Practitioners (JCCP) says:
“As an aesthetic practitioner, you may come into contact with vulnerable adults who are at risk of harm, abuse or mistreatment. You may hear or see past suffering, early signs or witness an event that indicates real time mistreatment or suspect future endangerment.
This includes concerns about the treatment of a patient from another aesthetic practitioner. Safeguarding is an integral part of providing high-quality care, and you must be suitably prepared for this.”
According to Rape Crisis, one in four women has been raped or sexually assaulted as an adult; that’s 6.54 million women (and that doesn’t include attacks that go unreported).
A 2023 British Journal of Surgery survey revealed that almost one in three female surgeons working in the NHS had been sexually assaulted in the past five years, 29% had experienced unwanted physical advances at work, more than 40% had received uninvited comments about their bodies, and 38% received sexual “banter” at work.
In addition, more than 35,000 incidents of sexual misconduct or sexual violence – ranging from derogatory remarks to rape – were recorded on NHS premises in England between 2017 and 2022, according to data collected by the British Medical Journal (BMJ) and The Guardian.
Rape, sexual assault or being touched without consent accounted for more than one in five cases. While more than half of the incidents reported in this study (58%) involved patients abusing staff, in 2022, The Independent reported that nearly 150 doctors had been disciplined for sexual misconduct in the previous five years, describing a “systemic” and “cultural” problem of sexual assault within healthcare.
Between 2016 and 2020, an average of 28 doctors were sanctioned each year by the General Medical Council, which regulates more than 350,000 doctors in the UK, after allegations of sexual misconduct were proven against them.
The majority of these doctors were erased from the register, meaning they lost their licence to practice. Of the proven allegations, 41 were made by another healthcare professional, 42 by a patient – the remainder were unknown.
Furthermore, a 2019 report for the Professional Standards Authority looking at fitness to practise cases brought against doctors, nurses, midwives, and allied professionals found that of 275 cases that included sexual misconduct as a charge, 232 related to sexual harassment or sexual abuse.
It showed this commonly happens in general practice, surgical settings, and mental health services. 59% of the cases involved patients, and 39% of the cases were about colleagues.
In collaboration with Menopause in Practice (MiP), Hamilton Fraser conducted a snapshot survey to assess the current state of safeguarding practices in aesthetic clinics.
Despite its importance, safeguarding training remains inconsistent across the sector. Practitioners often lack mandatory Disclosure and Barring Service (DBS) checks unless working in CQC registered clinics, leaving gaps in patient protection.
This has led to cases such as that of Terry James, an already convicted sex offender, who in 2023 was sentenced to 17 years in prison and placed on the sex offenders list for life for assaulting and secretly filming women at a Bradford salon where he was offering intimate laser hair removal.
The BBC reported that James had been given a suspended prison sentence of four months for possessing indecent images of children, and in May 2020, he had been arrested again for having similar material.
He was released under investigation for those offences and went on to commit more serious sexual offences against the women.
This highlights the lack of requirement for enhanced DBS checks for people offering treatments like laser hair removal for intimate areas.
The need for more robust policies across the sector is paramount, an issue first highlighted by nurse practitioner Cheryl Barton in an article in The Journal of Aesthetic Nursing, where she described a “safeguarding gap in plain sight” and argued that the “whole landscape on safeguarding the public within the cosmetic sector and beauty industry must now be urgently addressed.”
Barton wrote: “If DBS checks for doctors and nurses within the private aesthetic sector are at best scanty, then they are almost non existent within the lay groups. Those undergoing intimate bikini and buttock area laser hair removal treatments are often visually impaired due to the eye protection they must wear, this makes them vulnerable to being covertly photographed. The recent criminal case has proved predators will always find their way to the vulnerable, be that a child, a young adult or a vulnerable adult.”
Safeguarding is also often overlooked as a result of the de-medicalisation of procedures deemed to be “aesthetic”.
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Dr Lakhani comments, “The aesthetic industry often sees treatments as lifestyle enhancements rather than medical procedures, which creates a gap in safeguarding expectations.
People don’t necessarily anticipate the need for chaperones in non hospital settings like home clinics or rented rooms. However, this can leave both practitioners and patients vulnerable. In any medical setting, safeguarding needs to be a top priority, regardless of how casual the treatment may seem."
I'd love to see safeguarding and regulation in aesthetics become more like what we see in hospitals. Medical professionals should be the only ones practising. It’s concerning to see people from non-medical backgrounds offering treatments they’re not qualified for, especially when it comes to intimate health. Safeguarding in this industry is about protecting patients and practitioners and maintaining the integrity of the field. Anything less is unacceptable.
Practitioners highlighted gaps in training, resources, and policy implementation
74.19% of practitioners have not received formal safeguarding training specific to intimate health treatments, though all respondents (100%) expressed interest in receiving it.
Only 48.3% felt their existing training adequately prepared them to handle safeguarding issues, while 24.1% stated it did not, and 27.6% were unsure
62.1% receive annual refresher training, but 24.1% never receive updates, creating gaps in knowledge over time
These findings underscore the need for consistent safeguarding training across the aesthetics sector, particularly for those performing intimate health treatments.
