Seòmar agus comataidhean

I am not sure that I entirely understand your question, convener. Do you mean a sampling of records or of data? There is a recognition that, where medical devices in particular are used, they need to be more traceable. More clarity is needed on which devices were used where, and we need a system of retrieval in place. We are working closely with the United Kingdom Government on that aspect, so that, in future—I guess this answers your question, as we found ourselves in a situation in which it was quite difficult for us to tell precisely what had happened—that data should be gathered much more routinely. Where there are issues with a product, it should be perfectly straightforward to find out where that product has been used, and there should be a strong audit trail in a patient’s notes.

I see that Mr O’Kelly is raising his hand—I am sure that he is very keen to contribute, as a practising surgeon who has to go through such issues with patients time and time again, day in and day out.

You are absolutely on the button, Mr Stewart—it is really important that these decisions are shared, and that is what we are talking about with regard to realistic medicine. We are moving away from what has happened in the past, when we had a paternalistic style of medicine. Back then, the doctor was all-powerful and told the patient what to do, and their advice was almost always taken as law. We now recognise that health is much better when it is delivered in a shared way. People are much more likely to attain good health if the decision making is shared.

The individual has to be party to a decision, and they must be able to discuss it with their clinician. As I said, that discussion should cover not just the general risks, but how those risks apply to that person as an individual. It should be a very individual discussion, and a patient should feel that, instead of having to access the internet in order to find and assess the data themselves, they can, as they make their decision, talk to their own health professional and have the risks explained as those risks apply to them specifically.

Patients are often in a very difficult situation in which there is no risk-free option. If someone has a hernia, continuing to live with it is not a comfortable situation for them to be in, but the options for treating it are never going to be risk free. As you said, an honest, transparent and well-documented discussion about those risks is a very important part of the process.

Secondly, you raised the point that there is sometimes a sense that people are not listened to. As a politician, I—and we all, as politicians—probably hear about that more than it actually happens, through a select few, or even many, stories. We hear from people who have been to see their health professional and have felt that their concerns have been dismissed or their health problems minimised. Again, we are working hard to improve that situation so that people, when they present to a healthcare professional—often, five years on, it will not be the same surgeon who operated on them—will receive a response that is more empathetic and understanding. We want to ensure that they are suitably directed to people who might be able to help them to disentangle whether what they are experiencing is related to the surgery that they have had.

I am sure that Mr O’Kelly will want to come in at this point.

I will let Mr O’Kelly answer the bulk of that question. He can certainly give you a picture of what clinicians are doing to understand those issues. As with medicines, it is possible to do randomised controlled trials with these medical devices in order to learn more about them. It is also possible, as the unit in Canada has done, to collect anecdotal and observational evidence. That happens on an on-going basis in this area of medicine as in any other.

I go back to your concern about how we find out about different types of mesh and which types may have defects. The Cumberlege report focused on the regulation of medical devices, and it found the UK environment wanting in that regard. As a Government, we are absolutely committed to taking forward the recommendations that were made by Baroness Cumberlege and her team, and we have made significant progress on them since the report was published, last year.

We in the Scottish Government are certainly working with the report and taking positive steps. There is still work to be done to ensure that patients’ voices are heard and listened to—that is why we proposed a patient safety commissioner in our programme for government; it was also a manifesto commitment. We consulted on that recently. The consultation has now closed, and we recently published a report that provided an analysis of the results. We are going to take that into account as we continue to work with patients and experts to develop the commissioner role. We are keen to do that in Scotland, and we are keen to deliver what patients are asking for on that front.

With regard to UK-wide discussions with the MHRA, there has been slow progress—as has often been the case over the past couple of years—which is understandable, given the situation that we are in. Nevertheless, we are pretty keen to pick that up as a priority and to make UK-wide progress on these issues.

I will bear that in mind, convener, and I will take up your offer if necessary.

