Meeting of the Parliament

Meeting date: Tuesday, October 24, 2023

Official Report 1124KB pdf

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Transvaginal Mesh

The next item of business is a debate on motion S6M-10915, in the name of Jenni Minto, on transvaginal mesh. I invite members who wish to participate in the debate to press their request-to-speak button now or as soon as possible.

15:49  

The motion to which I speak is on the impact of transvaginal mesh on women’s health, which the Parliament has rightly debated on a number of occasions in this session and previous sessions.

The fact that our Parliament has addressed the issue regularly underlines the seriousness of the harm experienced by women who continue to suffer painful complications after having mesh implanted. I will not be alone in hearing from women who have described how their lives have been blighted personally and professionally by complications after mesh surgery. What is worse, for some of them, their suffering was added to when they felt that their pain was downplayed, dismissed or ignored altogether.

However, members of this Parliament listened to women. They believed them, raised their experiences and pressed their concerns. The Government has listened, too. It is fair to say that, by working with the Parliament and committed professionals in the national health service, enduring improvements have been made to the care that is offered to women affected by mesh.

One of the ways in which the Government sought to respond to affected women was the establishment of the transvaginal mesh case record review. The review was led by Professor Alison Britton with the assistance of an expert panel and conducted entirely independently of the Scottish Government. We had no contact with the participants as part of the review nor sight of any records. The review was established to examine the medical records of women who feared that their treatment had been recorded inaccurately. Women considered that they had been informed that their mesh had been fully removed but subsequently discovered that it had been removed only in part.

I thank Professor Britton for her meticulous work and echo her thanks to the women who shared their experiences and insights. Professor Britton notes that, despite the personal and emotional cost to them, women engaged in the review not only or even mostly for themselves but to make a difference to other women’s quality of life.

The review’s approach was not to seek to establish blame or necessarily to find fault but to allow women an opportunity to discuss and better understand their health records with an expert panel. Forty-seven women who had been involved in a meeting in 2019 with the then First Minister and Cabinet Secretary for Health and Sport were invited to take part. Eighteen women, six of whom had had mesh removal surgery, took up the offer of a report on their records. Each of the women received a bespoke report about their circumstances and their records. Women were offered an opportunity to talk to the panel about their report. Time was allowed for them to talk again after reflecting on the report and their first discussion.

It will be for the individual women involved to judge the benefit of the process to them, but the panel noted that there was a general appreciation of not being rushed and being able to define their journey in their way. From the Government’s perspective, we were grateful to Professor Britton, the panel and their staff for fulfilling their remit so thoroughly and in a way that has respected women’s experiences.

The report is not easy to read and we note with concern the following observation:

“Every patient is entitled to expect and receive accurate information both before any treatment is chosen and to be advised on the effectiveness and consequences of any intervention. Most of the cases that we reviewed did not meet these standards.”

That is a critical point to which I will return.

The review’s remit also sought a wider report, which Professor Britton published in June with 21 recommendations. As was only reasonable, most of the recommendations were about the care that is now available to women affected by mesh. They addressed communication between clinicians and patients and between different parts of the NHS; information and support made available before and after removal surgery; and collaboration across the United Kingdom and the establishment of a register of surgery.

The Government endorses all the recommendations. Moreover, we believe that the NHS in general and the complex mesh surgical service in Glasgow in particular are acting now to make substantial progress towards achieving the objectives that the recommendations pursue, as well as responding to comments from women.

As I noted in my letter of 22 August to the Health, Social Care and Sport Committee, it is accepted by all that there remains a need for continuing improvement in the Glasgow service. However, at the same time, we know from patient feedback, which is gathered annually, that changes in the service that were made in response to previous feedback are already better matching women’s needs.

The complex mesh surgical service in Glasgow is centred on a published national clinical pathway.

I am grateful to the minister for giving way. She highlights the important issues that the review has identified, but it is important to understand that this is not a historical case or set of affairs. It represents women who currently do not know their status, what happened to them and, critically, what the future pathway for treatment and care looks like. When will that be resolved so that all women who need corrective procedures know where they are in the process and when they will receive treatment?

I believe that the rest of my speech will answer a lot of Daniel Johnson’s questions. The Glasgow mesh service is listening to women and amending the way that it works to ensure that it provides the best service for women.

Referrals are made on the basis of a single national form provided by the Glasgow service. Before attending the centre, patients have access to a range of information that is available on one website operated by NHS Greater Glasgow and Clyde. The website explains what a patient visiting the centre can expect, including how long the consultation might take and what will happen during it. The service is being further improved in response to patient feedback. Patients are encouraged to bring a companion and are free to record consultations on a personal mobile device, so that they are under no pressure to remember everything that is said. Patients can also see and discuss any scan pictures that are taken during investigations.

The service is not just about surgery. Women are supported by a multidisciplinary team of psychologists, physiotherapists and specialist nurses and they can access advice about diet, lifestyle and pain management.

It is also made explicitly clear that women can choose to have surgery elsewhere. Information is provided online and in hard copy about mesh removal surgery with one of the independent surgeons. Patients and the multidisciplinary team can take time to reach decisions about care, and they will be taken only after the patient has been given time to reflect on their options, while being supported by high-quality decision aids and consent forms. After surgery or after treatment has concluded, patients are referred back to their local health board for on-going support.

Patient feedback shows good and improving results. As I noted earlier, that has led to changes, such as having fewer people present in examinations.

I am listening with interest, and I will obviously have an opportunity to say more in my contribution. Does the minister not accept that, for most women at the moment, the pathway to removal of mesh means being treated by the very same surgeons who implemented the mesh in the first place, in whom they have no confidence whatsoever? So much of what Professor Alison Britton recommended in this report and in her earlier report is—although embraced by the Government—vague about following in a transparent route how the recommendations are implemented.

I thank Jackson Carlaw for his intervention, and I recognise the fantastic work that he has done in supporting women in this situation.

Women have the option to choose an independent surgeon to remove mesh, but I absolutely understand his point about trust, having heard about that directly. We are focused on finding solutions to rebuild that trust, and that is what we learned from Professor Britton’s report.

The service continually reviews its operations and listens to patients to ensure that it is getting it right. The Glasgow service is part of a United Kingdom-wide network of 10 specialist mesh centres. It will be a key partner in the development of a pelvic floor register, one of Professor Britton’s recommendations to which the Government has committed. Further recommendations address training and information for general practitioners and surgeons, and the Government has already acted on those. A training package that is intended to help GPs to feel more confident in supporting women with mesh complications can now be accessed through the NHS Scotland online learning service. The Government continues to make progress with partners to support the development of a General Medical Council-regulated credential in mesh surgery, and we know that clinicians in Scotland are keen to take part in a pilot stage.

I return to the observations that the review offered about the accuracy of some medical records that it examined. As I said at the outset, the Scottish Government has had no access to any records and no contact with any patients as part of the review. Nevertheless, the chief medical officer has taken careful note of the findings and, with significant concern, he notes observations around consent and record keeping. As a consequence, Professor Sir Gregor Smith has now written to all health boards to draw their attention to the report of the review and to the failings that it identified. It is clearly unacceptable that any medical records in Scotland might, in the words of the review,

“not bear any reflection to the surgery that had occurred, nor its outcomes.”

I am very sorry, on behalf of the Government, that those failings happened.

As the review fairly reports, the failings might not have come to light without it being commissioned. Both the chief medical officer and I have great confidence in the professionalism and dedication of doctors across Scotland, but we also look to all in our NHS to take careful note of the report and to reflect anew on how everyone acts to maintain the highest standards of professional practice.

I conclude by repeating the welcome that I offered earlier of Professor Britton’s report, along with the Government’s thanks. Importantly, I thank the women who were able to share their experiences and be heard.

The report and its recommendations put new and welcome focus on what is already an important agenda for the Government. We want women to feel empowered and encouraged to ask questions, to share concerns and expectations about their care and to be treated at all times with dignity and respect. The NHS should continually reinforce good practice in confirming and recording consent in the treatment that is offered to patients.

I move,

That the Parliament welcomes the report of the independent Transvaginal Mesh Case Record Review; acknowledges the severe and painful complications endured by women after the implantation of transvaginal mesh and regrets that their trauma may have been exacerbated by initial service responses that doubted their lived experiences; notes the continuing improvement in support, informed by the views of affected women, offered by the specialist mesh surgical service at the New Victoria Hospital in Glasgow in particular and NHS Scotland in general, in ways well aligned with the recommendations of Professor Britton’s review; further notes the Chief Medical Officer’s request of NHS boards to sustain good practice in the seeking and recording of patients’ informed consent and to be assured locally that affected women are able to access the national mesh removal referral pathway, and supports the Scottish Government’s continuing commitment to offering women a choice of surgeon, if mesh removal surgery is considered appropriate, and to reimbursing women who had previously arranged qualifying mesh removal surgery privately.

16:01  

At the outset, I want to recognise the hundreds of mesh-injured women who have fought so hard for so long for their voices to be heard. They have lived with debilitating pain. For some, their symptoms and internal injuries have been so excruciating that they have had to give up their jobs. Others have become socially isolated because managing their symptoms is so difficult and depleting. The impact on their physical and mental health has been horrendous, compounded by the betrayal by a healthcare system that repeatedly told them that there was nothing wrong. The women felt diminished and disempowered by the clinicians whom they trusted to care for them. Heartbreakingly, one woman said that she felt like an “insignificant little nothing.”

I pay tribute to Elaine Holmes, Olive McIlroy and the Scottish Mesh Survivors, who, almost 10 years ago, started a campaign with a parliamentary petition to rectify the mistakes that mesh-injured women have endured. My colleague Jackson Carlaw and former MSPs Alex Neil and Neil Findlay heard their call to action and took up the cause in the Scottish Parliament. They helped to provide a platform for women to share their experiences of surgical mesh, but it should never have had to come to that. Our healthcare system should be patient centred and not stacked against them.

