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International Women’s Day (IWD) (8 March) is a focal point in the women's rights movement, putting issues such as gender equality, reproductive rights, and violence and abuse against women under the spotlight.
One of its missions is to address inequality in healthcare, and “assist women to be in a position of power making informed decisions about their health”.
As we’ve seen in recent years, one of the biggest women’s health issues currently getting a lot of airtime is menopause. Having been a taboo for so long, women are now taking charge and speaking out about the impact menopause has on them across every area of their lives.
From the Menopause Mandate to a new Government scheme for cheaper hormone replacement therapy, menopause is high on the agenda. And with the aesthetics industry moving more and more into the women’s health space, Hamilton Fraser has been partnering with Menopause in Aesthetics (MiA) to work towards supporting women in getting the right advice through the clinics they are accessing. One of the key motivations behind this is to make sure that menopause care is provided safely and ethically, especially when it comes to intimate health treatments.
At the recent MiA conference in London, our Founder and CEO, Eddie Hooker, sat on a panel to discuss safeguarding, a topic that’s important across the board in aesthetics but is essential when considering providing intimate treatments that involve examining and treating a woman’s vulva and/or vagina internally and externally.
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).
According to a survey published in the British Journal of Surgery in 2023, it was reported 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.
It’s clear from these statistics that there is a need not only to safeguard vulnerable patients from the potential risks of sexual assault, but also that aesthetic practitioners need to be vigilant about their own practices to minimise the risk of any allegations being made against them. Whether this is making sure anyone performing such treatments has an enhanced Disclosure and Barring Service (DBS) check (not mandated unless you are working in a CQC-registered practice) or putting chaperoning policies in place within the clinic, safeguarding is a topic that needs to be on the agenda.
In The Journal of Aesthetic Nursing, nurse practitioner Cheryl Barton described what she believes is 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.”
Kimberley Cairns, integrative psychologist and trustee of the Joint Council for Cosmetic Practitioners (JCCP), says, “Safeguarding involves protecting a person's health, wellbeing and rights to enable a life 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.
“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.”
You can read Kimberley’s article on Mental health: Safeguarding and fitness to practice here.
We’d also recommend that you read Kimberley’s article ‘Treating Menopausal patients: menopause, mood and the mirror’, in which she explores how menopause affects body image and subsequent patient motivations for treatment.
Here are Eddie Hooker’s key safeguarding takeaways for intimate treatments following the MiA safeguarding panel.
“Our job is to protect the practitioner and, in turn, protect the patient because without insurance, of course, there's no recourse for the patient if something goes wrong”, Eddie says. “So, how do you protect yourself? The first thing is you've got to have the right insurance.
“The aesthetics industry is rapidly changing. Ten years ago, menopause was not even on the agenda. Most women would go to their GP or wouldn't know they were experiencing some of the conditions you can go through. So, things are changing, and insurance companies are trying to catch up.
“The internet doesn't help because you can get quotes and policies online. Practitioners are being thrown a lot of information. They don't read all of the conditions of their policy. They don't know what they're supposed to provide.
“The most important thing is to talk to people like us. If you are insured with Hamilton Fraser, get on the phone. Once you start treating on and around the more intimate areas of the body, cover is NOT provided as standard. And you can understand why—the risk, unfortunately, is a lot higher. We are picking up phone calls every day now about these types of treatments, and whilst we can extend your insurance to cover these areas, you need to ask us.
“So my advice is that whenever you are thinking of introducing any treatment into your clinic, you should get on the phone with us. My team has been doing this for years; there isn't a treatment that we are not currently aware of. Yes, there are some treatments we need more information about, and we may well ask more questions, but I would always advise it's worth a five to 10-minute phone call or even dropping us an email just to make sure that we note these things on your policy schedule.”
Read our article, ‘Insurance risks of aesthetic treatments for menopause’ for more information.
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“Good communication with your patient is of the highest importance when you are sitting with your patient is to understand their issues and the types of treatment that might be suitable for them. And that's really, really important,” says Eddie.
“Take your time when discussing any treatments of intimate areas of the body. Something may come out in that discussion that means the patient may need more of a medical [or specialist] referral. They also may not be suitable for treatment within the clinic that you are actually operating in.
“When you are on a one-to-one basis with a patient, and you are performing some of these intimate procedures, then there is always that opportunity someone could end up making an unfounded or founded allegation against you. This is the difficulty of these sorts of discussions; your word against theirs. That's where your notes come in. That's where your continual communication with them comes in. Get them to confirm that your notes are accurate and sign them if possible. Consider a chaperone or at least offer them the opportunity especially if there is a need for the removal of clothing in those areas.
“If the patient is starting to feel uncomfortable, you need to stop and have another chat about things, really explain the procedure and give them an opportunity to go away and think about it rather than just jumping in.”
“Under most malpractice policies and indemnity policies, you are required under the terms of the policy to take before and after photos. If a claim or allegation is made against you, and you don’t have those photos, that puts you in breach of your policy condition”, explains Eddie. “So you've got to make sure you have before and after photos.”
“But then there's the discussion about how you do that. How do you make the patient comfortable when you are taking those photos? Again, offer the opportunity for a chaperone, or do they want to bring someone in with them if they feel more comfortable, perhaps a close partner or family member? If you are offering a chaperone make sure they are suitable and ask permission from the patient. And then, what do you do with the storage of all of those photos? I hope no one would dream of putting them on their website or social media, but you must be very, very careful about what you do with these images, who can access them and how you keep them.”
“If sexual allegations are made against you, how do you deal with that? A malpractice policy will not pick up any claim if you are criminally negligent or if there is a criminal issue.
“But if an allegation is made that you've done something, that's when your insurance policy can pick that up. These sorts of allegations are awful. They're awful for you, they're awful for the patient, and you need some professional help there. I've dealt with claims exactly like this, and they are traumatic for everyone involved. Call us immediately.”
“A lot of people are going on training courses run by unqualified practitioners. It’s a minefield, there are no common training standards and a lack of practical after-course support. That's why I work closely with the Joint Council of Cosmetic Practitioners (JCCP) and am proud to sit on their Trustee Board to advise on these sorts of issues.
“I am calling for heavier regulation in the sector so that we can deal with the real issues.
“We need to get some form of recognised qualifications in across all of the treatments that we are doing and educate the public because that's a big thing, that when they go into a clinic or into a salon they're asking the right questions. Are you qualified? Where can I find out if you are insured? Have you ever done this? Can I bring someone with me? Can I go away and think about this? That's what we also need to be shouting about and pushing for as a community.
“I am proud that Hamilton Fraser has, for 30 years now, stood our ground that we will only insure medical practitioners. That's something I fundamentally believe in.”
While IWD shines a light on issues surrounding women’s health and violence and abuse against women, safeguarding is a topic that we as an industry should be thinking about year-round. Insurers, manufacturers and practitioners all have a role to play in safeguarding vulnerable patients, not just when bringing intimate health or menopause treatments into the clinic but across the board in our aesthetic practices. In the absence of regulation, the medical aesthetics industry has a duty of care to uphold the commitment to “do no harm” and to make sure all patients are safe when they walk through your door.
At Hamilton Fraser, we offer more than just insurance. For more advice and for information on cosmetic insurance, contact Hamilton Fraser on 0800 63 43 881 or get a quote today.