Certainly. Overprovision is a tool by which licensing boards can prevent new licensed premises from opening in areas where they consider that too many licensed premises are already in operation. It is a valuable tool. I am not sure whether you are asking me to support local authorities to use it more or to encourage them to do so. Again, that is absolutely the way to consider the issues going forward.

I do not know whether either of my officials today has anything to say on that. I will speak to officials to see whether there is anything that the Government can consider. We are not planning to change the licensing laws, but, if there is anything that I can do to support local authorities to be more confident in applying them and achieving the balance that we all seek to achieve, I am more than happy to consider that.

There is always a challenge in that regard. We are asking councils to make a decision that is based on balancing the rights of people who drink responsibly with the need to protect people who might be harmed by the more ubiquitous availability of alcohol. There are five high-level licensing objectives, which are

“preventing crime and disorder, securing public safety, preventing public nuisance, protecting and improving public health, and protecting children and young persons from harm”,

and those objectives are ranked equally.

Councils already have the powers and the guidance on what they need to consider as they make those decisions, and public health should be part of that consideration. As I said, if you have a particular suggestion that you want me to consider in order to strengthen the hand of local licensing boards, I am more than happy to hear it.

We are certainly open to considering that. That is why we must look very closely at what has happened with minimum unit pricing. We carefully crafted it so that it would not harm the economy, employment opportunities, local shops and so on. However, if people are getting a windfall from minimum unit pricing, we should consider that.

I say strongly that we must better understand exactly what is happening on the ground before we make a decision about next steps. I am not averse to the possibility of a social responsibility levy. I am willing to consider it, but I do not think that this is the appropriate time to do so.

I do not think that the consultation has been published yet; certainly, it was not published by half past 4 on Friday. I have seen the media reports around it, but I think that we ran into the holiday weekend before it could get published in full. We will be poring over that information, and we are very interested in the approach that is proposed by the bill.

We know that there is a mixture of views in society, from stakeholders and from people with lived experience. I am keen to see how the consultation, which I expect to reflect those diverse views, evolves into a bill. We will be more than happy to consider the contents of the bill when it is introduced and consider whether it is something that we can support for Scotland. As I understand it, we are already working on much of what the bill aims to do. We are keen that people have a right to recovery and we are keen that they are able to make an informed decision about what treatment they have.

The way that you framed your question gave the impression that the Conservatives’ right to recovery bill is largely about residential rehab. I am very clear: people need to have access to a range of treatments, rather than to one. The goals of abstinence or of harm minimisation should be decided along with the person who is experiencing drug misuse. I would not say that there is only one path or goal in recovery. It is usually a long and winding path and a suite of options must be available to support people as they recover from addiction.

I thank the committee for inviting me to assist in its deliberations on the provisional common framework on food composition standards and labelling.

Officials in Food Standards Scotland have been working with their counterparts in the Department for Environment, Food and Rural Affairs and in the Food Standards Agency in Wales and Northern Ireland to develop a four-nations approach to delivering repatriated European Union functions on common areas of interest in the framework. Ministers of the four nations have agreed the content of the provisional framework, which was published as a UK Government command paper on 17 February 2022.

Policy on food composition standards and labelling was, and continues to be, highly regulated at the EU level. The purpose of the framework is to ensure that there is a joined-up approach across the UK on the continued maintenance of high standards of safety through delivery of regulatory functions in that area.

Throughout the process, we have committed to working collaboratively to develop common frameworks on the basis of consensus and in line with the agreed principles of the joint ministerial committee on EU negotiations. That includes the principles that UK frameworks should ensure the functioning of the UK internal market and acknowledge policy divergence, and that they should respect the devolution settlements and the democratic accountability of devolved legislatures.

The Scottish ministers fully support the common framework programme and consider that frameworks are all that are needed to manage any potential legislative divergence in the future. We consider that common frameworks provide necessary and proportionate assurance to respective Governments, legislatures, consumers, citizens and industries on issues concerning public health, and that the framework will ensure that internal market issues are duly considered in food composition standards and labelling policy development but are not prioritised over consumer interests.

I am happy to answer the committee’s questions.