The latest review from Professor Alison Britton makes for grim and difficult reading. It examined 40,000 pages of medical notes and 18 case records of women with transvaginal mesh implants and found that many of them were not informed of the risks and implications of the treatment if it were to go wrong. Some had conditions that would not have been helped by a mesh implant in the first place and, horrifyingly, many were misled about the extent to which the mesh had been removed by the NHS. One patient lost her bladder, and she said that what had happened to her was “bordering on criminal”. Another described the feeling of being “deceived” and “gaslit” by clinicians. The legacy of distrust from the transvaginal mesh scandal will endure for a long time to come.

Professor Britton’s review has made 21 recommendations, which span communication with patients; the creation of a mesh register for procedures in Scotland, the wider UK and abroad; clarification around the mesh referral and treatment pathways from the patient perspective; requirements for post-operative care following surgery abroad; and improvements to the consent process. Today, the minister has thanked Professor Britton, so I am sure that she will agree that those are reasonable and common-sense suggestions, which the Scottish Government should implement at pace with the appropriate partners.

The minister’s motion suggests that support for mesh-injured women is already well-aligned with Professor Britton’s recommendation, but a polite way of replying to that is that it is a striking example of noncommittal political parlance if ever I heard one.

Professor Britton authored the 2018 investigative report into the initial review of the use of transvaginal mesh. The minister said today that she is grateful to Professor Britton and that she wants to find ways to build back trust, yet five years on from its publication, Professor Britton confirmed that not one of the 46 recommendations have been implemented by the SNP Government—hardly a track record to fill us with confidence.

Does the member agree that alignment will happen only once every person who has survived mesh knows what treatment they will get and is satisfied with the outcome of it? The reality is that too many women are still in the dark about what will happen to them.

I strongly support and echo that. Women need to build back trust. The minister talked about building trust, but the fact that not a single one of Professor Britton’s recommendations have been implemented is absolutely disgraceful.

Effective treatment for mesh-injured women has been a hard-won prize, but serious systemic problems remain. As our amendment highlights, waiting times are far too long. Earlier this year, I raised a case with the minister of a woman who had to wait a shocking 82 weeks simply for referral to the specialist mesh service in Glasgow.

Part of the issue is that the referral pathway—a complex diagram that is clear as mud for most patients—requires women affected by mesh to be seen by a local urogynaecologist for referral to the specialist service in NHS Greater Glasgow and Clyde. Their GP must refer them first to the health board, which then refers them onwards; there is no direct pathway.

It is a lengthy process, especially when urogynaecological services are under so much pressure. The process could be much better integrated to reduce waiting times. In the meantime, GPs and other clinicians must become well-versed in how to support women with surgical mesh implants to manage their physical and emotional pain.

Post-operative care in the NHS needs to be more clearly defined for mesh patients when independent providers of surgery are involved. Women have described being in limbo. They do not know whether they have been discharged or whether they require follow-up care. One patient in NHS Tayside, who had her mesh removed at Southmead Hospital in Bristol said:

"Nobody in Scotland has asked if I'm OK. I've had no communication from my health board.”

A mesh register—a longstanding initiative that has yet to be implemented—would help in that regard.

On the reimbursement scheme—welcome though it is—patients have expressed concerns about the pedantic penny counting for treatment that they had to arrange abroad because options were limited closer to home.

The transvaginal mesh scandal has shone a light not just on one particular procedure, but on the way that the healthcare system manages women’s healthcare more widely. Let us not forget why women were given mesh implants in the first place. Often, it was to treat urinary incontinence and pelvic prolapse; they have gone from one trauma to another. There is still so much to be done to ensure that women have equality of care, and that they are listened to and respected by clinicians.

I urge the minister and the Scottish Government to heed the words of Professor Britton:

“After the wealth of knowledge and evidence gathered, it would be an appalling waste if this was not put to good use to prevent future medical scandals.”

This cannot be allowed to happen again.

I move amendment S6M-10915, to leave out from first “notes” to end and insert:

“recognises that waiting times for mesh-injured women accessing the specialist mesh surgical service are significant and that urgent action is required by the Scottish Government and NHS National Services Scotland to reduce long waits; notes with concern that affected women must be seen by a local urogynaecologist within their NHS board before being referred to specialist services and that a GP referral is not available; further notes that the referral pathway is lengthy and complex, especially relating to independent providers and post-operative care; urges the Scottish Government to implement the full recommendations of Professor Britton’s review to improve the support and outcomes available for women affected by surgical mesh, including the implementation of a new register for patients; requires the Scottish Government to report back to the Scottish Parliament on progress towards the implementation of the review’s recommendations, including on how the management of women’s healthcare and the communication of treatment implications are being addressed by NHS boards; seeks assurances that there will be a patient role in shaping how services supporting mesh-injured women are provided, and calls for clarity around the reimbursement arrangements for women who have arranged qualifying mesh removal surgery privately.”

16:09  

Mesh campaigners have had to fight for many years for action on their concerns and the reality is that, despite the parallel universe set out by the minister, that fight continues.

The Scottish Government has promised to listen to and support the women involved, but progress has been glacial. There are reports that the complex mesh surgical service is not working. It was set up three years ago but the story now is one of long waiting lists and no follow-up care. I have been contacted by many women, including Lisa Megginson, who, having had mesh surgery herself, now supports women to access treatment through the complex mesh surgical service. She points to dither, delay and a lack of aftercare.

In the real world, Government figures reveal that women have waited up to 448 days for a first appointment at the service, with the subsequent wait for mesh removal surgery lasting up to 341 days. My information is the same as Tess White’s: urgent referrals have, in some cases, taken 82 weeks, which is a year and a half, and women who are being referred now are being offered appointments in 2025. Women have been left suicidal by the waits that they face and they daily suffer the risk of developing sepsis because of the constant infections caused by mesh. Must someone die before the Government takes swifter action?

The story is not much better when it comes to surgery. In a letter to the Health, Social Care and Sport Committee, the minister said that, by the end of July, only 89 women had undergone surgery in Glasgow, that 26 had travelled to the United States or to Bristol for surgery and that only 20 women had been reimbursed for surgery that they had sought and paid for out of their own pockets.

Although I understand that Dr Veronikis has been awarded another year-long contract, he has been told not to carry out any repairs to damage that he finds but only to remove mesh devices. When patients have already undergone removal surgery in Scotland, it is only once they are on the operating table in the US that Dr Veronikis can see the damage that has been caused. It cannot be morally acceptable to instruct a world-class surgeon to ignore the internal damage that he finds and to stick strictly to mesh removal only, so his contract must be reviewed and should be extended until all the women who need mesh removal have been treated.

Those who have been able to access the clinic and have received mesh removal report that follow-up support has been non-existent, leaving many feeling that they are in the same boat as they were 10 years ago. Maureen Kane from Fife underwent mesh removal surgery last November. Since then, Maureen feels as if she has, yet again, been left to suffer. She said:

“It is like we have been forgotten about. It’s just the same as before. I didn’t expect miracles from the operation but I did expect there to be some follow-up. I just feel like as soon as they have got the mesh out, they are done with you.”

Women like Maureen are on a merry-go-round of misery, dealing with this Government’s failure to provide any follow-up care.

Another woman returned from the United States with a catheter still inside her. She contacted the complex mesh service, which did not get back to her. She went to the Queen Elizabeth university hospital, only to be told that that hospital did not provide treatment for those who had had procedures overseas. The hospital eventually, and reluctantly, agreed to help her. She could have contracted sepsis and died. Why is there no follow up? Proactive follow-up services must be set up immediately to provide essential aftercare for those women.

Mesh-injured women face lifelong pain and disability. They will require adaptations to their houses and funding to support their lives. Many have lost jobs, careers, partners or homes as a direct result of becoming disabled due to the use of mesh.

The Cumberlege report, which was welcomed by the Government, called for the setting up of a redress scheme. Why has that not yet been set up? Why is there still a delay? That is simply unacceptable.

I turn to the reviews, of which there have been a number. The independent review on transvaginal mesh implants came to a series of conclusions and recommendations in 2017. How many of those have been implemented?

As we heard from Tess White, the first of Professor Britton’s investigative reviews, which was published in 2018, made 46 recommendations, but it would appear that not one has been implemented. We now have the second Professor Britton report, which was published in June 2023. That is extremely welcome, but what will the SNP do to implement its 21 recommendations—not just to endorse them, but to make them real? Are they simply to gather dust? Will the Government simply proceed at a snail’s pace?

The report exposed damning evidence of women being blatantly lied to and told that they had had a full mesh removal when that was not the case. There are cases where women were given mesh implants when they should never have been treated with them, causing them life-changing injuries. I ask the minister whether those cases are subject to criminal investigations. Can the Government explain why surgeons who were found to have lied are facing no consequences for their actions? Can the minister explain why those same surgeons are providing their opinions on the future care of the very women they harmed?

The problems are not just with transvaginal mesh. There are petitions before the Parliament calling on the Government to suspend the use of all surgical mesh and fixation devices. Similarly to transvaginal mesh-injured women, people who were fitted with mesh to treat things such as hernia have reported debilitating pain and issues with their mesh devices. There is a need for a viable and safe alternative to mesh. Transvaginal mesh-injured women were ignored for years, and now other mesh-injured survivors find themselves in the same position.

The issues are clear. The Scottish Government must urgently address delays in the Glasgow service, tackle long referral times, provide an aftercare service and actually listen to the experiences of patients. It must extend the contracts with specialists in the United States and Bristol and put in place a redress scheme. Failure to act will amount to a further betrayal of mesh-injured patients. The promise to listen to these women is one that the Scottish Government must not continue to break.

