Transvaginal Mesh Implants
To ask the Scottish Government what action it has taken to suspend the use of transvaginal mesh implants since the Cabinet Secretary for Health and Wellbeing called for this on 17 June 2014. (S4T-00954)
I recently met women who have experienced complications and I have asked that the acting chief medical officer writes again to health boards this week requesting that they consider suspending these procedures until the independent review has reported. The chief medical officer originally wrote to health boards in June 2014 to request that following the former Cabinet Secretary for Health and Wellbeing’s decision regarding the procedures.
In requesting that, I recognise that a small number of women, having discussed options with their clinician, will still want to proceed, which may be because they have experienced extremely difficult symptoms. In those instances, the women concerned must fully consent, must be completely aware of the risks, and must have considered alternatives.
I have also requested that health boards follow a protocol to provide assurance that the process is being followed in every case, and I will work with women concerned to develop an outline protocol.
It is fair to say that there is extreme confusion about what the Scottish Government’s position is, because women left Parliament last June understanding that the then health secretary found the operations to be completely unacceptable and that no more would happen. We have found that 166 operations have taken place since then. At the weekend, Shona Robison seems to have guaranteed Scottish women that the operations will not now take place. Can she tell members whether any more mesh operations will take place in Scotland and whether her guarantee is any firmer than the one that was given last June by her predecessor?
There is no confusion, other than perhaps in the mind of Jenny Marra. Let me explain why that is.
From 17 June until the end of September last year, health boards carried out 76 mesh implant procedures for stress urinary incontinence. The number of procedures for pelvic organ prolapse is too small to report, due to the risk of disclosure. Prior to the request to suspend procedures, health boards carried out around 1,500 mesh implant procedures annually for stress urinary incontinence and 350 procedures for prolapse. Therefore, there have been dramatic reductions in the numbers of those procedures.
As I explained in my first answer, when women ask for the procedure to be carried out in consultation with their clinician—when they are aware of all the risks, have had it explained to them what the alternatives are and have decided in that full knowledge that they want to proceed—there is nothing that we can do to stop that. It is very important that the women whom I met understood that fully. In fact, that is why they took part in drafting the patient information leaflet. They did that so that the women concerned would have the full information to be able to make an informed decision. The women whom I met fully understood that.
That is why we will ensure that the protocol is followed. I want to ensure that there is informed consent in every case. The women whom I met also wanted to ensure that there is a protocol and they wanted to be involved in its development.
Finally, the regulation of medical devices, including implants, is reserved to the Medicines and Healthcare Products Regulatory Agency, which is responsible for regulating all medical devices in the United Kingdom. It has not banned mesh implants; in fact, it has said that there is no evidence that they are unsafe. Therefore, they are not banned products. Because of that, although we can ask health boards to suspend procedures—that would be my preference—where a woman explicitly asks for the procedure in consultation with her clinician in full awareness of all the risks and with informed consent, that is what should happen. The women whom I met fully understood that.
Given the growing number of compensation claims in America, does the cabinet secretary share my concerns about potential compensation claims in Scotland, especially in the light of several health boards having ignored the advice of the former health secretary, Alex Neil, to stop such operations? Some 166 operations have taken place since that advice was given.
It would not be appropriate for me to pass judgment on compensation claims. Obviously, that is a legal matter.
John Scott will be aware that the independent review is looking at all the evidence, including the work that the European Union has carried out, and that it will report in May. Our suggestion to boards is that procedures should be suspended until that report comes out in May.
However, as I explained in my answer to Jenny Marra, when a woman wants to go ahead with that procedure—which is not banned, as the MHRA, which is the regulatory body, has said that, in its view, there is no evidence that the implants are unsafe—and gives her explicit informed consent, being aware of all the risks, a clinician cannot say no to that woman as long as she is absolutely clear. The protocol that we are developing at the moment is to ensure that that conversation is absolutely clear about the alternatives and the risks and that there is fully informed consent. In May, when we get the report of the independent review, I will be happy to come back to Parliament and inform members of what the review says and the action that we will then take.
Last week, the Public Petitions Committee heard that several multimillion-pound pay-outs have been made in the United States while mesh is still being used. What assessment has the Scottish Government made of the risk to national health service finances of similar action being taken here? How many cases have been lodged in the courts? Will she publish, through the Scottish Parliament information centre, the Scottish Government’s risk assessments of both the procedure and the financial implications for the Scottish health service? If everyone understood the policy in June, why is she reannouncing the same policy in March?
