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Thank you, Mr Sweeney. I think that you might have the same sense that I have that there is a lack of ownership of the actual direction of the pathway to a solution. That seems to be the point.

PE1865, by Roseanna Clarkin, Lauren McDougall and Graham Robertson, calls on the Scottish Parliament to urge the Scottish Government to suspend the use of all surgical mesh and fixation devices. I apologise for the fairly long preamble. The petition has had something of an airing in the Parliament in connection with the bill on compensation for transvaginal mesh surgery that was recently passed. The petition calls on the Parliament to suspend the use of 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.

The petition was last considered on 17 November 2021 and at that meeting the committee agreed to write to the Minister for Public Health, Women’s Health and Sport and to the Shouldice hospital in Canada. Responses have been received from the minister, the Shouldice hospital, Sling the Mesh campaign and the petitioners.

I am delighted that Jackie Baillie is still with us this morning and I welcome Carol Mochan MSP, who joins us online; both members wish to speak to the petition. Before I bring in my colleagues, I will provide a little bit more of the background, which I apologised for the length of a moment ago.

In 2019, the Scottish Health Technologies Group carried out a review into the use of mesh in primary inguinal hernia repair in men. The review concluded that, compared to non-mesh procedures, using mesh resulted in lower rates of recurrence, lower rates of serious adverse events, and similar or lower risk of chronic pain. The advice for NHS Scotland was, therefore, that surgical mesh should be used in elective repairs in inguinal hernia in adult males.

The SHTG review was subsequently expanded to include women, examining the outcome of mesh versus non-mesh surgery in a variety of groin or abdominal wall hernias. The Scottish Health Technologies Group concluded that current evidence supports the continued availability of surgical mesh for elective repair of primary ventral hernias, incisional hernias, and primary inguinal hernias in adults in Scotland. The group recommends, however, that consideration should be given to patient preference and that patients should also have access to alternative hernia treatment options such as non-mesh—suture and natural tissue—repair.

The chief medical officer has also undertaken a number of activities relevant to the petition, including: writing to the board chief executives and medical directors to draw their attention to the SHTG report’s findings; asking health boards to consider the availability of non-mesh surgery within their health board, and how any skills gaps can be addressed; asking health boards to consider the development of local clinical groups and broader clinical networks for the management of complex cases; and asking medical directors to remind clinicians of their obligations under the principle of realistic medicine, of informed consent and of the importance of recording both the content and outcome of such discussions.

With regard to the issues raised about the quality and authenticity of certain materials being used, the minister states that the Scottish Government contacted the Medicines and Healthcare Regulatory Agency in 2018, which confirmed that there was no new evidence to prompt regulatory action and that the products in question remained acceptably safe when used as intended.

The committee also wrote to the Shouldice hospital in Canada, as the leading experts in natural tissue repair. In what I thought was a fascinating submission, Shouldice states that in its own practice, surgical mesh is not used unless absolutely necessary and that has led to it being used in less than 2 per cent of cases. The hospital specialises exclusively in abdominal wall hernia repair. It states that where the body’s natural tissue is strong enough to support the surgical repair, natural tissue repair should always be used and where underlying patient tissue is poor, surgical mesh may be necessary in some femoral and large incisional hernia repairs. All the hospital’s surgeons are trained to do a natural tissue repair as their first choice; natural tissue repair should be the first choice for all primary inguinal hernias, most recurrent inguinal hernias, most femoral hernias, most epigastric and umbilical hernias, and small incisional hernias.

Shouldice also notes that since mesh was introduced in the 1980s, the recurrence rate for inguinal hernia repair—more than 85 per cent of most of its hernia repair—has not improved. There has been a staggering increase in post-operative complications not seen prior to mesh. Chronic and debilitating pain and other severe complications such as mesh shrinkage, mesh migration, and related nerve entrapment are widespread. There are no side effects of tissue repair if it is done correctly. Training for surgeons on the natural tissue technique ranges from three months for an experienced fellowship general surgeon to six to nine months for an inexperienced general surgeon.

The Sling the Mesh campaign shared the results of its recent survey of its 9,300 members with experience of vaginal, abdominal, pelvic, rectal, hernia mesh and mesh following mastectomy. It notes that one in four have considered taking their life,?six in 10 suffer depression, one third have been forced to give up their work, one in four now need a stick to walk, and one in 14 now need a mobility scooter or wheelchair.

In their submissions, the petitioners welcome the information contained in the Shouldice hospital submission and ask for further information to be sought on the use of protacks, which are devices used to fix mesh to soft tissue. The petitioners believe that there is evidence to suggest that a considerable sum of money has been spent recently procuring hernia mesh and other fixation devices and they feel that that money could have been spent on investigating and teaching natural tissue repair. The petitioners also query why mesh is still being bought and why clinicians are not yet accurately and systematically recording the effects of such material on patients.