I move amendment S6M-10915.2, to insert at end:

“; is concerned by the long waits for a first appointment at the Complex Mesh Surgical Service, whilst some women have reported a lack of clarity around accessing the full range of support available for mesh-related injuries; regrets that not all of the recommendations of the reviews by Professor Britton have been implemented; agrees that a realistic medicine approach is essential going forward, where patients are empowered and supported to be in control of their healthcare, and calls on the Scottish Government to set out how it will eradicate long waits for appointments and ensure that women affected by transvaginal mesh are informed and able to easily access the range of support available, which should be person-centred and trauma-informed ongoing care, and to publish both a strategy for increased surgical training and capacity building in alternative procedures to mesh, and data on waiting times for alternative procedures.”

16:17  

In the seven years for which I have been an MSP, I have spoken on the subject of transvaginal mesh several times, as have many of the speakers in this afternoon’s debate. I am gratified to be speaking in a debate on the subject in Government time, because for far too long we had to debate it in Opposition time and members’ business debates. It is good that the SNP Government is now taking it with the seriousness that it requires.

It is fair to say that the issue is one around which members have coalesced: there is agreement on it, and that is right. We have come together to support those women who have been harmed through no fault of their own. In speeches like this one, I have often shared the story of my constituent Cathy, whose account echoes those of hundreds of women—many of whom we have heard about today—who were referred by GPs or physiotherapists to receive mesh implants. Cathy was given very little information other than being told that the procedure would alleviate the mild incontinence that she had. What followed was five years of crippling pain and gaslighting, which we have heard many others describe, and her mobility, her mental health and her intimacy with her partner all suffered as a result. Her quality of life was absolutely devastated.

It was an important moment for this Parliament when, in January 2022, we passed the legislation to reimburse victims of transvaginal mesh for the surgery that they would have to undergo to have it removed privately. However, as Jackson Carlaw rightly pointed out in his intervention on the minister, care pathways are still uncertain for victims and, more often than not, they lead them to the very surgeons who harmed them in the first place, in whom they have no confidence at all.

I echo the points that Jackie Baillie made about the contract under which Dr Veronikis is removing mesh in America. That desperately needs to be reviewed. We also need to make sure that the women have wraparound, holistic care.

I, too, pay tribute to the many people who have campaigned to get us to this point. I have already namechecked Jackson Carlaw, but he, Alex Neil and Neil Findlay all deserve recognition for their tireless efforts to get us here.

I mean no disrespect to the minister, but Mr Cole-Hamilton mentioned the many debates on the subject in which he has participated, and I note that, in nearly all of them, the health secretary was present and actively engaged. Is Mr Cole-Hamilton just a little bit surprised, like me, that the recently appointed Cabinet Secretary for NHS Recovery, Health and Social Care is not present? Does that reinforce in him a worry that there is a sense that we have moved on when, in fact, for many of the women, we have not?

That observation is correct. This debate, like those that preceded it, will be watched far beyond the chamber by the many victims of mesh, who will share Jackson Carlaw’s and my dismay that the front bench of the Scottish Government is not represented.

Although nothing can take away from the trauma that far too many women endured, at least they did not have to bear the hefty financial costs of having the implants removed. The problem has been in accessing that surgery.

The legislation was not the panacea that many hoped it would be. The reimbursement scheme did not include the victims of other mesh implants—for instance, those who have suffered complications from devices associated with hernia mesh. We have heard some very graphic descriptions of those cases. That is why I was one of the first to raise hernia mesh in the chamber, along with a number of other MSPs. We have probably all met constituents who are missed out, still. One of my constituents has, in effect, been left crippled by her hernia mesh.

In January, we debated a petition to suspend the use of mesh altogether. I was mindful then of the concern that suspending the wider use of mesh could leave some people with no—or very limited—treatment options.

There are some life-or-death cases in which the use of mesh for a surgical implant is essential. What is utterly essential is that every patient is given access to the full facts before going ahead with any treatment of that nature. Many cases involving the use of transvaginal mesh had in common the abject failure of those who provided the treatment to make patients fully aware of the attendant risks of using those implants. Informed consent is—or should be—one of the key principles of our health service. It is right for every patient to be given full information about what their treatment involves—what is being put inside their body and what it has the potential to do to them. That is realistic medicine—treating people like grown-ups. That information must include the potential risks as well as the benefits, and patients must always, wherever possible, be offered a reasonable alternative treatment.

It is also important that health boards are provided with all that they need to ensure the availability of non-mesh surgery, and that any skills gaps in their workforce that impact on the treatment of complex cases are addressed.

I am glad that the transvaginal mesh case record review, which was conducted by Professor Alison Britton and about which we have heard today, was finally published in June. However, it is worrying that, in the introduction to the report, Professor Britton makes it clear that none of the 46 recommendations that she made in her previous report in 2018 has, so far, been properly implemented by the Scottish Government. I am grateful to the Government for using Government time for the debate, but I am sure that the minister will agree that such a glacial lack of progress is unacceptable, and I hope that she will address that in her closing remarks.

The harrowing experiences of many survivors of mesh implants have seriously damaged their trust in the NHS. It is therefore vital that we now get the issue right and that all the recommendations are implemented as a matter of urgency.

I give a reminder, as we move into the open debate, that we are very tight for time, so we will stick to the allotted speaking times.

16:23  

This debate on what is a tragic and complicated issue is one of many in which I have taken part, as has Alex Cole-Hamilton, since I was elected in 2016.

I welcome the fact that we can have further debate in the chamber today on the recent report of the independent transvaginal mesh case record review, because I believe that the misery and devastation that was caused to so many women, not just here in Scotland but globally, will go down in history as one of the greatest medical injustices ever suffered by women.

The severe and painful complications that were experienced by so many women who were implanted with mesh were exacerbated because the women were let down by those whom they should have been able to trust. By that, I mean the health boards, the medical establishment, a disgracefully flawed review and, frankly, politicians.

Cross-party consensus has existed since the horrendous problems with mesh implants came to light, which resulted in the ill-fated moratorium on implants in 2014. I commend Jackson Carlaw for his unwavering commitment.

It is not constructive to revisit in the debate the distressing history of problems, but thanks must go to Professor Alison Britton, who chaired the review, and the 18 women who agreed to take part in what was to become a two-year process. The report reveals that only two of the 18 women who took part had undergone either full or partial mesh revision surgery, with a further four receiving it over the next two years. That meant that the majority of those who participated in the case record review had not undergone any revision surgery, and the review group had to rethink its framework regarding how it would tackle the broader range of issues around the treatment and experiences of healthcare of the majority of women who had experienced implants.

Practically, that entailed the review group requesting more than 40,000 pages of records. From the initial meeting with each participant to the subsequent request for case records, to the completion of each report, the group spent some 45 to 50 hours on each participant’s case, and it wrote 18 bespoke participant reports. It is not rocket science to see how labour and resource intensive that undertaking was, but the group concluded that it was worth it to get an in-depth study of the experiences of the volunteers.

So, where are we now? Crucially, the implantation of transvaginal mesh has been halted since 2018, and there are no plans to lift that halt. The review group supports the Scottish Government’s continuing commitment to offering women a choice of surgeon, if mesh removal is considered appropriate, and to reimbursing women who had previously arranged to have mesh removed privately. Scotland is the first UK country to reimburse people for private treatment that has been sought.

The Scottish Government is determined to ensure that those with mesh complications get the treatment that they want and need, but I acknowledge the points made by Tess White and Jackie Baillie, and I will not defend anything that exacerbates the suffering of these women. I would like all the problems that have been raised today to be addressed urgently.

The Government has introduced new training on mesh for general practitioners and has improved information for patients about the specialist service in Glasgow. As we have heard, patients can also have the surgery at an English NHS centre or at one of the independent providers in Bristol or the United States. Women who previously used their own money can apply to have that reimbursed by the end of March next year.

The mesh service in Glasgow offers specialist assessment and care in the treatment of complications. It is hosted by NHS Greater Glasgow and Clyde and forms part of the UK network of 10 specialist mesh centres, and it is recognised for its clinical expertise in the field.

The report makes recommendations, only some of which I have time to list. We have heard some of them. It recommends that bespoke data-sharing agreements should be put in place prior to the commencement of a large case review. It advocates for Scotland having a mesh register that records surgery in Scotland as well as surgery that has occurred in other parts of the UK. Women should have access to information, and additional support mechanisms should be put in place for GPs and practice teams to aid understanding of the concerns that women raise with them.

There should be clear and transparent communication with patients regarding the type of surgery that they will undergo, and a detailed set of medical notes and dialogue. The counselling advice that is given and communication on the risks and potential complications all have to be clear and transparent. There should be the creation of a national specific consent form for use across the country to improve the consistency of information that is given during the counselling process. The report also recommends that information on referral and treatment is clarified and published on a website.

Training and credentialing of surgeons in Scotland is a critical element. The process has to be clearly articulated, not only for clinicians but for women who use the service. Patients must be informed that when they turn up for appointments they have the option of having a trusted person with them and that they can record discussions that take place during the appointment. All that will restore some trust.

It is crucial that there is an agreed system of NHS follow-up and on-going support in place for patients who are returning from mesh revision surgery taking place outside Scotland, and that that data is captured and collated.

All those recommendations are sensible and necessary, and I hope that those that have not been implemented will be as soon as possible.

Many people, including me, regularly call the mesh survivors group brave and courageous for taking on the fight, and they are. However, I am sure that most days they do not feel brave or courageous, as they struggle to cope with the basic things that most of us take for granted. The damage has been done to them, but they simply do not want a sister, a friend, an aunt or any other woman to go through what they had to endure. That, in my view, is dignified, unselfish and inspirational.

16:30  

I refer members to my entry in the register of members’ interests. I am a practising NHS GP.