As I said to John Scott, I am not going to comment on compensation claims—that is a matter for those outwith the chamber. As I have said to Jenny Marra and John Scott, the MHRA, which regulates medical devices, has not banned the products, so they are available. I have explained in quite a lot of detail today, in terms of clinical judgment, the circumstances under which—
What was the risk assessment?
If the member would allow me to finish, that would be helpful.
There are very clear procedures for establishing informed consent to the procedure. Neil Findlay should also be aware that women have been writing to us to say that they have benefited from the procedure. However, we have asked for the suspension of the use of the products because, in the light of the independent review, we believe that we need to look at all the evidence and come to some conclusions, and that will happen in May.
The reason why the chief medical officer wrote again to boards was to remind them of our position that it would be better for boards to suspend such procedures. Nevertheless, we recognise that individual women will have the right to ask for the procedure to take place. As long as there is informed consent and the women know all the risks, in accordance with the protocol that I have described, that is how we will proceed.
Is the cabinet secretary aware that Dr McGuire of the MHRA, who gave evidence to Parliament last week, expressly declined to support or call for a moratorium? In support of his position, he cited a report from October 2012 that turned out to be a short review that had been conducted by three people and led by a librarian in 2012, two years before the petition was lodged. Does she agree that she has the unequivocal support of all of us in the chamber in taking the precautionary line of calling for a moratorium on the operations, which is based on the evidence of the many women in Scotland who have experienced dreadful difficulties and injuries as a result of them? Does she also agree that the MHRA’s reliance on a two-year-old study that was nothing more than a literature review is, frankly, disgraceful?
I am aware of the evidence that the MHRA gave to the committee. We are not in control of the MHRA—it reports to the UK Government and is responsible for the regulation of medical devices—and we do not have direct powers to remove mesh products from use in NHS Scotland. The MHRA has made clear its position on the matter which, at the moment, is that there is no evidence that the implants are unsafe. However, as Jackson Carlaw will be aware, there is a lot of other research going on. The EU is looking at the matter in detail and the independent review that we have commissioned, which will report in May, will look at all the evidence and will guide where we go from there. As I have said to other members, I am more than happy to return to the chamber, in whatever format would be most appropriate, to discuss the matter further at that time.
I put on record my thanks to the women involved, who have done a tremendous amount of work on the patient information leaflet. They are working with us on the new helpline that NHS 24 will provide and on the protocol. I record my sincere thanks to them for their efforts in the very difficult circumstances that they find themselves in.
Pegida Scotland Anti-Muslim Demonstration
To ask the Scottish Government what concerns it has regarding reports that an anti-Muslim demonstration is to be called by the organisation, Pegida Scotland. (S4T-00957)
Police Scotland’s monitoring of social media has revealed that Pegida intends to hold a static demonstration in Edinburgh on the evening of Saturday 21 March. Police Scotland is taking the event very seriously and closely monitoring developments. Public safety is paramount and those who seek to demonstrate must behave lawfully or face prosecution.
I spoke earlier today to Chief Superintendent Mark Williams, police commander for Edinburgh. He has provided assurances that all steps are being taken to ensure that no issues arise out of Pegida’s proposed demonstration. Police Scotland has, under the Public Order Act 1986, powers available to it to ensure that public safety is protected and order is maintained. Those who seek to incite violence will be dealt with firmly and reported to the Crown Office and Procurator Fiscal Service. The Scottish Government fully supports Police Scotland in taking all appropriate and proportionate action required.
I speak for all my colleagues in the Scottish Government and, I am sure, all members of this Parliament, when I say that we do not tolerate Islamophobia or any other form of hatred or hate crime. We will not tolerate extremists who peddle hatred under the guise of protecting society.
I am grateful to the cabinet secretary for his answer, particularly the last part of it, which properly addresses the threat that such organisations pose across Europe. We have seen some Governments in Europe make the mistake of aping or giving ground to the hard right and racist xenophobic movements. That strategy is doomed to fail. Others have given clear leadership and said that such movements are not welcome in their countries. I hope that the Scottish Government will continue to do that, too.