We have gathered quite a lot of evidence since we last considered the petition. I invite both Jackie Baillie and Carol Mochan to contribute ahead of comments from committee members.

PE1885, which was lodged by Karen Murphy, calls on the Scottish Government to make community shared ownership a mandatory requirement to be offered as part of all planning proposals for wind farm development.

The committee wrote to the Scottish Government asking whether the Scottish Government could use? existing ?planning powers to ?provide incentives ?for developers to offer community shared ownership. The Scottish Government’s response highlights good-practice guidance, which indicates that planning authorities

“should not seek to secure shared ownership though the use of planning conditions or obligations”.

The Energy Saving Trust suggested that the UK Government’s contracts for difference could be a route to making community shared ownership offers mandatory. The trust notes that due to competitive bidding rounds, opportunities for community shared ownership could be threatened by bidders cutting costs to try to win contracts. It was suggested that community shared ownership could be protected if additional points in the contract evaluation were awarded to bidders for offering community shared ownership.

The petitioner raises a number of additional issues. Her view is that some developers refuse to interact with the local community, some refuse to offer community shared ownership, and others might make community shared ownership offers that do not meet the definition of community shared ownership as defined by the Scottish Government. The Energy Saving Trust and the petitioner make a number of recommendations for improvement: they are detailed in the clerk’s note in your papers.

Do any other members have any comments or suggestions for action?

We have decided that we will invite the cabinet secretary to come in relation to petition PE1864, which is a different aspect of the whole wind farm debate, so I think it would be perfectly reasonable to combine this petition with that on that occasion.

That is a novel suggestion, but yes, the issues are very important. In the first instance, we will seek to take evidence from the petitioner and the bodies that Ruth Maguire suggested. We will write to the Scottish Sentencing Council, drawing its attention to the issues involved and the evidence that we might seek from the Crown Office and Procurator Fiscal Service, while trying to fathom and bottom out the scope of the potential issue that we are addressing here. It is a very important issue. In the first instance, let us take more evidence, but it might well lead to recommendations that could form the basis of initiatives that others might wish to take forward thereafter.

I think that that is right. I was almost going to ask, “Are we able to initiate bills?” but I think that, as a committee, we are. It is perfectly open to us, but we will get a bit further down the road before we get to that.

Are we agreed in the first instance to hear evidence from the petitioner and relevant stakeholders?

Members indicated agreement.

Yes. The committee had delegated it to me to decide on the appropriate minister—you are quite right. It could be either minister in that event.

Yes, the same thought had occurred to me: why is it not allowed? Therefore that is very much a question that you could put to the appropriate minister. If colleagues are happy to again delegate determining who that is to me, we will proceed on that basis.

Members indicated agreement.

PE1887, which was lodged by Nicola Murray, calls on the Scottish Parliament to urge the Scottish Government to create an unborn victims of violence act, creating a specific offence that enables courts to hand down longer sentences for perpetrators of domestic violence that causes miscarriage.

The committee has received submissions from the Crown Office and Procurator Fiscal Service, Scottish Sentencing Council, Scottish Law Commission and Victim Support Scotland. The Scottish Sentencing Council notes that it has established a committee to oversee the development of a draft guideline on domestic abuse. The Scottish Law Commission highlights an opportunity to contribute to its programme of law reform consultation that will open in the coming months. In its submission, Victim Support Scotland notes its support for the petition and its aims, stating that it believes an update to the law is necessary.

In view of the responses received, I welcome comments from colleagues.

That makes eminent sense. Are we agreed on that, colleagues?

Members indicated agreement.

PE1895, which was lodged by Gary Wall, calls on the Scottish Parliament to urge the Scottish Government to make it mandatory for NatureScot to explain its conservation objectives in decision-making within the framework of the Scottish regulators’ strategic code of practice and Scottish Government’s guidance, right first time.

The committee wrote to the Scottish Government seeking information on the application of test 2, including whether assessing licence applications on the basis of there being no satisfactory alternative, as opposed to no other satisfactory solution, is likely to lead?to a different outcome.?

The Scottish Government sought advice from NatureScot and responded to state that

“The terms ‘no satisfactory alternative’ and ‘no other satisfactory solution’ are considered to be analogous.? This view is supported by the European Commission’s recently updated guidance on the strict protection of species, which refers to birds directive case law for the interpretation of test 2”.

The petitioner highlights that although NatureScot references European Union Commission guidance, the rejections that he has received in relation to licence applications have been on the basis of actions that are not challenged by the EU Commission in other countries. He states that the

“Scottish Government recognise that ‘proportionality’ is one of the foundations of regulation and yet in ten years of license refusals it has never been explained to me what factors have been considered in relation to ‘proportionality’.”

The petitioner concludes by stating that

“at least a citizen should be able to expect clarity in what the conservation objective is in refusing a license.”

Do any members wish to comment?