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The Scottish Government does not have access to specific data regarding the maximum, minimum, or average costs for individuals renewing a guardianship order over the past five financial years.

The costs associated with renewing a guardianship order can vary significantly depending on various factors such as the complexity of the case, the involvement of legal and medical professionals, and the specific needs of the individual in question.

While we can identify certain standard fees like the £138 Court lodging fee and £95 Office of the Public Guardian (OPG) fee, additional expenses such as medical assessments and legal representation can fluctuate based on individual circumstances and preferences.

Non-means-tested legal aid is available in certain cases.

Legal aid, via the Scottish Legal Aid Board (SLAB) can provide financial support to families renewing guardianship orders for adults with learning disabilities. This assistance may cover legal representation costs, including solicitor fees and court expenses, depending on financial eligibility criteria. The support aims to alleviate the financial burden associated with navigating the renewal process, ensuring access to legal assistance for families in need.

It is difficult to confirm costs in guardianship cases as the circumstances will differ in each case.

When registering a guardianship order renewal, the Office of the Public Guardian (OPG) will charge a £95 fee. This fee covers the administrative processing of the renewal application. There is also a lodging fee of £138 charged by the Sheriff Court (from 1 April it will be £141). There may also be a fee for the medical examination, however this will depend on the doctor that is used and whether they charge for such a service.

The parents will need to seek legal assistance from a solicitor to navigate the renewal process, in which they will incur additional costs in the form of legal fees for the services provided by the legal professionals. These fees can vary depending on the complexity of the case and the amount of assistance required.

The Scottish Legal Aid Board (SLAB) are responsible for administering legal aid in Scotland. SLAB will assess eligibility based on financial circumstances of each case. If individuals were to meet the criteria, SLAB can provide funding for representation in legal matters, reducing or eliminating the costs associated with renewing their guardianship order.

If a family cannot afford to renew a guardianship order, the local authority can offer support by providing non-legal advice on the Adults with Incapacity (AWI) (Scotland) Act 2000, suggesting independent advice sources, and conducting needs assessments for both the individual and the carer. The Scottish Government has published AWI codes of practice for local authorities. Chapter 7 highlights the responsibilities of local authorities in this domain and their duty to apply for a guardianship where one is necessary and no application is being made or likely to be made.

Last winter Scottish Government published its good practice guidance for AWI delayed discharge based on engagement with majority of local authorities. This highlighted the most efficient ways to facilitate moves of adults lacking capacity from the hospital estate to more suitable accommodation. This included the guardianship process and ensuring the adults rights, will and preference are first and foremost.

The National Complex Mesh Surgical Service assesses patient needs and, where appropriate and subject to shared decision making and informed consent, performs mesh removal surgery. To date, 135 mesh removal procedures have been undertaken by the Service. Many women make the choice following assessment and discussion with the specialist team to follow a conservative pathway of care and do not undergo surgery.

The needs of patients and their goals may differ and therefore their definition of success will vary too. The removal of mesh is often only part of the treatment journey, with further reconstructive surgery depending on clinical need taking place at a later date. Patients may also have other needs which require to be addressed by other members of the clinical team.

The service is required to comply with normal clinical governance mechanisms in place within NHSGGC to provide an assurance that the service being delivered is safe and of an appropriate quality.

The report of the Transvaginal Mesh Case Record Review underlined what was already an important agenda for the Scottish Government: to improve care and services for women who are experiencing complications as a result of a transvaginal mesh; and, to ensure that the NHS continually reinforces good practice in confirming and recording patient consent and the treatment offered to patients. Progress continues in a range of connected activities relevant to Professor Brittons’ recommendations.

The recommendations made align with the practice that is embedded in the operation of the Complex Mesh Surgical Service, and through NHS Scotland more generally. We continue to work with NHS colleagues to ensure that women can access the care that they need, are fully supported by their GP and other clinicians, and have access to information they need to make informed decisions about their care.

The Chief Medical Officer wrote to Health Board Medical Directors on 10 October to draw their attention to the report of the Review and to the failings it identified, and to require them to seek assurance through local clinical governance committees that measures are in place locally to prevent a recurrence of the failings identified, and to assure the quality of processes connected to patient consent and record keeping. With regards to more recent patient records she reviewed, Professor Britton herself noted she was encouraged by the improvement in practice, with increasingly robust consent processes in place.

Work continues in other areas including enhancing information available to patients, credentialing of clinicians in mesh removal and improved data gathering.

The Scottish Government therefore considers that it is taking appropriate action to embed the report’s recommendations with regards to healthcare services in Scotland.

Under powers contained in the Local Government (Scotland) Act 1973, it is for local authorities to consider byelaws as provided for in section 201 of that Act. The Act provides that local authorities ‘… may make byelaws for the good rule and government of the whole or any part of the their area, and for the prevention and suppression of nuisances therein.’ It is entirely a matter for local authorities to consider whether to make byelaws with confirmation of any byelaws a matter for Scottish Ministers.

The Scottish Government is happy to engage with any local authority who wished to consider making any byelaws under the section 201 powers including where such byelaws may relate to XL Bully dogs in public places.

£648,000.

At the time of its announcement we indicated that the Mesh Fund would have an upper ceiling of £1 million, we have therefore ensured that the remainder of those funds have been invested in other mesh-related initiatives, including the Reimbursement Scheme, in line with calls made in the mesh campaigners’ Charter.

Once there is agreement between the patient and her clinicians that removal surgery is the best course of treatment, the decision on where that treatment is carried out, whether it is by the NHS or an independent provider, rests with the patient.

Both NHS Greater Glasgow and NHS National Services Scotland, National Services Division will provide information and assistance to women in whom surgery is being recommended as part of their treatment plan and where they wish to explore alternative options. It is made clear that women can choose to have surgery elsewhere and there is information provided, both online and in hard-copy, about choosing mesh removal surgery with one of the independent surgeons.

It is normal practice to record the content and outcome of any discussion taking place within the contemporaneous, confidential patient record. This includes a note of which leaflets have been provided as part of these discussions.

As at 15 February 2024, £481,423.63 had been paid to applicants. Administration costs to the same date are approximately £120,000.

The original scheme closure date was specified in the Scheme documentation and announced at the time of the Scheme’s opening as 6 December 2023. This date was then extended to 31 March 2024. The Government therefore urges any woman who wishes to apply, but has not yet done so, to ensure that an application is sent prior to this date.

The closure of the Reimbursement Scheme to applications has no effect on the arrangements that NHS National Services Scotland has entered into with both Spire Hospital, Bristol, and Dr Veronikis in the USA. In any situation where it is determined that removal surgery is clinically appropriate, the patient will remain able to choose, via the official NHS referral process, to have that surgery carried out in the Complex Mesh Surgical Service in Glasgow, in an NHS England centre, or by one of the two contracted independent providers.