Given that part of the organisation’s express aim is to rid these islands of Islam, is it not clear that the movement poses explicit threat to Muslim citizens in this country? Any such organisation clearly raises public safety concerns that must be addressed and taken seriously.
The member raises an important point. The Muslim faith is an integral and important part of Scottish society; it is part of the rich, multi and interfaith relationships that we have in Scotland. Any organisation that seeks to unpick or exploit that should not be tolerated in any shape or fashion. The Scottish Government will certainly not tolerate that.
Pegida and the message of hatred that it seeks to peddle should not be tolerated in any shape or fashion. I give the member and the chamber an assurance that Police Scotland will deal with the issue robustly and proportionately; so, too, will the Government. We are a Government that believes in a tolerant society and that the Islamic faith has an important part to play in Scottish society.
Alongside the important work that Police Scotland will take forward in dealing with the issue is the offer of reassurance to those members of the Muslim faith in Scotland, especially those in Edinburgh, prior to and after this particular demonstration. I also give the member and the chamber an assurance that Police Scotland and the Government will provide the local community, the local Muslim community and the Muslim community in Scotland with all the reassurance that they require.
Does the cabinet secretary agree that many Muslims in this country, and in many other European countries, feel under threat and marginalised not only by these aggressive and hostile movements against them but by the expectation that it is for them to apologise continually for acts of extremism that they have never sought to condone or support? Does he agree that the Scottish Government must work across departments, including the education department, to ensure that all young people growing up in Scotland are given a sense of an inclusive Scotland in which the values of tolerance and respect are important? It is not just about responding to the movement of hatred, but about building an inclusive sense of the kind of Scotland that we want to build in the future.
Patrick Harvie is right: as well as being robust in how we tackle hatred within our society, we should promote community cohesion and partnership. That is an important element of the work that the Scottish Government does in the justice directorate and with the help of my colleague Alex Neil to support members of our faith groups in Scotland.
Some of the meetings that I have had with individuals in the Muslim community have been about providing reassurance that it is not a question of Muslims having to apologise for the appalling behaviour and acts of barbarity by certain individuals and organisations that conduct their operations under the guise of Islam, and that Muslims in this country are seen as valued members of our society. They should in no way feel that they have to apologise for the appalling acts of other people in other parts of the world or—should this ever happen—on our own shores. Alex Neil and I will continue to offer that reassurance.
I add that I think that our media have an important part to play in getting the message across that we do not expect Muslims in Scotland to apologise for the barbaric actions of those in other parts of the world. That is the message that I have taken out to the Muslim community, and it is the message that this Government will continue to take out to the Muslim community.
Does the cabinet secretary think that it would be entirely appropriate for the City of Edinburgh Council to use whatever powers it has to prevent the demonstration from taking place, given that the whole purpose of the demonstration is to foster Islamophobia and to stir up hatred against the thousands of Muslims who live in Scotland and who contribute so much to Scottish life?
We have already been in contact with the City of Edinburgh Council on the matter and it has had no contact from Pegida. The reason for that is that it would appear that Pegida is not intending to have a march, for which it would require permission from the council.
I assure the member that Police Scotland, the City of Edinburgh Council and the Scottish Government will take the measures that we consider to be appropriate. We are still at an early stage in terms of having the full details of what is to happen, but from the discussion that I had with the chief superintendent today, Malcolm Chisholm can be assured that Police Scotland and the council are taking the matter very seriously, and that they will take measures that they consider to be appropriate when they get further information on the nature and the potential scale of the demonstration.
Does the cabinet secretary agree that, in the light of recent incidents of anti-Semitism and Islamophobia, it is essential that we safeguard freedom of speech? Will he join me in commending the United Kingdom Government’s work to ensure that all of us, regardless of our religious or racial background, feel safe and respected in our country?
I recognise that freedom of speech is a fundamental human right, which we all have a duty to protect, respect and uphold, but it is not an absolute right and it must not be exercised in such a way that it has an impact on the rights of others. That is why there is a clear difference between gatherings for legitimate public protest and gatherings the intention of which is to stoke up racial hatred and to cause fear and alarm in our communities, and that difference should be recognised appropriately.
I associate myself with all that the cabinet secretary has said. How do we get the right balance between allowing freedom of speech and preventing hate speech by groups such as Pegida?
