Hansard

:This group of amendments goes to the heart of the bill. It contains amendments to section 4, which sets out the most important public safety provisions on where non-surgical procedures can be carried out and the need for healthcare professional involvement in those settings. Those are the issues that have been the subject of most of the correspondence and representations that I have received, and I must make it clear that I have listened carefully to all sides of the discussion.I will start by discussing my amendments. Amendment 22 is the most substantial. It does not add to or remove any setting from the list of permitted premises, but it provides additional clarity about those premises. Amendment 22 will replace the existing sections 4(1) and 4(2) with a new section 4(1). The new subsections (1)(a) and (1)(b) provide new drafting so that the permitted premises for Healthcare Improvement Scotland-registered independent clinics and independent hospitals are those where the address is entered in the register that is maintained by HIS. Subsection (1)(a)(ii) makes it clear that an independent clinic can include a vehicle. Subsections (1)(c) to (f) are the same as provisions in the bill at introduction, but with minor technical drafting changes.Amendment 25 will amend section 4(5) to include definitions that relate to new subsection (1). Amendments 9, 23, 24 and 31 make technical drafting changes that are proposed as a consequence of amendment 22. The changes address concerns raised by HIS in evidence to the committee about the clarity of those provisions.The inclusion of vehicles might surprise some members, but, in the case of dental settings, mobile settings were included in the bill at introduction, and the inclusion is consistent with how those settings can already operate. In the case of a HIS-registered independent clinic, that has been made explicit, recognising that it is possible but not easy for a vehicle to be equipped in the same way as a traditional clinic. For example, such vehicles already provide dental scanning and blood donation services within the NHS. I assure members that independent clinics that are vehicles would be inspected by HIS and would be expected to meet the same standards as fixed premises in relation to the appropriateness of fixtures and fittings.Amendment 22 also makes it clear that procedures must not be carried out from clients’ homes. It would, however, be possible for a clinic to be established out of rooms in a provider’s home or in a purpose-built outbuilding, because, again, such a setting can still be inspected by HIS and be held to the same standards as any other clinic.I urge members to support all the amendments in my name.I will now turn to other members’ amendments in this group and the clear themes that they fall under. Amendments in this group take a variety of approaches. Amendments 22D and 73 would create an additional category of HIS-regulated setting. Amendments 40, 44 and 61, amendments 68 and 71 and amendments 69 and 113 would amend requirements of existing categories of HIS-regulated settings.Other amendments would provide for new licensing or registration schemes, such as amendments 22A, 41, 42 and 60, on licensed non-healthcare premises, amendments 22B and 43, on community clinics, and amendments 22C and 112.A number of these amendments seek to allow businesses to operate without healthcare professional involvement. In respect of the proposed licensing schemes, the Civic Government (Scotland) Act 1982 (Licensing of Non-surgical Procedures) Order 2026 has recently been approved by the Scottish Parliament in order to introduce a local authority-run licensing scheme for lower-risk non-surgical procedures. It is intended that the licensing scheme under the order and the regulation of higher-risk procedures under the bill will both commence at the same time. As such, there is no need for any amendment that introduces a new licensing scheme.I appreciate that all of these amendments seek to address business concerns around the impact of the bill, with the focus being the cost and practicality of having a healthcare professional always present in a setting. I will take this opportunity to explain why I believe that the presence of a healthcare professional is essential.All the procedures currently described in schedule 1 to the bill carry some risk. Many of them require the use of a prescription-only medicine, and the remainder are all likely, in varying degrees, to require the use of a prescription-only medicine in addressing complications. We heard during the debate that these complications may not emerge immediately. However, I have clinical advice on and examples—some of which were shared in Parliament by Dr Gulhane—of complications emerging or being identified immediately and requiring immediate action to prevent serious adverse outcomes.In these cases, someone needs to be available to assess the situation and have the ability to prescribe or administer the relevant medication. The setting needs to hold supplies of such emergency medication. Non-regulated settings delivering non-surgical procedures are not able to routinely hold supplies of prescription-only medicines without the involvement of a suitably qualified healthcare professional. I cannot endorse any proposal that could allow procedures to continue to be undertaken without access to emergency medicines.With specific reference to amendments 44 and 61, which are linked with amendment 40, which seek to create a prescription-only medicine governance process, and amendments 69 and 113, which would require an arrangement for named prescribers to be attached to each permitted premises, there are concerns about the effect of these amendments on the reservation of the subject matter of the Medicines Act 1968 in the Scotland Act 1998.There are other advantages to the presence of a healthcare professional in settings that provide non-surgical procedures. For example, a healthcare professional’s involvement in consultation can support fully informed consent and consideration of risks, particularly with regard to existing health conditions. A healthcare professional also offers the wider assurance of professional regulation. Complaints can be made against such professionals to professional regulators, with serious consequences if they are upheld. This is not the case for practitioners who are not healthcare professionals.For all those reasons, I urge members not to move amendments that would in any way undermine the connection between a permitted premises and the presence of a healthcare professional.Again, I urge members to support the amendments in my name.I move amendment 9.