In the past two decades, some 20,000 women in Scotland underwent transvaginal mesh implant surgery. They were advised to do so in order to treat conditions such as incontinence and prolapse, often as a result of trauma at childbirth. Tragically, some 600 women who underwent implant surgery have suffered painful and life-changing side effects. There have been complications from surgery because of erosion of the mesh inside the body, causing nerve damage, chronic pain and vaginal scarring. There have been cases of organ perforation, with synthetic propylene mesh actually becoming exposed inside the vagina.

In the Health, Social Care and Sport Committee, we have heard from women who have had to endure harrowing experiences following mesh surgery: pain, infections, reduced mobility, difficulties with intimacy and psychological strain. Many of those women were simply not believed when they were crying out for help. It was nightmarish. Despite their pleas, those suffering women were forced to wait and wait before remedial intervention was offered. Having lost all confidence in our NHS, those with the means turned to the private sector, including travelling to the United States. They sought out specialists who believed them and had the expertise to correct our health service’s mistakes.

We have come a long way since 2014, when sufferers brought a petition to the Scottish Parliament calling for action: the implant procedure was halted in 2018; in July 2021, the Scottish Government agreed to meet the costs of private treatment to remove transvaginal mesh; and in January 2022, Parliament passed a bill to reimburse women who had already paid for private healthcare. We now also have specialist clinics in NHS Greater Glasgow and Clyde to support women experiencing complications from mesh implant surgery. There has been cross-party support since Parliament began trying to right the wrongs of failed transvaginal mesh implants and support those who are suffering. However, have we done enough?

In her motion, the Minister for Public Health and Women’s Health, Jenny Minto, highlighted the continuing improvement in the support offered by NHS Scotland and notes that it is well aligned with the recommendations of a major case review of records. The motion also notes the assurance that affected women are able to access the national mesh removal referral pathway and that the Scottish Government is committed to offering women a choice of surgeon. However, are the processes that are in place today robust? Do women still find themselves at the mercy of an absurd, Kafkaesque bureaucracy?

There is still a long way to go to rectify the injustices of Scotland’s implant mesh failures and still further to posit Scotland as an example for others to follow. Waiting times to access specialist surgical services for mesh-injured women are still unacceptably high. The referral pathway is still lengthy and complex, especially when patients seek care outwith the NHS. Complex mesh surgical services are hosted by NHS Greater Glasgow and Clyde. Despite agreements being in place with private providers, there are real concerns that bureaucratic gatekeepers at the Glasgow service may obstruct the signing off of patients’ preferred plans to seek treatment outwith Scotland. Patients who return from abroad are left with no follow-up.

There is a reason why some patients may want to look elsewhere. Professor Britton’s review found that trust in the complex mesh surgical service was all but completely depleted. The review found evidence that women had been repeatedly misled and told that they had undergone full mesh removal when, in fact, just small amounts of plastic had been surgically excised—with no groin incisions, full removal was impossible.

The Health, Social Care and Sport Committee also found that many women faced long waits for treatment from the NHS service, with one woman saying that she had waited nearly two years between appointments. There is more. GPs cannot refer patients directly to the complex mesh surgical service. Patients have to first see a local urogynaecologist in their local health board before being referred on, which means another layer of bureaucracy, significantly more time waiting and significantly more time in unnecessary pain. That is unacceptable.

We must make it easier for patients to get the help that they deserve. This SNP Government talks the talk but, having not implemented any of Professor Britton’s 46 recommendations or thought about other changes, it does not walk the walk. There has been a complete failure of implementation, despite cross-party support.

The minister must do better and perhaps show some contrition for those women who are suffering.

16:36  

As we have heard, complications relating to the use of vaginal mesh have caused widespread and severe symptoms in thousands of women. Those patients have been failed once and, as it stands, the complex mesh surgical service, or CMSS, which is a service designed to remedy the pain and suffering of those patients, continues to fail some of them.

In its scrutiny of the CMSS, the Health, Social Care and Sport Committee took a variety of evidence. Some reported positive experiences, which is to be welcomed, but others reported barriers to accessing long-term holistic care and support that they feel that they need and should be entitled to expect. Evidence that we heard demonstrates a lack of urgency. Without intervention, the service could exacerbate the trauma of some patients. I am pleased to hear that the minister acknowledges that and to have the opportunity to highlight some of the key issues that the committee heard evidence on.

Uncertainty around referral pathways is rife, with variation between different NHS boards and confusion among medical professionals. If people working in the sector are not clear on how this works, what hope is there for patients? The minister has set out plans to remedy that, including a letter to GPs clarifying the referral pathway. I seek detail on how the Government will ensure that those measures are effective.

Once referred, patients report

“‘living in limbo’ and ‘treading water’ whilst waiting for a mesh complications consultation, ‘pushed from pillar to post’: an ‘endless conveyor belt’ of ‘humiliating tests’ and ‘red tape’ with no one really knowing what to do.”

Patients told us that during that uncertain time it was difficult to contact the CMSS. Poor communication is an on-going theme, with limited information provided to patients. Waiting well initiatives could help, and I eagerly await an update and detail on how the Government will ensure that information is accessible to patients for whom English is not their first language.

On top of years of life-changing symptoms, these patients face difficult decisions and a complicated procedure, which participants described in a study as like

“taking fish bones out of chewing gum.”

It is clear that emotional support is much needed. Demand for proposed peer support groups was limited, but is that surprising when peer support groups put the onus on patients to support each other? That lack of uptake should absolutely not be taken for a lack of need for emotional support. That is very much needed by those women. The minister has acknowledged the struggles of patients who face doubt from medical professionals.

Indeed, academic research has found that patients have felt that the medical community has denied that symptoms were caused by mesh. Some felt treated as if they were hysterical. Some report months—if not years—of trying to be heard. Studies from University College London show that healthcare staff routinely underestimate women’s pain and that not everyone who will have a complication from surgical mesh has started to have symptoms. That issue is on-going, and we have a chance to learn from previous mistakes.

Bias creates shame and taboo around women’s health. That makes it difficult for women to communicate their pain and the issues that they have. When they have finally found the words and the courage to talk about this, they have not been listened to. I seek assurance from the Government that it will tackle the bias that is present in the healthcare system so that we do not fail another wave of patients who are adversely affected by transvaginal mesh or any other healthcare issue.

We must also grant attention to prevention. Many do not know about stress urinary incontinence until they give birth. Open and frank conversations about the importance of pelvic floor strength are required. I am pleased to see that the Government has accepted the Health, Social Care and Sport Committee’s recommendation on that matter.

On-going monitoring of the success of the initiatives and changes that have been made accordingly will be vital. Reducing stigma is an important factor in prevention.

I thank those who shared evidence with us. There can be no doubt that we have failed those patients and that they, quite rightly, expect more.

16:41  

I start by paying tribute to the tireless campaigning of mesh-injured women. It is their campaigning that has been the driving force for much of the progress that we have seen on transvaginal mesh. The independent reviews, the creation of the complex mesh surgical service and the reimbursement scheme are all testament to their efforts.

That is one of the reasons why it is so disappointing that many of those women continue to experience so many problems in accessing the medical care that they need. Some have shared publicly their experience in dealing with GPs who still lack basic knowledge and understanding of the complications arising from transvaginal mesh implants. Others have spoken about the long referral times in order to access care and support at the complex mesh surgical service. Women who have been referred to the complex mesh surgical service have also described the lack of a full range of treatment and support options, and women who have had mesh surgically removed have spoken about the lack of aftercare support in relation to their mental health and the trauma that they have endured.

According to Professor Britton, whose initial report on the issue was published back in 2018, the Scottish Government has yet to act on her recommendations. That has been said a number of times in this debate. In her second report, which was published earlier this year, Professor Britton made a series of recommendations to improve the healthcare experience of mesh-injured women. Those recommendations include improving support mechanisms for women who wish to raise concerns with their GP following transvaginal mesh surgery, the creation of a mesh register to keep track of surgeries that have been carried out, and putting patient consent at the heart of healthcare. Labour urges the minister to come forward with recommendations and to deliver. We hope that she is able to give a commitment on that today.

My own office is still receiving new cases from mesh-injured women who are suffering complications and getting in touch. They are currently not getting adequate support from their GP, and they are unaware of the complex mesh surgical service. It is clear that the Scottish Government must do more to support those who are injured and that the issue continues to have an impact on too many lives even after a decade of campaigning by those affected.

The minister will be aware of the work that I have been doing with my constituents Roseanna Clarkin and Lauren McDougall on surgical mesh that is used to treat hernias. Informed consent has been discussed in the debate. Roseanna gave me permission to say that she was told that pig skin, and not the mesh that was used, would be used in her procedure. Such surgical mesh differs from transvaginal mesh, but many people are now suffering from similar complications and life-altering injuries to those that were observed in women who were implanted with transvaginal mesh.

Roseanna and Lauren have a petition before Parliament that calls for an independent review of the use of such mesh and for its use by NHS Scotland to be suspended pending the outcome of that review. I am grateful to the Citizen Participation and Public Petitions Committee for its on-going work on the petition. I know that many of that committee’s members were involved in the initial petitions on transvaginal mesh and recognise the parallels in the experiences of those who have been implanted with surgical mesh to treat hernias.

Despite years of campaigning, Roseanna and Lauren have found the Scottish Government unwilling to engage or failing to take their concerns seriously. The same disregard for the lived experiences of mesh-injured people delayed progress on addressing issues that related to transvaginal mesh. I fear that we are at risk of making the same mistake with surgical mesh that is used to treat hernias.

I therefore very much welcome the fact that the minister recently agreed to meet my constituents and me in the coming weeks to discuss the issue. The need for an urgent independent review could not be clearer, and I hope that the minister will give that further serious consideration.

I previously submitted freedom of information requests to every health board across Scotland in an attempt to establish the scale of the problem with surgical mesh that is used to treat hernias. Many health boards did not hold the requested information or did not respond, but the health boards that did provide information showed the scale of the problem. In NHS Ayrshire and Arran, 8 per cent of patients who were implanted with surgical mesh to treat hernias said that they had complications, and the figure in NHS Lanarkshire was 10 per cent.

