Meeting of the Parliament

Meeting date: Thursday, September 29, 2022

Official Report 1188KB pdf

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Mesh Treatment Clarity

The Parliament is still in session. I ask members of the public who are leaving the public gallery and members who are leaving the chamber to please do so as quickly and as quietly as possible, because we are about to start the next item of business. Thank you.

The next item of business is a members’ business debate on motion S6M-05086, in the name of Daniel Johnson, on mesh treatment clarity. The debate will be concluded without any question being put. I invite members who wish to speak to press their request-to-speak buttons now or as soon as possible.

Motion debated,

That the Parliament understands the difficulties and desperation that women can experience as a result of transvaginal mesh implant surgery, both in terms of their physical wellbeing and their mental health; notes the view that there is a need for urgent reform so that women have the necessary treatment available; notes the calls for greater clarity and preparedness in dealing with mesh cases, so that more women, including in Edinburgh Southern constituency, can be supported with the clinical support they need, and further notes calls on the Scottish Government to do all it can to engage with mesh survivors.

12:54  

I thank all those who have made it possible for this debate to take place in the chamber. I rise mindful of the fact that it is the first time that I have spoken about mesh. What goes before me is the tragic situation of debilitating pain and life-changing procedures that many women have had to face over a number of years, from which they will never truly recover. I am also mindful of, and I pay tribute to, those who have gone before me in raising the issue, particularly my former colleague Neil Findlay, whose work on the issue was truly outstanding. I also pay tribute to Jackson Carlaw, who has tirelessly campaigned on the issue.

The reason why I lodged the motion for debate is quite simple. I was approached by a constituent who had undergone mesh treatment. Although she is grateful that there has been movement and progress, she still has questions about the current status of the situation. I sought a members’ business debate because it is a means of inviting the minister to the chamber so that we can put those questions and get the updates that are required.

The simple reality is that, although measures have been put in place and treatment made available, the issue will never truly come to an end for the women who were implanted with mesh. We must not let the issue go quiet; we must continue to endeavour to provide the information and updates.

The issues around mesh have been well discussed, but I will briefly restate the situation. Approximately 40 per cent of women who underwent transvaginal mesh treatment faced immediate physical complications. A further 40 per cent had complications within two years. Those complications ranged from leg, groin, abdomen, back and bowel issues to autoimmune disorders and neurological disorders. It is difficult to overstate the life-changing and debilitating consequences that such chronic pain has.

It is not only physical pain—my constituent has spoken of the impact that TVM has had on her mental health, from severe trust issues to post-traumatic stress disorders and panic attacks. There is a real sense of the mounting frustration that she and others have about the lack of clarity and information. It is also about the financial impact, including the reduction in working hours—the giving up of paid work—and the financial impacts involved with taking up the care and treatment that they required.

To that end, I will ask a number of questions, and I hope that other members will as well. I have spoken informally to others about the tenor of the questions and the manner in which I intend to ask them. My first question is around support for aftercare provision. The Scottish Government fund ran for two years, from July 2020 to June 2022, with £1 million set aside for those who suffer from the after-effects of mesh to purchase self-care items, such as incontinence pads, and to undertake travel. How many women benefited from that fund, and how much of that £1 million remains? What will be done to extend any potential funding that women might require?

My second question regards access to removal surgery. The recent contract to enable national health service patients to visit Dr Veronikis in the United States to receive transvaginal mesh removal surgery is welcome, but there are key issues that require clarity. In order to access that surgery, many women are having to go back to the very facilities and physicians that performed the procedure on them. It is understandable that that is potentially hugely traumatic, and it is very difficult for those women to trust the individuals who carried out those procedures in the first place.

How many women have been able to take up the offer to travel to the United States for surgery from Dr Veronikis? Does the minister acknowledge that there is a need to have a more sensitive and prudent approach to both the consultation and the assessment, with regard to women having to go back to the place and the physicians that undertook the original treatment? The question that my constituent asked me to ask is this: how would the minister feel if she or a family member had to go back to that person?

My third question is about the reimbursement fund. Although there is a fund that makes available £20,000 for women to receive the treatment privately, it is a reimbursement fund. Because of that, unless a person has £20,000 available to them, that fund might as well not exist at all. I ask again: how many women have been able to use the fund? Will the Government consider the impact on those who cannot afford £20,000, for whom reimbursement is quite simply inappropriate?