There is no straightforward way in which to do that, as the member will properly recognise. The human right of freedom of speech and expression is not an absolute right. It is possible for someone to fail to have regard to the offence and injury that they might cause to another. That is particularly true of those whom I have mentioned who might wish to incite racial hatred and racial violence, and to create fear and alarm in our communities.
We must ensure that we are alive to such issues and that we respond to them at the appropriate time. The member and the chamber can be assured that, as a Government, when we believe that action is taken that is about promoting racism and causing fear and alarm in our communities, appropriate measures will be taken by our law enforcement agencies and by other partners who work to promote cohesion within our communities to ensure that neither communities nor individuals feel alienated as a result of such events.
Welfare Reform
To ask the Scottish Government what its response is to the findings of the research commissioned by the Welfare Reform Committee, which suggests that parents and disabled people are being hit hardest by the United Kingdom Government’s welfare reforms. (S4T-00959)
That report highlights the scale of the damage inflicted by the UK Government’s cuts and changes, and it adds to the growing evidence base on the negative impacts of welfare reform on Scottish households. The changes that are being introduced are placing parents and disabled people under intolerable strain as they struggle to cope with them.
The Scottish Government is doing all that it can to help those affected, and we will have invested around £296 million from 2013-14 to 2015-16 to limit the damage of the reforms. Within the powers and resources that we have, we cannot fully mitigate all the effects of welfare changes, but we will continue to make the argument for a fairer welfare system.
The report gives further evidence that some of the most vulnerable members of our society are losing out—and that is before we include the impact of the harsher sanctions regime, which we already know is increasing the impact on the incomes of lone parents and disabled people.
Does the minister agree that, given the scale of the income lost through benefit cuts, the UK Government must urgently investigate claims of Department for Work and Pensions-imposed pressure on staff to apply benefit sanctions, which are clearly impacting on the incomes of the most vulnerable in Scotland?
I certainly do agree with the member. We are in a situation in which we have a Government in the UK that is so far removed from the reality of what is going on in communities throughout the country that it will not accept the evidence that has been put in front of it regarding sanctions and food banks. Organisation after organisation is lining up to produce evidence for the UK Government, but it absolutely refuses to accept it.
We have even seen the churches intervening to say that the sanctions regime in particular and the targets set for it are inhumane, but the UK Government ploughs on. The Scottish Government is totally opposed to that, and we accept that austerity does not reduce inequality.
The minister might be aware of the recent article in The Scotsman entitled “Poverty is a child protection issue”, by Harry Stevenson, president of Social Work Scotland, in which he posed the questions:
“Can you imagine the despair of parents who are fully aware of being unable to meet the basic needs of their children? Can you imagine the impact of the indignity of living in long-term poverty? And most importantly, can you imagine the impact on children’s confidence and self-worth?”
Given those comments and the growing evidence about welfare reform policies, what message would the minister send to the UK parties that voted for continued austerity in the UK budget?
I would say clearly to them to think again. However, this situation is why the First Minister argued last month that we need to bring an end to the austerity agenda of the Tories and Labour and increase public investment by £180 billion instead of implementing the Tory plans for the UK over the next four years.
It is only by ending austerity that we will be able to bring an end to the need for food banks and an end to people suffering because of benefit sanctions. The Scottish Government wants to see the economy grow and to reduce inequalities. To do that, we must end austerity.
Does the minister not agree that, although we all understand that welfare reform is a long and hard road, it is a necessary one that we must tread? Further, with regard to the minister’s comments on the use of sanctions, is it not appropriate to acknowledge that in the previous cycle sanctions peaked in 2007 under a Labour Government and that, although that peak was exceeded in 2013 and early 2014, that now represents a peak and the use of sanctions has fallen off largely because of the willingness of those who claim benefits to abide by the rules and carry out the necessary requirements to seek work as part of the process?
I do not believe that punishing people on benefits gets the results that we are looking for. We want to encourage people to take up work and comply if they are able to do so. [Interruption.] The member is shouting, “It’s working” across the chamber, but the evidence that we are getting from those on the front line and the stories that we are hearing and seeing in our constituency offices day and daily tells me clearly that it is not working.
We do not force people to do something, which is what the UK Government is trying to do. We have churches saying, “This is not right” and standing up for people because they see that the system is not working. It is punitive, it is unfair and it is impacting on children—as Clare Adamson said in her question—and the most vulnerable, so I do not agree with the member.
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