Ms Clark, I ask you to conclude.

I very much look forward to hearing the minister’s response to my points.

16:48  

I am speaking in the debate because, as I have previously mentioned in the chamber, I have met several of my constituents who have suffered with the horrors of transvaginal mesh. I have also spoken with and supported women who have travelled outside Scotland to have the removal procedure carried out.

Unfortunately, that highlights the extent to which the relationship has broken down between some patients and NHS Scotland when it comes to the issue of transvaginal mesh. The thought of travelling to the US to have surgery while in excruciating pain clearly will not be pleasant, yet some of our constituents have felt that they had no choice but to do that. That is why I note that the Scottish Government’s motion

“acknowledges the severe and painful complications endured by women after the implantation of transvaginal mesh and regrets that their trauma may have been exacerbated by initial service responses that doubted their lived experiences”.

Some of the most harrowing conversations that I have had as an MSP over the past 16 and a half years have been with constituents who have suffered because of transvaginal mesh. How any of those women could have been doubted is beyond me. That said, I am sure that some will welcome the fact that the Scottish Government accepts that more could and should have been done to support women who are suffering from these terrible complications.

I also welcome the Scottish Government’s commitment to offer women for whom mesh removal is considered appropriate the services of a surgeon of their choice, and to allow women who have already paid privately for such surgery until 31 March 2024 to apply for reimbursement of the cost. As other members have commented, the paper-based process for getting the money back is sometimes lengthy. It is certainly not an easy process, but the fact that it exists is helping some women. Scotland is also the first country in the UK to reimburse women for private treatment that they had previously sought, which I genuinely believe is very much the right thing to do.

Hindsight is always a great thing. That said, we should always strive to ensure that we do not need to say the words “in hindsight”. Too many lives have been impacted, too many women are suffering through the use of transvaginal mesh, and too many families and friends have had to watch them suffer over the years.

Back in November 2019, the former First Minister and the former Cabinet Secretary for Health and Sport met women who had experienced complications following surgery for mesh implants. Following those meetings, the then First Minister confirmed that the women would be given an opportunity to raise their concerns, and she offered them a review of their case records. It then took until 12 February 2021 for the transvaginal mesh case record review to be introduced, which reported in June this year. I accept—I am sure that other members will, too—that the Covid pandemic had a part to play in the length of time that it took for that to happen. It should have happened sooner. Women across Scotland have continued to suffer, while others who might have had the removal surgery before now have been waiting for answers. I hope that the recommendations that were published earlier this year will go some way towards answering their questions. The fact that the Scottish Parliament is again debating the subject demonstrates that it is listening. We want to ensure that women get the treatment that they need to enable them to recover.

Stuart McMillan is right to say that this is not about hindsight. However, the reality is that acknowledging recommendations is not enough. Too many women are still in the dark, do not know what is happening and are suffering. The issue is not yet in the past. We need action now—not just acknowledgement of action points in a report, which seems to be all that we are getting. Does the member not recognise that?

I do not disagree at all. I have spoken in similar debates in the past. My comments in those are on the record, so if the member wishes to go and have a look at them, he certainly can do so. This is still very much an issue of today; it is not purely about the past.

I have met women who have recovered, so I know that removal surgery can help to give them their lives back. The contrast that I saw in some of them was stark as they compared the pain and suffering that they had had before the removal operation with what their lives are like now.

Jackson Carlaw rose—

Two wee seconds.

The contrast was stark. I welcome that change, but it does not take away the mental challenges that those women have had to endure for many years.

I would normally take Mr Carlaw’s intervention, but I am running out of time.

We should not lose sight of the fact that the work that has been done is welcome, but there is still a challenge for the NHS. More work is very much required, but I welcome the minister’s comments on the 21 recommendations. We cannot change the past, but we have an opportunity to right some wrongs and implement changes that will have a lasting, positive impact. The Scottish Parliament has consistently been told that its members should listen to clinicians, as they are the experts. That is the case for professionals in many disciplines and for many health debates, as we have heard over the years. I am glad that the women who suffer from transvaginal mesh issues did not listen to the clinicians but fought the system. I thank them for all their work on the issue, which they have consistently pushed to the fore. We all owe them a huge debt of gratitude.

16:54  

Like many others, I pay tribute to the incredible efforts of the mesh survivors in bringing this issue to light in order to secure justice. Their bravery and determination are an inspiration to us all.

I also want to mention the efforts of the MSPs who have raised the issue previously, including the “meshketeers”—Jackson Carlaw, Neil Findlay and Alex Neil. I know that all three have been champions of the issue for a long time.

The final report of the transvaginal mesh case record review carefully sets out what a long journey it has been for mesh survivors and how far we still have to go to restore justice fully. I want to focus on a few of the report’s findings and how they relate to transparency and the rebuilding of trust.

One such finding is that, in a number of cases, there was a lack of clarity in the case records. Some notes were misleading, while others

“did not bear any reflection to the surgery that had occurred, nor its outcomes.”

The report notes that, in some cases, misleading or missing information from case records led to a breakdown of trust between the patient and their clinician, as women felt that they could not trust what was in their records. That lack of trust fed into many wider areas within the NHS. One quote from the report stands out:

“I’ve lost a lot of trust in the NHS and that doesn’t just apply to mesh. It applies to everything”.

The health service is meant to care for us and to keep us safe and well. I cannot imagine the betrayal that some of the women must have felt.

Rebuilding trust will necessarily be a long process. The report makes a number of recommendations in that regard, such as organisations providing patients with an explanation of why certain information has been redacted and keeping a detailed set of medical notes of the dialogue between clinicians and patients. I would appreciate it if the minister could set out any work that is being done to provide that to patients.

Another important point that is made in the report is that we need to continue to listen to the women who are affected by mesh. It states:

“Having to exclude the lived experiences of the women from the practicalities of what could be evidenced in the case records, has made the Panel realise that the mechanics of a case record review cannot address the more nuanced parts of a lived experience ... Something more inclusive is required”.

It is essential that we continue to listen to and record people’s lived experiences in order to gain a comprehensive understanding of the impact of transvaginal mesh. The case record review provides us with valuable evidence about what went wrong and where improvements can be made, but it cannot capture the pain, anguish and frustration that many mesh survivors have felt. We need to support them to tell their stories, not only so that we can learn from them but because they deserve to be heard.

Many of the personal testimonies that are included in the report were heartbreaking to read. Women described feelings of awkwardness, shame and embarrassment, as well as a loss of autonomy and self-worth. Many cited social isolation as a result of mesh complications, and that isolation will inevitably have been worsened by the Covid-19 pandemic. Some find themselves having to plan going out around when and how they can access a toilet, or having to explain to friends and family members that they are unable to sit for long periods of time.

Those involved in the review spoke to women who are now being advised by clinicians that nothing more can be done for them surgically, which might result in additional trauma. The report illustrates the importance of providing mesh survivors with wraparound support that addresses their emotional needs as well as their physical needs. In the Health, Social Care and Sport Committee and in the chamber previously, I have spoken about the need for on-going mental health support for mesh survivors. They need targeted, specific counselling that takes account of the trauma that they have experienced.

We also need to ensure that people are properly supported to engage with information gathering. Those involved in the review heard from women who described their fatigue at continually having to tell their stories. One woman said:

“Wherever you turn you just don’t feel heard. You really don’t. It’s like here’s another survey or here’s another whatever, you know? The wee bit of energy you’ve got you are trying to fight to help”.

People need to know that action is being taken as a result of their sharing their story. The worst thing that we could do is cause people to disengage with the process. It has been such a long road for them, and they have had to fight every step of the way.

The report identifies several steps in the patient journey where improvements can be made. One example relates to the referral process. The report characterises the operation of the referral system as “confusing”, with the need for

“further explanation so that it is clear where the responsibility for patient care may lie at any given point and what might be expected from their care journey.”

I will end by once again paying tribute to mesh survivors. As the motion states, there is

“continuing improvement in support, informed by the views of affected women”.

We are taking significant steps towards righting a terrible wrong. The report highlights the importance of centring lived experience as we continue on this journey.

17:00  

Like many, if not all, members, I have heard from constituents over the years whose lives were devastated as a result of mesh implants. As we know, mesh was implanted in patients to support weakened or damaged tissue, and was used to treat conditions that some women suffer after childbirth, such as incontinence and prolapse. Over 20 years, more than 100,000 women across the UK, including more than 20,000 in Scotland, had transvaginal mesh implants. However, in 2018, the use of mesh was halted in Scotland, after hundreds of women were left with painful and life-changing side effects.

The physical symptoms and trauma that some women have endured are unimaginable and unacceptable. The situation was often made worse because they felt that their experiences were not taken seriously when they sought help. I have constituents who travelled to the USA and paid privately to be treated because they had, understandably, lost trust in those who would treat them here in Scotland.

One of my constituents sought help from Dr Veronikis in the period between the Scottish Government procuring an NHS referral route to private removal surgery and the Transvaginal Mesh Removal (Cost Reimbursement) (Scotland) Act 2022 coming into force. Initially, she would have missed out on being reimbursed, due to the cut-off date for reimbursement. I am sincerely grateful to the then health secretary—the current First Minister—for accepting an amendment at stage 2 of the Transvaginal Mesh Removal (Cost Reimbursement) (Scotland) Bill process to adjust the date to ensure that my constituent and many other affected women would benefit from that support. Rightly, the Scottish Government listened to the women impacted and ensured that no one was penalised for using their own funds to seek mesh removal surgery privately.

People turn to our NHS at times of need and expect our health service to do what it can to alleviate their health problems. Sadly, for too many women, the medical procedures only exacerbated the pain and suffering that they felt. The complications of transvaginal mesh surgery can have long-lasting effects, even after the mesh has been fully or partially removed, all of which contributed to a breakdown in trust for many.