I would also like to ask about other medical devices, because these issues are not limited to transvaginal mesh. Other devices that have been used, including Essure, have been subsequently found to cause debilitating side effects and pain and might have been withdrawn from use altogether, and many people suffer because of them. I have been contacted by women who underwent Essure placement.

What work has the Scottish Government undertaken to identify issues such as those associated with Essure? What work has been undertaken to reach out to people who have been affected and to provide treatment to them now?

I am sure that members have many other questions. My time in the debate is coming to end, but I hope that this is an opportunity for us to get updates and clarity. I intend to lodge more motions in the future, or seek other opportunities, to get that clarity. That is our duty and responsibility to the women who underwent these procedures and who have suffered in a way that I do not pretend to be able to understand. They deserve those answers and they deserve treatment.

We move to the open debate.

13:01  

I thank Daniel Johnson for bringing this important debate to the chamber. Indeed, it is one of many debates on this issue in which I have spoken over the years in this place. I also thank Jackson Carlaw and former MSPs Alex Neil and Neil Findlay for the immense amount of work that they did, long before I came on the scene, on the devastation that mesh implants have caused in women’s lives.

Today we are debating something that will go down in history as one of the greatest medical injustices ever suffered by women. Thankfully, there has been cross-party consensus since the horrendous problems of mesh implants came to light. That resulted in a moratorium on the implants in 2014, which was instigated by the then Cabinet Secretary for Health and Wellbeing, Alex Neil. Thankfully, now there is a ban on implants, which was brought in by former Cabinet Secretary for Health and Sport Jeane Freeman, which was warmly welcomed by campaigners. Award-winning journalist Marion Scott and mesh survivors Elaine Holmes and Olive McIlroy have blazed a trail on behalf of so many women and, after far too long, have achieved some form of justice.

I have to say that I was baffled by the text of Daniel Johnson’s motion on mesh treatment clarity. I now understand a lot more what the motion means. He is, of course, right when he says in the motion that women experience “difficulties and desperation” due their implants, although that is something of an understatement. I am genuinely sorry to hear of some of the issues that he has raised today. He asks very important questions, and I look forward to the answers.

This has been a long-running, complicated and distressing issue, with too many twists and turns to be detailed in a short speech. However, progress has been made—belatedly, I agree, but it is progress nevertheless. It builds on Baroness Cumberlege’s excellent 2020 report, “First Do No Harm”, on providing holistic care to women who have suffered with mesh complications.

Earlier this year, Cabinet Secretary for Health and Social Care Humza Yousaf introduced legislation to establish a £1 million fund to support women who have been affected by mesh complications after receiving mesh implants on the NHS. Such women have to travel abroad to have the implants removed by an experienced clinician. The first successful applicants to the fund received a one-off payment of £1,000 to help towards the costs associated with emotional or practical support. Women were entitled to apply if they had had to pay for that support at their own expense. That included, for example, purchasing self-care items such as incontinence pads or undertaking considerable travel as a result of their condition.

I understand that there is now a mesh centre of excellence in Glasgow, with clinicians who have been trained to remove mesh, a procedure that has not been available in Scotland before. I also understand why many women, as Daniel Johnson has outlined, would not want the surgeon who inserted the mesh to remove it—the mesh that has ruined their lives beyond belief. After everything that they have been through, I think that it is important that women have a choice of clinician and of where they go for treatment.

It has been a long, hard-fought battle for those women to get justice after the medical establishment was not held accountable for the scandal that affected hundreds of women in Scotland and, indeed, throughout the world. That battle for justice was fought by strong women who, despite their pain and discomfort, did not want their daughters and granddaughters to experience what they went through. They were not listened to by clinicians and were dismissed by an inadequate review that they branded as a whitewash, and still they kept fighting. I congratulate them and hope that they take some comfort that their efforts have ensured that it will not happen again. It must never happen again. Too many lives have been ruined already.

13:05  

Next year will be the 10th anniversary of the petition first coming to the Parliament. It identified what has emerged as one of the great health scandals of our time—transvaginal mesh. I want to continue to approach the issue in as bipartisan a way as possible, paying tribute to Alex Neil, Jeane Freeman and, indeed, Humza Yousaf, who have all made quantitative and qualitative steps forward in addressing the issue and improving the treatment of many women.

