Have we privatised skin?
An open letter to those responsible for public health in England.

At what point did we decide that skin — the body’s largest and most visible organ — no longer belonged to national care?

We fund dental check-ups.
We screen for cancers.
We invite over-50s to heart health reviews.

But we do not check the skin.

There is no structured, preventive skin guidance.
No national check-ups.
No public messaging around barrier care or everyday skin health.
No roadmap from birth to older age.

Instead, skin has slipped quietly out of public health and into the private sector — picked up by beauty, aesthetics, wellness trends, and commercial messaging. Not by policy design, but by omission.

One of the clearest examples is lesion care.
What was once unequivocally a medical concern is now frequently treated as cosmetic. People are paying privately to remove moles, skin tags, and other lesions — sometimes by medics, sometimes by non-medics — often without any formal requirement to have them properly assessed first.

It isn’t just confusing for the public.
It’s confusing for professionals too.

Other parts of the body benefit from national systems, however imperfect. Oral health has NHS-backed preventive advice and regular check-ups. Heart health has structured invitations. Mental health is embedded across multiple government strategies.

Skin does not.

Unless something goes wrong, there is no prevention, no check-up, and almost no publicly accessible guidance.

And when public health leaves a gap, commercial interest inevitably fills it.

This is the landscape we now have: a patchwork of advice, services, and risks with no national coordination.

A further complication is that most of the hands-on skin workforce — beauty therapists, electrologists, nail technicians, hairdressers, massage therapists, and some non-medical aesthetics providers — sit within the personal care sector, governed by the Department for Education. Their training is built on Ofqual-regulated qualifications and HABIA’s National Occupational Standards.

But there is little to no connection with the Department of Health and Social Care.
And while some procedures, such as cryotherapy or microneedling, occasionally appear in NHS clinics, they are limited, condition-specific, and consultant-led.

There is no wider NHS-supported skin therapy service.
There is no national preventive skincare guidance.
And there is no public-facing education on everyday skin health.

So we have ended up with a parallel system:

Recognised in education.
Deregulated in practice.
Commercially driven in messaging.
Publicly invisible unless something goes wrong.

This matters.
Because these professions touch skin daily — often deeply — and are the first, and sometimes only, point of contact for people worried about their skin. Yet they receive no public health-aligned guidance, no national updates, and no consistent framework.

So yes — this is what privatised skin looks like.
And no — it’s not safe, fair, or sustainable.

The Skin Well® asks a simple question:
If skin is a vital organ — and one worked with by hundreds of thousands of professionals every day — why is it not included within national health frameworks? Why is it not protected, monitored, or guided like other parts of the body?

And if we never meant to privatise skin…
isn’t it time we let skin back in?

Respectfully,
The Skin Well®
Updated November 2025

Related Read: - Quiet Case for Statutory Oversight of Skin Work in the UK

📚 Connected Scenario(s):

• Scenario Zero: Naming Skin in Public Health

• Scenario Three: Policy at Every Level

• Scenario Five: 224,000 Reasons for Regulation