I know that the Scottish Government is working hard, as is our health service, to rebuild that trust. The Scottish Government has taken decisive action on mesh and has already taken many steps that address a number of Professor Britton’s findings in the transvaginal mesh case record review. Scotland is also the first country in the UK to reimburse people for private treatment previously sought. Rightly, the Scottish Government has agreed with the principle that women should be supported and empowered to make decisions about their treatment.

A range of other measures are being undertaken to improve the services for people with complications arising from a result of mesh surgery, whether that is through the reimbursement of costs that I mentioned, the procurement of private providers in Bristol and Missouri or the specialist service in Scotland. It is that latter service that I want to speak about, particularly through the lens of the work of the Health, Social Care and Sport Committee. Members will be aware that, throughout this year, the committee has been taking evidence on the complex mesh surgical service, and that is on top of the previous scrutiny of the cost reimbursement bill, which took place before I became committee convener.

The committee’s primary purpose in carrying out its scrutiny of the CMSS has been to highlight the issues that have been raised through the consultation process to those who are responsible for delivering the service, and to explore what is being done and what further can be done to improve the service so that it properly meets the needs of its patients. As convener, I have written a number of times to the Minister for Public Health and Women’s Health to share concerns that have been raised with the committee in evidence. Those include concerns about the referral pathways, which other contributors have mentioned this afternoon, waiting times for CMSS, perceived inconsistent information being provided and the need, among other things, for an integrated system that provides holistic support to women.

In the minister’s most recent response, she acknowledged that there is scope for further improvement in the service. I know that the Scottish Government wants to ensure that the satisfaction levels of women attending the NHS specialist service in Glasgow continue to grow and that waiting times fall.

I also note the minister’s comments on the progress that is being made regarding a training pathway for mesh removal credentials as well as the recruitment of a specialist consultant to work with the core urogynaecology team in the Queen Elizabeth university hospital campus. Additionally, I welcome the action by the chief medical officer, who has written to all GPs to raise awareness of the referral pathway and to encourage them to access a mesh learning package that has been made available on NHS Scotland’s online learning service.

Those actions will continue to improve the support that is on offer to the women who are impacted. I know that all members are united in our determination that everything be done to help those whose lives have been impacted by mesh complications, whether women opt into or out of surgery.

It is only the courage of the women affected that has brought us to this point. Of course, it should not have taken their retelling of their experiences for them to be listened to. As the First Minister has recognised, they were badly let down by the initial service responses that doubted their lived experiences. We owe it to all the women affected and their families to continue listening to their concerns and acting on them.

17:06  

I have raised questions about vaginal mesh in the chamber before and have written articles in support of the women affected, and I welcome the chance to speak in the debate. Like many of my fellow MSPs across the chamber, I have constituents who have come to me regarding their post-operative experience of transvaginal mesh surgery and of the circus of on-going referral that continues to this day as they seek help.

I know that there are countless women who had the procedure and benefited greatly from it, with their pelvic organ prolapses being cured or their stress urinary incontinence reversed. However, we cannot ignore the voices of the women who have experienced life-changing complications from the procedure and continue to struggle as a result.

When I look at the motion that the Scottish Government has presented to us, I feel a sense of disappointment and perhaps even a shared sense of bewilderment with the women. The motion appears not to recognise that many women are still unable to access the treatment for which they are desperate.

Whether that treatment be in Glasgow, Missouri or Bristol, many women no longer trust the services that are provided by NHS Greater Glasgow and Clyde, albeit at the new ambulatory care hospital in south Glasgow. In fact, at the Health, Social Care and Sport Committee in April, 75 women came to share their experiences of the complex mesh surgical service. Women with long-term negative experiences felt that, rightly or wrongly, those views coloured their views of the current west of Scotland services. In fact, things were so bad that it was said that

“trust in the many medical professionals they have encountered”

was

“all but completely depleted”.

A constituent of mine told me that she has been in constant pain since her operation 17 years ago. The plan that the Scottish Government unveiled in July 2020 gave her hope, but she is living proof that the promise has not been fully honoured. She said:

“I find it impossible to trust the NHS to care for me with mesh issues. A life with mesh is a painful, humiliating, and soul-destroying existence and has already destroyed so much of our lives.”

Today’s Scottish Government motion makes no reference to that continuing pain. That is deeply concerning. We hear time and again that the Scottish Government is listening to the women’s views, but I am afraid that the actions taken do not appear to reflect that. The women deserved to get free specialist treatment after many of them were rebuffed by their health authorities.

Our Conservative Party amendment reflects the unnecessarily complex referral pathway that women must endure and the lengthy waits as they ping between services. Evelyn Tweed commented on how the women were moved from pillar to post. As of April 2023, the median wait for referral to the complex mesh surgical service in Glasgow was 236 days and the longest wait was 448 days. Women then need to wait a significant length of time to start treatment that might alleviate or even remove their symptoms. However, I ask members to remember that that does not even include the time that it takes to get an appointment with their health board first.

Our amendment also acknowledges that, to date, there is no clear pathway for women to be referred to an independent external service, whether that be in England or Missouri, should they not want to go to Glasgow. In 2019, First Minister Nicola Sturgeon promised that she was absolutely committed and determined to do everything possible to get those women the treatment and care that they needed. However, when he was Cabinet Secretary for Health and Social Care, Humza Yousaf agreed to the principle that the treatment that those women desperately need can be accessed only after approval from the same authorities that were obstructive in the first place.

Neither I nor the women who have contacted me over the years believe that the Scottish Government has done enough to engage with mesh survivors or to help with their heartbreaking plight. The victims must receive the treatment that Mr Yousaf now says that they are entitled to receive for free. Unfortunately, I am not certain that the commercial terms for those external referrals have been arranged on a long-term basis.

The Scottish Conservatives supported the Transvaginal Mesh Removal (Cost Reimbursement) (Scotland) Bill, and we have been supportive since the issue was raised in the Scottish Parliament by public petition. However, the Scottish National Party Government must do more to ensure that women who are affected by mesh can access the services that they need.

17:11  

When we have discussed transvaginal mesh in previous debates, I have started by paying tribute to fellow MSPs who have campaigned on the issue. However, I do not think that I can do that this afternoon, because it has been nine years since the petition first came before the Public Petitions Committee. That means nine years of debates in the Parliament, nine years of people expressing concern and bewilderment about the pain that women have had to endure, and nine years of failure to act. I do not think that I can pay tribute to that. In fact, all that I can do is apologise to those brave women who have campaigned so hard, because, frankly, as I stand here today, I wonder just how much progress we have really made.

Today, we have had an acknowledgement of what women have had to endure. We have outlined initiatives that might take place and funds that might be available if the women qualified and they applied in time, and we have heard that training and a register might be in place. However, the reality is that, as the most recent report said, not one of the 2017 report’s 46 recommendations has been implemented.

Notwithstanding the facts and whether those reports have been adhered to, for too many women, the reality is that their simple questions are not being answered. Those women rightly have simple questions about what is happening to them. When is it going to get better for them? When will they receive treatment? How can they get information? Speaker after speaker has said that we do not have answers for them, or if there are answers, they are incredibly difficult to get, and that is not good enough. We can talk about policy and reports, but the simple reality is that, for nine years, we have been discussing an issue of individual women’s pain and suffering over many years.

I came to the issue through one of my constituents, Samantha Hindle, who has endured 18 years of pain. I have written time and time again to the Government and the health board in an attempt to get her some updates and information about what is happening. Let me outline what has happened after 18 years. Samantha Hindle first approached me in 2019, after she had exhausted every other avenue. I wrote and wrote and we finally got a referral in July 2022, which, I note, was a month after the closure of the fund for reimbursing people if they had already received private treatment.

We then followed up on when an appointment might be received. I wrote twice in December and, in February, we finally got a letter from the health board saying that my constituent had received her treatment. On 23 January, she had apparently had the mesh successfully removed, except that that was news to my constituent. No such appointment had taken place and no such procedure had been carried out. What is more, and what makes it worse, is that she then got an appointment for an ultrasound, which was apparently to locate the mesh and see whether it had been removed.

When she showed up for the appointment, she found out that the ultrasound was not to identify where the mesh was but to investigate her ovarian cysts. Those were cysts that she did not know were suspected and which—guess what?—were never found. Given that we are talking about a person who presented with mesh problems after her MSP had written time and again to the Government and the health board, yet the health board could not even get those basic facts right, what progress have we made?

After that saga, I wrote to the First Minister to say that, on a human level, putting aside policy and commitments, the situation was surely not right. I appealed for an acknowledgement that, on a basic human level, leaving people in the dark without answers was just not right. Unfortunately—this is no reflection on the minister—my letter was handed to the minister and the First Minister did not even reply.

What did we get? We got a list of those self-same initiatives—in other words, that a letter had been written so that NHS Greater Glasgow and Clyde would make contact; that work would be undertaken; that training would be in place; that there was a fund, although it was now closed, so my constituent could not apply for it; and, above all else, that there was the prospect of “waiting well”. I have to say that the phrase “waiting well” rings a little hollow for my constituent Samantha Hindle, because the reality is that, after nine years, she still does not know when she will get an appointment, when her situation will get better or what treatment she can get. Until we get such answers for her and the hundreds of women like her, we will continue to fail women who have been implanted with mesh.

17:16  

I welcome the opportunity to speak in this important debate. As always, I extend my gratitude to the campaigners, medical professionals, researchers and constituents whose invaluable efforts continue to put the important issue of transvaginal mesh implants on the agenda.

Once deemed a medical solution, transvaginal mesh implants have now become a source of debilitating complications for many people across Scotland. As we are aware from the numerous occasions on which the issue has been debated in the chamber, the complications arising from implants are not merely physical but extend to psychological distress, too.