What was a bill is now an act, and women who went to the United States to have transvaginal mesh removed are now having the costs reimbursed. I have heard from constituents who have now received back the funds that they had to lay out in the first place in order to undertake what was, in effect, life-enhancing and life-saving surgery for themselves.

However, I say to the minister that I have a concern. I am hearing that a rather pedantic dead hand is beginning to be applied to the women who are now in the process of seeking to have that money reimbursed. They are being told for the first time that only basic economic flight costs will be reimbursed, not necessarily the cost of the flight that they undertook.

For some of the women, whose health has been seriously compromised and who have been physically in a distressed situation, a basic economic flight was not the most appropriate way for them to travel to the United States. We have to be very careful that we do not start treating those women as if they were going on some holiday excursion. They were going to the United States to have the transvaginal mesh removed to enhance their quality of life. When we say that we are going to reimburse the costs that they have incurred, we should be prepared to reimburse all the reasonable costs that they have incurred in undertaking that.

Secondly, I am slightly concerned that, although Dr Veronikis has removed transvaginal mesh from women, the cost of which has been reimbursed, and has been given a contract by the NHS to remove transvaginal mesh from other women, I understand that not a single patient has been referred to him—not one. In addition, his contract is for just a year and I understand that, even if women are referred to him, a cap has been placed on the number of women who can go to him. That is because there is still a prejudice, not within this Parliament but within our medical establishment, that they know better than Dr Veronikis and they want women to go through a process that involves them.

Yes, we have the Glasgow centre for mesh excellence that has been referred to, but there is currently a 46-week waiting time for anybody to be seen at it. If you have been waiting all these years for the removal of a mesh implant that has compromised your living, 46 weeks is not an acceptable delay whatsoever. In addition, many of the women are being sent to a doctor in Bristol who is one of the doctors who was telling women that they had had a full mesh removal, only for Dr Veronikis to pull out acres of additional centimetres of mesh from within them when they saw him. It is no wonder that they do not have confidence in the process.

I say to the minister that, although we are making superb progress, we have to be mindful that there are still some very serious and significant issues in the practice that need to be addressed. We have to ensure that we are listening to the women who have been affected and doing right by them, not just saying in the chamber that we are doing right by them. My concern is with some of the medical establishment, and we need a strong hand in responding to and dealing with that.

My final point is one that we come back to on a number of occasions. Daniel Johnson made reference to it in relation to the Medicines and Healthcare products Regulatory Agency. There is cross-party consensus in this Parliament for us, as a Parliament, to approach the United Kingdom Government in respect of what we have seen as the shortcomings of the MHRA and to try to find a solution that would allow Scotland—I say this as a unionist—to approach these issues from a health perspective that is unique to Scotland. For whatever reason, the Scottish Government has not wanted to take advantage of that cross-party consensus in the chamber. I really implore it to consider doing so. We do not want to see future avoidable surgical implant health crises that we could, if we applied ourselves more directly and appropriately, avoid.

13:09  

It is always a tall order to follow Jackson Carlaw in a debate of this nature. I put on record my thanks for, and appreciation of, the work that he has done over the years alongside the likes of Neil Findlay, working with the campaigners Elaine Holmes and Olive McIlroy, in particular, whom we have heard described already. I thank Daniel Johnson, too, for introducing today’s debate, which is a measure of the distance that there is still to travel in the mesh issue. I come to some aspects of the challenge that is still before us.

To the women who are still suffering physical and mental trauma due to mesh procedures and who have come forward with their own deeply personal stories—we have heard all of them—I say that your bravery is awe inspiring but it should never have been necessary; you should never have had to drag this issue this far yourselves.

I want to talk about Cathy. I have talked about her previously in this context, but her story bears repeating. Like thousands of others, Cathy, who is one of my constituents in west Edinburgh, underwent mesh procedure because she was referred for it and recommended for the treatment. She was assured that the procedure was safe and that it would treat her mild incontinence with very little risk of complication and that she could get on with the rest of her life. That could not have been further from the truth. After her surgery, Cathy experienced agonising pain and made various desperate attempts to contact the nurses and doctors who had administered her treatment. Those calls went unanswered—in some cases, the phone literally rang out and she never received a response.

