Chamber and committees

That is very helpful. Thank you.

It seems that colleagues do not have any further questions. It was quite brief this morning, minister, but I think that, from our point of view, we got to the nub of the matter. It was short but sweet—I am sure that you are perfectly happy that that was the case. We thank you all very much for your participation.

Welcome back. We continue our consideration of continued petitions.

PE1865, which was lodged by Roseanna Clarkin and Lauren McDougall, calls on the Scottish Parliament to urge the Scottish Government to suspend the use of all surgical mesh and fixation devices while a review of all surgical procedures that use polyester, polypropylene or titanium is carried out and guidelines for the surgical use of mesh are established.

We are joined for our consideration of the petition by Katy Clark and our former committee colleague, Carol Mochan, both of whom have previously been concerned with the issues raised by the petition. Good morning to you both.

We most recently considered the petition nearly a year ago, last March, when we agreed to write to the Cabinet Secretary for NHS Recovery, Health and Social Care and to the Scottish Parliamentary Corporate Body. At this point, I should probably remind colleagues that I am a member of the SPCB.

The SPCB’s response sets out the process for appointing the patient safety commissioner for Scotland. The post was first advertised in March 2024, although, as members might be aware, it remains unfilled and was readvertised on 7 February.

We have also received a response from the Minister for Public Health and Women’s Health, which highlights the expectation that, regardless of where mesh removal surgery takes place, local health boards should provide any necessary aftercare that patients might require. The response also highlights that

“A patient should decide upon their treatment with their clinician, following meaningful discussion and sharing of all necessary information”,

and that those discussions should be documented.

On the issue of natural tissue repair, the minister tells us not only that a “significant number” of hernias are repaired without mesh in Scotland, but that Government officials are working with surgeons who have a specific interest in hernia repair and have begun to identify individuals who have the skills to take forward surgical hernia repair that is consistent with the Shouldice technique, on which the committee took oral evidence from the Shouldice folk in Canada back in February 2022—PE1865 is a long-standing petition.

We have also received two submissions from the petitioners. The first draws our attention to an article in the Journal of Abdominal Wall Surgery on hernia repair surgery in adolescents and suggests that a similar approach, whereby consideration is given to the risks of hernia recurrence and mesh complications, should be adopted for hernia repair in adults. The petitioners believe that hernia surgery should be considered as principled surgery, with surgeons being trained specifically in the Shouldice and natural tissue repair techniques as well as mesh techniques. In their second submission, Roseanna and Lauren restate the call for a centre of excellence to be established as a means of ensuring that informed patient pathways are available for natural tissue repair and mesh removal.

Alongside that call, the petitioners continue to advocate for an independent review of the use of mesh, and they have provided a brief summary of their meeting with Terry O’Kelly, who is the Scottish Government’s senior medical adviser, whom the committee previously heard from, and representatives of the Scottish Health Technologies Group, which has only strengthened their calls for an independent review to be carried out.

I will invite Katy Clark and Carol Mochan to contribute before the committee considers how best to proceed. However, it is only fair to say—I say this as someone who has been closely associated with the issue for more than a decade—that the committee is not certain how to take this particular petition forward. Important issues have been raised. There has certainly been some advance in respect of the Government’s approach to the use of Shouldice techniques, which was a bit of an uphill push, but which the committee, with our introduction of the Shouldice evidence, helped to make happen. However, we are a little unsure as to what more we can usefully do, given that the parliamentary session is now beginning to wind down from the point of view of our ability to consider petitions.

I am keen to hear from Katy and Carol before we make any determination. It has been decided that Katy will speak first.

Good morning, everybody, and welcome to the third meeting in 2025 of the Citizen Participation and Public Petitions Committee. Our first agenda item is the simple task of deciding whether to take in private item 4, which is to consider the evidence that we hear this morning, and item 5, which is to look at our recommendations on embedding participation into the life of the Parliament. Are members content to take those items in private?

Members indicated agreement.

In that case, I invite each of you to introduce yourselves and explain your work, because four different voices will sound much more interesting than my just reading it all out.

Okay—thank you.

Thank you. Do colleagues have any thoughts? I am between a rock and a hard place on this one. There is probably not much more that we can do in this parliamentary session, and I am minded to move to close the petition. However, I might be prepared to defer closing it, and to indicate to the Government that although we are moving in that direction, we would like to have further confirmation on the points that have been raised about data, in particular.

If colleagues are content, we could approach the Government to get a specific response on that. However, we should be mindful of the fact that, notwithstanding any response that we got, we are probably nearing the point at which we would have to say that any future work on the issue would be best served by the lodging of a fresh petition in the next session of Parliament. I think that I would feel most comfortable if we agreed to go down the route of giving the Government a further nudge on the aspect that arose from the work of the Scottish Health Technologies Group, as amplified in Katy Clark’s written submission and the oral submissions of our colleagues.

Do we agree to keep the petition open on that basis?

Members indicated agreement.

We will keep the petition open and move forward on that basis.

That brings us to petition PE2048, which has been lodged by James Anthony Bundy, who I see joins us in the public gallery. The petition calls on the Scottish Parliament to urge the Scottish Government to increase awareness of the symptoms of stroke by reviewing its promotion of the FAST—face, arms, speech, time—stroke awareness campaign and ensuring that awareness campaigns include all symptoms of a potential stroke. My colleague Stephen Kerr joins us for consideration of the petition.

At the previous meeting—I apologise again that I was indisposed and unable to participate—the committee heard evidence from representatives of stroke awareness charities, the Scottish Ambulance Service, NHS 24 and clinician academics who specialise in stroke care. Following that meeting, we have received a new submission from the Stroke Association to provide further detail on the research that Mr John Watson referred to during that discussion.

I remind Mr Bundy that the option to provide written submissions to aid our consideration of the petition is always available, whether that is sharing new views or any additional suggestions that he might hope that the committee would consider.

Unfortunately, as I said earlier, David Torrance is not well and is unable to be with us today, but members have had an opportunity to reflect on the evidence that both panels of witnesses provided. On my reading of the Official Report, that evidence appeared to suggest that improving clinical awareness of less common symptoms of stroke and ensuring timely treatment for people experiencing a stroke might hold the key to delivering better outcomes for patients.

Although there appeared to be consensus that the current situation is not good enough, participants raised concerns that, with regard to public awareness, widening the FAST approach to include balance and eyes could have the counter-productive effect of delaying individuals from presenting for diagnosis and treatment, with initial studies indicating lower levels of recall for BE FAST—balance, eyes, face, arm, speech, time—compared to FAST and a risk that individuals will wait for all symptoms to be present before they seek help.

The committee also heard that Scotland’s stroke services have limited capacity and that our priority should be ensuring that people experiencing a stroke can access timely and appropriate treatment. Witnesses expressed concern that, if everyone who presents with vision or balance issues was sent for a stroke assessment without further generalist diagnostic examination, the risk increases that we would end up delaying access for patients experiencing a stroke.

Before I invite colleagues to comment and reflect, I invite Mr Kerr to contribute to our discussion.

Are we content to act on those proposals?

Members indicated agreement.