We have made significant progress in recent years, which we can confidently attribute to the joint efforts of campaigners and individuals who have been massively affected by the issue. I am absolutely certain that future generations will benefit from better healthcare thanks to their incredible work.

I acknowledge the work that the Scottish Government has undertaken to mitigate the suffering of the affected patients. Many of our constituents have suffered life-changing complications related to mesh implants, so I support the Scottish Government’s decision to establish a fund that will support those with mesh complications, providing a semblance of relief to patients and their families. I am proud that Scotland is the first UK country to reimburse people for private treatment that was previously sought. That is a reflection of our commitment to providing holistic care and financial support to those who are in need.

Despite those significant achievements, there is more to be done, which brings me to the main focus of the motion: the transvaginal mesh case record review. The review has been a massive and impressive undertaking by Professor Alison Britton of Glasgow Caledonian University, and I commend the 18 women who came forward to have their case records reviewed as part of it. The review is a significant initiative commissioned by the Scottish Government to address the profound concerns that women have raised. Their experiences will be integral in informing the future of mesh procedures. We must take this important opportunity to learn from their experiences.

As a member of the Health, Social Care and Sport Committee and the Citizen Participation and Public Petitions Committee, I have had the privilege of hearing invaluable evidence from medical advisers, NHS experts, campaign groups and, most importantly, patients. The recommendations in Professor Britton’s review are very much consistent with the evidence that the health committee has taken over the years. The committee evidence sessions have helped us to ensure that patients’ voices are heard, amplified and carefully considered. I thank each and every one of our witnesses for their influential contributions.

The discourse surrounding transvaginal mesh has brought to the fore the importance of ensuring that medical interventions are not only safe and effective but transparently documented and communicated to patients. The unanimous backing of the Patient Safety Commissioner for Scotland Bill earlier this year exemplifies Scotland’s commitment to amplifying the voice of patients, including those who are impacted by mesh implant complications, and will drive safety improvements across our health service. Insights from the review are a testament to the collective endeavour of addressing the concerns of affected individuals and improving the standards of patient care.

I am grateful to the member for taking an intervention. We have debated the Cumberlege report before, which proposed a redress scheme. Can the member shed any light on why that has not happened, and would he support it being implemented quickly?

I think that Jackie Baillie knows my view on that—I would be very supportive of it. Members know how many times I have debated this subject in the chamber. I think that Jackson Carlaw and I are the only two remaining members of the public petitions committee that originally considered this issue, which shows how many times I have taken part in debates on it.

Although the country has made progress, we must continue to scrutinise the complex mesh service and the many issues surrounding the procedure. Our healthcare system must be equipped with the necessary resources and trained personnel to provide both physical and psychological support to affected patients. The establishment of specialist clinics for post-mesh surgery care, psychological counselling and community support groups are vital steps toward addressing the multifaceted needs of those who are affected.

Furthermore, robust monitoring and regulation of medical devices, alongside comprehensive informed consent processes, are imperative to prevent future complications. I am confident that the Scottish Government will continue to work closely with stakeholders and experts to ensure that patients can access the care that they need and are fully supported by their GP and other clinicians.

Scotland can also learn from our international partners in Australia and New Zealand, where groundbreaking research found that there was a significant lack of available data regarding the exact number of women who received a transvaginal mesh implant and how many also experienced complications. In 2017, Western Australia established a confidential free telephone line as well as a mesh register to aid with data capture, which has been found to be informative. Professor Britton’s review recognises that a lack of reliable data is also an issue in Scotland, and I very much support its recommendations to address that.

Scotland can also learn from New Zealand’s restorative justice approach to mesh implants, which is centred on patient involvement and focused on enabling women to share their experiences in a safe environment.

It is reassuring to know that the Scottish Government has already taken a number of steps to address the recommendations in Professor Britton’s report. Those include making a mesh learning package available to GPs to offer additional support and help them understand and address concerns that women might raise with them following mesh surgery. The Scottish Government is also taking steps to improve the information that is available to patients through online information and patient information leaflets. It is crucial that women have the information that they need to make informed decisions about their care.

Safety lies at the heart of delivering our health services, and it is essential for the Scottish Government to act on the recommendations and continue to be a clear and strong voice for patients.

The transvaginal mesh case record review is a mirror reflecting both our achievements and the areas that necessitate improvement in the healthcare domain. As we move forward, let us take the insights garnered from this review to heart, working collaboratively to foster a healthcare environment that is safe, transparent and supportive of every individual’s healthcare journey. I look forward to achieving even more progress under the guidance of Professor Britton’s review.

We move to closing speeches.

17:23  

My colleague the member for Edinburgh Southern hit the nail on the head: for nine years—the best part of a decade—we have condemned our fellow Scots to suffering and pain. That should be a mark of shame on our country.

I acknowledge the apologies that have come from those on benches across the chamber, but it is simply not good enough that the Government has failed to respond in the way that it has. Indeed, the latest insult is the letter from the minister to the Health, Social Care and Sport Committee. I am afraid that it is not good enough, as it fails to acknowledge the severity of the trauma that is faced by the women who are affected.

Listening to my own constituents and many others at the petitions committee during the past number of years has, in many cases, been harrowing. For them to simply be talked down to in the form of being given advice about waiting well or for them to be informed that a leaflet will be published in due course does not acknowledge the sheer agony—not just physical but psychological—and torment that they have endured over the years.

The Parliament has been a champion for those voices in many different ways, but it simply has not moved quickly enough to push the Government to put in place the necessary measures to address the scale of the challenge faced by people in this country.

The minister acknowledged in her letter that 135 women have been treated so far. There are more than 800 women in the Scottish Mesh Survivors group. The national health service has had no formal engagement with that group, but it ensures that membership of the group is noted in a patient’s records, which surely shows that that is significant.

What are we doing to engage formally with those women and to understand what can be done about pathways to treatment? It is just not good enough to say that health boards are carrying out consultations, because the answers are already obvious. It is not sufficient to tick a box and to say that the pathways meet the guidelines set out by the National Institute for Health and Care Excellence; they must be far more robust, customer focused and patient focused. They must address the reality of the complexities faced by women who may be deeply distrustful of the medical establishment that has gaslighted them for so long and of surgeons who have continued to stand by the treatments and mesh that they have used and who do not accept that they should be concerned about what has happened.

That is the reality faced by women in Scotland today. The whole system has failed them and medical fashion has trumped their rights. That is a devastating realisation—it is devastating that it has taken so long to realise it.

Does the member agree that we are seeing a failure of implementation and that what women want, need and deserve is a very simple process for getting help?

I could not agree more with the member’s point. He is absolutely correct.

The establishment of the service in Glasgow is to be commended, but it is agonisingly frustrating that it is not achieving outcomes at pace. I acknowledge that it was established during the pandemic, but now, three years on from its establishment, we are not seeing the necessary pace of change. I said that there are 800 women in the mesh survivors group, but there are probably at least another 800 out there who do not have such access or membership. The scale of the problem is huge and the treatment rate is not sufficient.

The follow-up rate is also not sufficient. We already know that further complexities have arisen after surgery to repair mesh implants. Those women have not been sufficiently followed up and their on-going psychological trauma is not being addressed.

As the minister’s letter acknowledged, another issue is that no specialist consultant has yet been recruited to the mesh service. It is not good enough to say that the service is co-located on the Queen Elizabeth university hospital campus; a dedicated consultant should be in post and there should be a dedicated helpline for patients, not just a leaflet.

We need clear pathways. We know that the dissemination of advice to GPs is patchy at best and that many GPs are simply so burnt out and hard pressed that they do not have time to do the continuous professional development courses that would give them the latest advice and options available. They are overwhelmed: we get that feedback loud and clear almost weekly from GPs in our constituencies.

I encourage the minister to take on the chin the powerful comments that have been made by members from across the chamber, to note them with the necessary modesty, showing real contrition for this Government’s failure to meet the needs of our fellow Scots and, in her closing remarks, to say clearly what she will do to address those comments.

I also encourage her to take particular note of the transvaginal mesh case record review. There are 46 recommendations in the 2017 report. The minister should clearly inform parliamentarians and our constituents what the Government is doing to meet each of those recommendations.

There is a further series of recommendations in the 2023 report, which was published in June and highlighted additional support mechanisms that could be put in place to aid GPs and practice teams in gaining understanding of how to address the concerns that women might raise with them following transvaginal mesh surgery. What is being done to ensure that that is happening? It is not enough to passively send out letters.

We could have a mesh register. The minister says that it is too onerous for health boards to do that; I say that that is nonsense. Those women’s pain is too onerous and it is time that the Government stood up and recognised that.

We need a clear understanding of the language used to communicate with people.

Please conclude, Mr Sweeney.

The biggest communication problem throughout all of this has been the illusion that communication ever happened. I urge the minister to address the Government’s huge inadequacy in dealing with this critical issue.

17:29  

I thank all those who have contributed to this afternoon’s debate. There have been some season ticket holders, I think, to our discussions on the issue over many years, and I am very grateful to them for having stuck with it. They include Jackie Baillie; Rona Mackay; Katy Clark; Gillian Mackay, who engaged with quite a bit of what the report actually has to say; David Torrance, who was there right back in the initial days when this was all discussed; Clare Haughey; Sue Webber; and Daniel Johnson.

Daniel Johnson said that we have made no progress, which is slightly ungenerous. I do not blame the Scottish Government for the mesh crisis. It happened in Australia, in America, in New Zealand and in England. It happened all across the world. The question is how we responded to it and whether we have matched our expectation and the promise that we gave the women in the response that we have managed to offer to date. That is where some of the shortcomings are. However, let us acknowledge that it was this Government—with Jeane Freeman and then Humza Yousaf—that passed legislation that saw the first scheme to reimburse women who had incurred costs by going internationally to have mesh removed and who were able to do that.