It is crucial to realise that Cathy’s case is not an isolated incident but rather points to a problem in the medical profession and our society. It is no coincidence that this problem is overwhelmingly experienced by women. We know that women are far less likely to have their pain taken seriously and to have their symptoms diagnosed. In fact, a study that the United Kingdom Government completed last year found that 85 per cent of women had experienced a time in which their healthcare professionals did not listen to them, which has devastating consequences. That is, in part, how we have got to this position.

Such consequences have been unjustly thrust on people such as Cathy. Instead of being treated, she has experienced years of crippling chronic pain and changes to her lifestyle—we have heard about those injuries being life changing, and they are. The physical and mental effects of the procedure still affect her to this day.

Twenty thousand more women up and down Scotland have suffered this problem in one form or another, and it is my profound hope that the bill that we pass in January will provide relief to those women through the introduction of that conversation. However, I associate myself with Jackson Carlaw’s remarks that we cannot be cheap about this—we need to recognise that additional costs are incurred when somebody who has mobility issues that are caused by the implant procedure that we are trying to reverse is moved across continents.

It is not enough to stop there. It is still deeply regrettable that the bill was not extended to include survivors of other mesh implants, such as hernia mesh, despite repeated calls from MSPs across the parties, such as me and Sue Webber from the Conservatives. Although there might be fewer victims of hernia mesh implants, their plight has been just as horrific, yet they have not received any real recognition or compensation.

Furthermore, although women who have undergone transvaginal mesh procedure will now receive compensation, it will barely scratch the surface of their ordeals. The ordeals that are caused by experiencing such crippling pain are that, in many cases, they are unable to go to work, to do things that they love or even to think about anything else—the pain becomes all consuming. Those ordeals leave not just significant physical scars but mental ones too. It is vital that the Government now provides mental health support to those women and to the victims of hernia mesh implants.

To boil the matter down, Cathy is one of thousands of women whom the state has egregiously let down. As such, it is incumbent on all of us to do everything that we can to rectify the situation, and the Government must do everything that it can to provide the support for those people in need.

13:14  

I thank Daniel Johnson for introducing the debate. So far, all the contributions have raised valid questions.

In August last year, a constituent of mine from Prestwick got in touch to ask me to help speed up her mesh removal, after what she called 12 years of living in a “nightmare”. Despite having surgery here, my constituent was unable to have all the mesh removed. She decided to navigate herself through the process and so was not under the care of a consultant. Naturally, she was worried that she would slip through the cracks, and all that she really wanted to know was whether the Scottish Government would pay for her to travel to the US for groundbreaking surgery with Dr Veronikis.

Until that point, I had only watched and read news reports of women speaking about the horrors of mesh. It was not until I spoke to my constituent that I understood the reality of living with it. She had received her mesh implant in the hope that it would improve the quality of her life after the birth of her second child. Mesh, which had been around for several years before that, was hailed at the time as a revolutionary treatment for women who were suffering from stress incontinence or a prolapse.

For my constituent, six surgeries, including a hysterectomy, did not correct the damage or take away any of the chronic pain, bladder complications or, sadly, the original problem, which was a bladder prolapse. The pain was so great that she had to call an end to her 30-year career in education.

My constituent’s story is not unique. More than 20,000 women in Scotland have been affected by mesh implant and, just like my constituent, they deserve to be helped. As we know, in January this year, the Scottish Parliament unanimously passed the Transvaginal Mesh Removal (Cost Reimbursement) (Scotland) Act 2022 to compensate women who have paid for mesh removal surgery. Any woman who wanted mesh removal here or in the US was urged to contact their clinician for referral to the Bristol centre or the one in the US. On 6 June, a dedicated fund opened so that the mesh removal cost could be reimbursed to women who had decided to have the surgery and had paid for it. I welcomed that news.

Fast forward to now, and, just this week, I have been speaking to my constituent, who has returned from the US. After four hours of surgery, she is now, thankfully, mesh free, which is great news and very welcome.

My constituent is in the process of completing her reimbursement form. It is not appropriate for me to go into all the details of the challenges that she is facing in that process, but I have written to the cabinet secretary about the reimbursement process, and I look forward to a response for my constituent’s peace of mind.

Even after all the forms are filled in and the money is paid, it will not be the end of the process for my constituent or any of the other women. The pain and damage might still be there, and rehabilitation might take a long time. Many women have suffered an unimaginable amount of pain due to complications as a result of transvaginal mesh implants, and it is absolutely right that the Scottish Government acted as it did. Rightly, there were concerns about women who might seek mesh removal in the future if symptoms develop, and I am pleased that the Scottish Government has provided assurance that the specialist national service—the complex pelvic mesh removal service—is available in the NHS in Scotland, hosted by NHS Greater Glasgow and Clyde.

The story does not end there; we must be mindful of that. There are women who might need help for years to come, and the Government must be ready and willing to act accordingly. I remember my constituent saying to me that, because of the on-going pain and complications, her youngest child did not really know her. We cannot give her that time back, but we can give her and others a future by doing everything in our power to enhance the lives of the women who have been so cruelly robbed of time.

13:18  

I congratulate my colleague Daniel Johnson on securing this important debate.

Scores of women across Scotland are being left in limbo as they continue to face prolonged waits for treatment that will reverse the damage that has been inflicted by transvaginal mesh implant surgery. For around 20,000 women in communities up and down the country, the surgery was life altering and caused unthinkable hardship. They had to fight to be heard, with clinicians telling them that the mesh was not the cause of their pain.

I pay tribute to Jackson Carlaw, Neil Findlay, Alex Neil and the women affected for their work and campaign that resulted in the Scottish Government making a promise of paid-for mesh removal and a reimbursement scheme for the women who had already paid for surgery. That was particularly welcome.

However, now things appear to have stalled, just a little. Despite Government promises, patients have been made to wait months to see a specialist, and there has been little progress on that to date.

Earlier this summer, in a written question to the Cabinet Secretary for Health and Social Care, I asked

“what the (a) average and (b) longest waiting time is for mesh surgery”.—[Written Answers, 26 July 2022; S6W-08949.]

Unfortunately, the cabinet secretary’s answer failed to provide any clarity. Either the Government does not know the answer or it simply does not record that information.

Less than a year ago, when I asked, at a meeting of the Health, Social Care and Sport Committee, how long women would have to wait, I was told:

“The pressure on the service is easing, so we hope that it will not be long before we are able to get back to a full service.”—[Official Report, Health, Social Care and Sport Committee, 2 November 2021; c 8.]

Currently, there are delays of 11 months.

We discussed waiting times in NHS Scotland just yesterday in the chamber, and it appears that mesh surgery has fallen victim to similar delays. Last month, I heard from Maureen Kerr, a mesh survivor who had to endure months of cancelled appointments before finally being scanned at the complex pelvic mesh removal service in Glasgow last November. Maureen was reassured that her mesh was flat and in place, following a five-minute scan. For her own peace of mind, she decided to pay for a private appointment, which confirmed that her mesh was, in fact, twisted. The continued failing of these women is unforgivable.

Maureen told me:

“I have lost my job because of this. The Scottish Government are just paying lip service to you. I have no idea how long this is going to take. A lot of people are being sent back to people they don’t trust, consultants who have told them all along that it isn’t the mesh that is the problem.”

She went on to say:

“It’s yet another fight meanwhile the pain is still there and you don’t know how fast things will progress and if they will get worse.”

Women are in chronic pain and are still being left to suffer while waiting for the necessary surgery. They continue to be failed.

I turn to the issue of cost. The women affected were promised flexibility, but they are now being told that there is a ceiling of £3,000 on reimbursement for travel for treatment. That is contrary to the financial memorandum to the Transvaginal Mesh Removal (Cost Reimbursement) (Scotland) Bill, which said that the estimated cost ceiling would be £4,000. There is no appeal system in place, and costs of that level will not be covered by the Government as promised.

In my view, the Government needs to do three things. First, it needs to get on top of waiting times for women to be seen by the complex pelvic mesh removal service, because these women have waited long enough.

Secondly, the Government must ensure that women who want to have their mesh removed outwith Scotland can get that done without further barriers being erected in their way. Jackson Carlaw is absolutely right—I understand that there has not been one referral directly from NHS Scotland to Dr Veronikis.