I do not intend to repeat all the speeches that I have made on the subject, but it seems to me that, at times, we have taken two steps forward and one step back. I hope that none of the members in the chamber who have been on this journey—and I urge the Government not to do this—will become defensive and feel that they now have to defend the medical establishment.

Will the member take an intervention?

I ask Mr Johnson to let me make a little more progress.

Some may remember that, just before the summer recess, I asked the First Minister whether he would agree to hold a debate on the Government’s response to the findings and whether he would comment on Professor Britton’s assertion that the 46 recommendations in her 2018 report had not been implemented. The First Minister said to me in a written reply:

“The recommendations have already been reflected in a number of inquiries and reviews established in recent years since the report was published.”

However, what does that mean? Paul Sweeney asked at the end of his speech whether there could be a grid showing progress on the 46 recommendations that were made—something that we could interrogate transparently to see what has happened to them.

The 46 recommendations have now been followed up with 21 more in Professor Britton’s latest report, and the chief medical officer’s response is remarkable in relation to one of them. I think that the minister has included the point in her motion. The chief medical officer said:

“Health Board Mesh Accountable Officers have discussed Professor Britton’s findings and have reported to Scottish Government officials that there are measures in place within the Complex Mesh Surgical Service ... in Glasgow and, more widely, in Health Boards, to prevent a recurrence of the failings identified in the Review. I am grateful to have received those assurances.”

It would be interesting to know what the assurances are. What are the procedures that are going to be implemented across health boards that will ensure that this does not happen again?

I have never been a Government minister—people will say, “Thank God for that”—and I am never going to be one, but it seems to me that part of the problem that we have had in relation to the whole mesh crisis is that we love and value our national health service and we are reluctant to interrogate it when things go wrong. It seems to me that there have been three parts to this: Government ministers have been advised by civil servants, and they have been advised by the clinicians. Only very lately did the patients have any look-in on any of this. They were told that they were talking nonsense, that they were psychologically disturbed, that they were not suffering any pain whatsoever and—worse than that—that they had had their mesh removed when centimetres of it were still within them.

I fear that the clinicians who were responsible for all this are now the clinicians who we have put in charge of remedying it. The people who put the mesh into the women are the same people at the centre who are now responsible and are reassuring them that they can take it out. In a different context, it would be like asking women to go and see Professor Eljamel to have the mistakes that were made with their brain surgery rectified by him. That is how the women feel. They have lost all confidence. They therefore wanted to go and see Dr Veronikis. A number of them have done so, thanks to the legislation, but they have come back and found that the NHS has disowned them and that there is no post-operative treatment or follow-up for any of the surgery that they had while they were in the United States. That is just not good enough.

Stuart McMillan said that he has spoken to many of the women and they have got their lives back. Some have, but what does he mean by “got their lives back”? For some of them, it is just about the knowledge that the mesh has been removed from their system, but others lost their homes, their husbands, their families, their jobs or their lives. Even if they do not have the mesh within them, they are going to need on-going care for the rest of their lives.

That is why, in the Cumberlege report, there is a redress scheme, which Jackie Baillie and others have referred to. The question is, why are we not embracing a redress scheme to ensure that those women can have confidence in their future as we go forward from here?

We have an awful lot yet to do. I will not extend but will cut myself short for once. Do members remember that ghastly moment when George Bush sat on an aircraft carrier underneath a big banner that said, “MISSION ACCOMPLISHED”? There is just a whiff of that from the whole NHS and from civil servants, encouraging ministers to think that we have moved on.

Earlier, I said that I was disappointed that the health secretary was not here. It is as if the issue has slipped down the agenda somewhat and is just not going to have the same urgency and attention as we go forward.

Here is what one woman said to me:

“Jackson, please do everything in your power to ensure the knowledge and information gathered over two years by Professor Britton in particular does not go to waste. Personally participating in this review was the best thing I have done. It was difficult reliving things but I was vindicated and believed. But don’t let go. Don’t give up.”

I can only say to her and to all the other women that, in the time that is left to me in the Parliament, I will not let go. I hope that the minister—who, everybody acknowledges, is sincere and is doing her best—understands that they simply do not think that we have yet gone far enough towards a point at which, in future, women can have confidence that the health service works for them.

17:36  

I am grateful to all the members who have taken part in the debate. I will try to address all the points that they raised, but if I miss some out, I commit to responding in writing.

What has been incredibly powerful about this afternoon is that members across the parties have reflected the pain and continuing trauma of women who have been affected so severely by mesh complications.

Paul Sweeney made very powerful comments, with which I agree. To Jackson Carlaw, I say that, through the reading that I have done in preparing for the debate, I am very aware that it is not just Scotland that this has impacted.

I recognise that we have further to go. However, to comment on what Stuart McMillan and Daniel Johnson said, it is still a today issue, which is why we have created the CMSS in Glasgow as a national service; we are giving women the choice of surgeon; and we are improving aftercare and information. I am not saying that we have done everything that we can do, but we recognise that women have been traumatised and have lost trust, and we are working as hard as we can.

I am sorry that I am not the cabinet secretary. I am the Minister for Public Health and Women’s Health, so the issue ticks two boxes for me. That is how important it is in my roles and responsibilities. It is high on my list. I have also met women in my constituency.

For clarity’s sake, perhaps I overemphasised the lack of progress but, to reflect on what the minister has just said, although we have the centre in Glasgow, do we not need to make sure, most importantly, that women who are referred have clarity and information about where they sit in the treatment process, starting from the point of initial referral and, if there is a second referral, what the status of that is and when they are likely to be treated? That lack of information and clarity is one of the biggest fundamental barriers that women still face in the daily hardship and pain that are caused by mesh.

I thank Daniel Johnson for that further comment. I recognise what he has just said, and I am taking note of it. My officials at the back of the chamber will also have taken note, and the service will be watching the debate as well.

Decision making between clinicians and patients should be about shared understanding of benefits, risks and alternatives. For some years, that ethos has been the focus of the new chief medical officer’s realistic medicine initiative. That work between the Government, NHS professionals and the public is helping to consolidate a changed culture that has informed consent at its core. However, the review’s report underlines that our focus and ambition has to be sustained, and both the CMO and I accept that responsibility.

As I have just highlighted, a number of members drew attention to the services that are now available to women. Members expressed vocally and quite loudly their frustration about waiting times for a first appointment in the Glasgow service, which can remain too long. That concern is fully appreciated by me and NHS Greater Glasgow and Clyde. I regret that patients are experiencing delays in the mesh removal service in Glasgow. As I said, waiting times for first appointments are too long. The service is increasing out-patient capacity, including by employing an additional translabial scanner, which will allow more patients to be seen.

Will the member take an intervention?

I actually have a wee bit to get through—I probably will not get through it all anyway.

Waiting times from decision to treatment to surgery are now generally in line with the 12-week treatment time guarantee, but we will continue to work with NHS National Services Scotland and NHS Greater Glasgow and Clyde to bring those waiting times down.

I should point out, because it is important, that the service in Glasgow is looked on across the UK as a model of clinical expertise and service development. Since its inception, it has sought out patient views and made positive improvements to its service based on feedback received, and it remains committed to further improvement.

Does that mean that it will urgently consider a follow-up aftercare service?

That leads me on to patients who have had removal surgery carried out by independent providers, who receive two follow-up telephone or video calls from their surgeon or specialist nurse after their operation. Any further aftercare will be provided by the patient’s local health board. That is a normal process for surgery aftercare, and it means that the patient is treated as close to home as possible. I can see that Jackie Baillie is shaking her head, so I will go back and speak to my officials about that.

Points were made about the Scottish pelvic floor register, which will allow clinicians to record details of pelvic floor procedures that are undertaken on individual patients. In time, that could allow for product recall in the event of a safety concern and comparisons of outcomes associated with different types of procedure. It is clear that better data collection is important for the NHS and for patients. Better data allows for comparisons of outcomes, more efficient recall of trends and many other benefits.

Jackie Baillie made points about redress, and others have commented on the mesh fund, the reimbursement fund and options for surgery outside the NHS. In her review, Baroness Cumberlege talked about a redress system. The Scottish Government accepted the recommendations of Baroness Cumberlege that were within the scope of Scottish powers. We also committed to supporting and working with the UK Government and others, including the redress agency. However, the UK Government did not accept the recommendation regarding a redress agency. I am aware of that process.

Members also talked a bit about the accountability of clinicians. Clinicians are subject to independent regulation, including through the GMC. The Government has had no sight, as I have said before, of any records involved in the review, but it is aware that the panel did not refer any individual to professional regulatory bodies. That was a matter for the panel’s professional judgment, which the Government of course respects.

There was discussion about the number of ways in which the Scottish Government has sought to assist women affected by mesh. I want to confirm two further actions. First, I can confirm that the NHS contracts that are in place with independent sector providers of mesh removal surgery have been extended for a further year into 2024—I know that in earlier debates there was concern that the agreements that allow for those contracts might expire. Moreover, the Government plans to offer further contract extensions after 2024, while there remain women to be seen by the Glasgow service who wish to exercise their choice to have mesh removed by other surgeons.

Secondly, my officials will shortly lay a new mesh reimbursement scheme under the 2022 act. That new scheme will extend the closing date for new applications from the original closing date of 6 December 2023 to 31 March 2024. Members will recall that the mesh reimbursement scheme was put in place to reimburse the small number of women who had entered into arrangements to pay privately for mesh removal surgery before the independent provider contracts were in place.

Let me end by repeating my thanks to all members who contributed to today’s debate. I know that the Government and the Parliament will not lose sight of the work that must continue to be done to offer respectful and dignified care to those courageous women who have suffered such enduring harm. I am committed to maintaining all the Government’s efforts to that end, and I hope that I will continue to have the Parliament’s support in that.

That concludes the debate on transvaginal mesh.