Thirdly, the Government must ensure that women are actually reimbursed for the cost of their travel and accommodation. None of us can begin to imagine the pain that these women have suffered and are still suffering, and it is incumbent on us to ensure that the welcome provision that the Government has made is effective.

13:22  

As other members have done, I thank Daniel Johnson for raising this important issue. These women have suffered, and in many cases, continue to suffer huge amounts of stress and anguish. I have previously raised questions about transvaginal mesh in the chamber and have written articles in support of women who have been affected, and I welcome the chance to speak in the debate.

Two years ago, the Scottish Government announced the service to help women who were suffering from complications after receiving vaginal mesh implants. Sadly, hundreds of sufferers are still waiting for their ordeal to end.

Backed by £1.3 million of Government money, NHS National Services Scotland was tasked with establishing the new service within NHS Greater Glasgow and Clyde. The official announcement said that it would be introduced “gradually” from August 2020; no one knew just how gradual the process would be. For some sufferers, the effect has been catastrophic.

A constituent of mine has been in touch to tell me that she has been in constant pain since her operation 17 years ago. The plan that was unveiled in July 2020 gave her hope, but she is living proof that the promise has not been fully honoured. She said:

“I find it impossible to trust the NHS to care for me with mesh issues. A life with mesh is a painful, humiliating, and soul-destroying existence and has already destroyed so much of our lives.”

One woman who has been affected by the scandal has been in touch regarding her experience of the transvaginal mesh removal reimbursement scheme, details of which Jackson Carlaw provided us with. She understood that there was to be flexibility on the reimbursement criteria, but she says that it now appears that a ceiling of £3,000 for flights to America has been introduced by NHS NSS.

In some situations, the cost of economy flights exceeds the £3,000 limit. There is nothing in all the supporting documents to the bill stating that there will be a ceiling on the cost of flights. Furthermore, as I am sure that we all appreciate, flight prices depend very much on the time of year and how far in advance you book them. When you are planning surgery, you do not have that foresight or the ability to do long-term planning. Under the guidelines made by the Scottish Government, there is no appeal system for the mesh reimbursement application process. Where is the flexibility and the due consideration that was to be given to each application? It is non-existent. Several women’s claims are in excess of £3,000, and all should be given equal consideration.

In 2019, the First Minister, Nicola Sturgeon, promised:

“I am absolutely committed to and determined that we will do everything possible to get these women the treatment and the care that they need”.

Neither I nor the women who have contacted me believe that enough is being done by the Scottish Government to engage with the mesh survivors or help with their heartbreaking plight.

The current Cabinet Secretary for Health and Social Care, Humza Yousaf, must be honest with Samantha and hundreds of other victims who are still waiting for help and justice and explain to them why the system is still failing. The health secretary must tell them exactly what will be done to get them the treatment that they were led to expect. As my constituent said,

“We don’t want mesh to wreck what time we have left.”

The Scottish Government appears to have washed its hands of these women as soon as the bill was passed, and that is unacceptable.

13:26  

It is a privilege to have the opportunity to take part in the debate. I congratulate all those who worked so hard to get the legislation on transvaginal mesh. I also congratulate my colleague Daniel Johnson for securing today’s debate.

It is clear from the people who are campaigning on the issue that they feel that they are still not being listened to. In the short time that I have today, I will focus on the concerns of hernia and other mesh survivors who do not currently seem to be covered by the scope of the scheme that is being discussed. Many of those survivors have suffered life-altering conditions. In particular, I want to pay tribute to Roseanna Clarkin and Lauren McDougall, who are petitioning Parliament and asking for the suspension of use of all surgical mesh and fixation devices that are being used in Scotland.

It is very much the case that mesh is still being used. I have spoken with women and men who have been affected by the procedure, including a 50-year-old man who had mesh implanted in the right side of his groin in 2013. He is still suffering extreme pain and debilitating conditions as a result of that procedure, including physical conditions that mean that he is unable to carry on with normal ways of living in the way that most of us would expect to do. He hardly sleeps and cannot get medication that alleviates the symptoms. He says that he is also suffering from depression.

My constituent Roseanna Clarkin was aware of mesh before her procedure. Indeed, she had been a campaigner and did not consent to mesh being used. Her understanding was that tissue would be used for the hernia procedure that was carried out on her. Unfortunately, she is not the only example of the medical profession not getting informed consent from patients.

Therefore, there are still many issues that the Parliament needs to discuss in relation to the use of mesh in Scotland. I hope that we will have further debates in Parliament, because many people are calling for suspension of the use of all surgical procedures involving mesh. That is a debate that Parliament must continue to have.

The petitioners are asking for an independent review and for suspension of the use of all mesh and fixation devices. They point to the substantial damages that are being awarded, particularly in the United States of America, to people who have had mesh implanted. They ask for improved patient pathways, with

“specialist surgeons who are aware of complications”

and who know

“how to properly insert mesh”

and remove it when needed. They also want

“a choice of surgeries where natural tissue repair is offered first”

and believe that mesh should not be used until that work has been done. They would like the establishment of a specialist

“mesh centre with more surgeons trained in natural tissue repair.”

In particular, they call for an apology and

“recognition ... from the Scottish Government”

and compensation for patients who have been affected. I believe that those are all matters that Parliament should debate.

I very much welcome the motion that Daniel Johnson has brought to the chamber and the landmark legislation that has been put in place. However, I fear that we will need to consider more issues. I hope that time will be made available for us to do so and that the minister will respond on that in her closing remarks.

13:30  

I am grateful for the opportunity to close the debate on behalf of the Scottish Government. I am also grateful to Daniel Johnson for lodging the motion.

We have, quite rightly, discussed mesh in Parliament on a number of occasions. Women across Scotland have been severely affected, and I know that we are all determined to do the best that we can now to help them.

I will try to respond to all the points that have been raised in the debate, but let me be absolutely clear in reiterating that my door is always open for me to hear members’ concerns. I ask any member whose concerns I do not respond to in my remarks to write to me.

For our part, the Government is absolutely committed to ensuring that women can access the care that they need, which clearly needs to be care in which they have confidence and that they can access as quickly as possible.

As members will know, we have established in NHS Greater Glasgow and Clyde a specialist service that carries out full and partial mesh-removal surgery and offers high-quality dedicated facilities. Fully holistic care is provided, giving patients access to pain management, physiotherapy and mental health support. So far, around 50 surgeries have been carried out and 150 outpatients have been seen.

I think that it is only right that we all acknowledge the effort that the NHS has made to establish and maintain that new service during the height of the pandemic. Its dedication and commitment are abundantly clear and are reflected in the positive feedback that it has received from patients. I look forward to visiting the service in the near future to demonstrate further my support for what it has done.

That said, we know that patients want choice. In the previous session, Parliament agreed that that is absolutely vital, so the Government and the NHS have worked together to deliver it. Therefore, patients who are referred to the Glasgow centre can now choose to have their removal surgery there or in an NHS England centre, or to have it done by one of two independent providers, one of which is in Bristol and the other of which is in Missouri, in the USA.

Patients have been understandably frustrated about the length of time that it has taken to put all the arrangements in place, but I am sure that members will acknowledge the importance of agreeing systems that ensure that referrals can be made safely, and of ensuring proper integration with the pre-operative care and post-operative care that are provided in Scotland.

There are really strong patient safety reasons for women being able to access care from private providers via the NHS in such situations. Those arrangements have now been agreed. They were not imposed by the NHS; they were agreed by the private providers and the NHS, along with arrangements for patients seeking treatment in Glasgow.

Members will be pleased to know that we expect patients to begin to travel to the independent providers from October. I assure members that there is no cap on the number of patients who can go to Dr Veronikis. Once the clinical decision has been made to remove mesh, the choice of where the surgery will happen lies with the patient.

Members will also recall that, earlier this year, we unanimously agreed legislation to allow women who had previously made their own private arrangements for mesh removal surgery to apply for reimbursement of those costs. The scheme opened earlier this year and, in many cases, payment has already been made. Meanwhile, 648 applications have been received to the mesh fund. The fund’s application period was extended by a year to enable more women to apply.

It is not the case that there is a cap on the value that can be reimbursed under the reimbursement scheme, but the Government and NHS National Services Scotland need to ensure that the costs that are being reimbursed are reasonable, and that the scheme is applied equitably to all applicants. In the event that the costs are more than the NHS expects, there will be a requirement for women to provide supporting documentation to show that those costs were necessary. To be clear, I note that there is in the reimbursement scheme an appeals mechanism that is explicitly for provision of payments that are above the normal rate.

The measures that we have put in place have arisen because we have listened to the women who have been affected and because their experiences were related with such power by a number of members of this Parliament, some of whom have since retired. I reassure Parliament that we are continuing to listen; I and my ministerial colleagues have heard directly from people who have been affected by mesh complications, and the cabinet secretary will meet another group of mesh patients in the coming weeks. Our colleagues in the Health and Social Care Alliance Scotland have done absolutely sterling work with focus groups and through other engagement. I am really grateful for what the alliance has done, and is continuing to do, with the women who have been affected.

It is important to point out that NHS Greater Glasgow and Clyde has engaged directly with patients who pass through its new service, and will continue to do so.

I am very grateful to the minister for everything that she has said, but I want to tie two pieces of the issue together. I am pleased to hear that women will be able to travel to an independent provider—I presume, Dr Veronikis—from October, but both Jackie Baillie and I have referred to the extended waiting time for women to go through the process of coming to a conclusion about what they want to do. If the contract with Dr Veronikis is for only one year, there is the very obvious danger that a significant number of women will not be in a position to make a judgment until we are almost at the end of the contract period during which they can take advantage of an independent provider that has been approved. Will the minister keep an eye on that and commit to potentially extending that contract to ensure that all women, irrespective of when they come to a decision, are able to elect for the independent option?

I can give you the time back for that intervention, minister.

We are absolutely aware of the situation and regret that patients are experiencing longer than normal delays in accessing NHS care, including at the mesh removal service in Glasgow, as the NHS seeks to recover from the Covid-19 pandemic. However, patients are being seen and surgeries are being carried out, and I absolutely reassure members that the service is making concerted efforts to continue to reduce waiting times.

I will certainly consider Jackson Carlaw’s point about the one-year contract and whether women might time out in that respect. I also say that, having put so much effort into ensuring that all this can happen seamlessly, and that women can access the care seamlessly, we certainly do not want them to time out just because of the pandemic-related challenges that we are all facing. I am therefore more than happy to look at the matter, should it arise in the future.

I welcome the point that the minister has just made and her openness to looking at things again. Could she also look at the ceiling on reimbursement costs? I have received an email from a constituent who talked about—I repeat—a ceiling of £3,000 for flights to America having been introduced by NSS. If the minister will take the matter away with her, I will happily provide her with the information for conducting such a review.

I am more than happy to look at that, too, but I assure Jackie Baillie and her constituent that there is no cap on reimbursement. There is simply a requirement to provide extra evidence—after all, it is public money—but there is absolutely no ceiling. I am happy to look at the matter, which should be fairly straightforward to resolve.

In going back to the involvement of the Health and Social Care Alliance Scotland, I have to say that it has done amazing work to ensure that the voices of lived experience are absolutely at the heart of the service that is being developed in Glasgow. The feedback that it receives helps us to refine and to further improve what is still a very new service; indeed, action is already being taken as a result of the help that the alliance has had from its patients—help that the alliance and we are truly grateful for.

As for the Essure implant, I have met women who have been affected by it, and we have agreed steps to highlight the issues related to it.

It is relevant to everyone who has an interest in the area that the Scottish Government has accepted in full the recommendations of the Cumberlege report and will bring forward legislation on a patient safety commissioner this year. Our aim in establishing the post of patient safety commissioner is to prevent tragedies on such a scale from happening in the future. The women who have been impacted by the mesh implants have absolutely made a tangible difference for those who come after them. The establishment of that post is evidence of that.

The Government will, of course, reflect on the discussion that has taken place today. We remain absolutely committed to ensuring that patients can access treatment that they have confidence in. To that end, I commend the service in Glasgow and hope that all members will acknowledge the efforts that our NHS colleagues have made in establishing a new service in such difficult circumstances.

We will ensure that engagement with patients continues so that their experiences further influence and refine the services that we offer. We will continue to offer patients choice in who provides their treatment, and the NHS will continue to communicate and discuss all those options with patients.

That concludes the debate. I suspend the meeting until 2.30 pm.

13:41 Meeting suspended.  

14:30 On resuming—