Chamber and committees

Do I have time in hand, Presiding Officer?

I thank the Conservative spokesperson for that clarification. Suspension in this instance is about addressing real harms that have been experienced, and that should be considered. The Conservative shadow minister makes a point about evidence gathering, and he described the low rate of defects and low requirement for repairs, but how can the evidence be valid or reliable when so many women are denied agency in the healthcare system? That is the issue that the petition seeks to address.

We have a kind of circular logic here. We are short-circuiting the issue and we are not addressing the reality of the evidence and picking up on the lived experience of the individuals involved. That is the issue for which the committee is seeking to provide a remedy. I hope that the Conservative shadow minister and the cabinet secretary might consider that, although there is a need to gather more evidence, those witnesses’ voices have not been heard thus far, which is simply not acceptable. What are the Parliament and the Government going to do to address that?

Canada provides a stand-out example of what can be done with national specialist centres for surgical repair for mesh and fixation devices, and survivors have expressed their desire for that to be delivered in Scotland. The Shouldice hospital is specifically devoted to hernia repair and holds the largest single database of hernia patients in the world. Each surgeon performs 600 to 700 hernia surgeries per year. The Shouldice repair technique has the lowest rate of recurrence, as Mr Carlaw described. Although in the short term we should enhance services that already exist in Scotland to better treat and remove mesh, the long-term goal should be to establish a similar national specialist treatment centre where survivors can access the support and treatment that they need from specialist medical professionals.

The issue of the structure of the specialist surgical centre was a key aspect of the evidence from Canada. Would the minister consider replicating that in Scotland?

I am grateful for the opportunity to speak in this afternoon’s debate on the suspension of the use of surgical mesh, both as a member who is representing survivors of mesh repair and as a member of the Citizen Participation and Public Petitions Committee. That committee and its predecessor committee have considered this extremely important matter in various forms over 10 years. The member for Eastwood has ably convened discussions about the petition in the current committee with great diligence, and with great sympathy for and empathy with those who have been affected.

Dealing with the petition has shown Parliament at its best. As a new member to this institution, I have been impressed to see how accessible and effective it is at addressing serious concerns of marginalised groups in society and I commend the committee for its work.

Like Katy Clark, I extend my gratitude to Roseanna Clarkin and Lauren McDougall in particular for their tireless work in keeping the issue on the parliamentary agenda by sharing their harrowing experiences of mesh repair, as Mr Carlaw described in stark detail earlier, with parliamentarians and the public alike. Constantly reliving and sharing that trauma is not easy. It is not easy to listen to and it must be even harder to talk about. I commend their courage in sharing their stories to the committee and for serving the public interest so well. I hope that the cabinet secretary has heard those remarks today and that he will consider the reasonable request that he meet the women so that they can describe that to him in detail and can seek redress not merely through the committee but through the machinery of Government

Transvaginal mesh is an issue that has been raised in Parliament on a number of occasions, but this petition focuses on the use of surgical mesh and fixation devices elsewhere in the body—that is a crucial distinction—particularly in relation to hernia repair, which has continued to cause pain and discomfort for survivors.

The petitioners have rightly raised the complex problems that mesh can cause, including infection, pain and adhesion. A lack of specialist services for survivors to explore treatment and removal is an issue that we have seen with transvaginal mesh and, unfortunately, the lack of treatment options is a key issue for survivors of hernia mesh repair, too.

Mesh specialists are scattered throughout Scotland, but their number is scarcely enough and many survivors’ referrals to those professionals are rejected, especially if their mesh repair was used for hernia treatment and was not transvaginal.

Medical professionals are trying their best to be of support to mesh survivors, but the simple reality that we have heard in evidence to the committee is that there is not a clear pathway for referral and treatment for their patients who are left feeling alone, isolated and reliant on emotional support from other survivors and their families in the absence of specialist medical treatment.

It is not sustainable or acceptable to deprive mesh hernia repair survivors of options to treat or remove mesh, forcing them to live in chronic pain. Therefore, I am dismayed that the Conservative spokesperson for health and social care said that his party will oppose the petition today. That is deeply harmful to those people, most of whom are women, who have said that they have suffered acute pain.

Will the minister accept an intervention?

I thank the member for that reasonable intervention. We heard that point in evidence, and it is certainly an important clarification that is, for sure, useful to have on the record. Those are important caveats but, nonetheless, it was explicit and clearly expressed in evidence that having that concentration of medical professionalism and skill is critical to achieving low recurrence rates and that doing high volumes in a focused national centre is absolutely important.

The Conservative shadow minister mentioned the need for evidence. Let us look at the structure of the medical service provision and the treatment pathways. We heard compelling evidence about that concentration in a national centre.

As the Labour shadow minister in this area has said, and as has been put to the committee—indeed, as a minister has put to the committee—it is important that that model is supported, and we should consider delivering it. The Government does not think that it is workable, but I think that it merits further investigation. If the issue of people living in chronic pain and illness due to mesh repair anywhere in the body is to be tackled, we need ambition, not abdication. These people deserve much better.

Thank you for your generosity, Presiding Officer. I will give way.

Certainly, the one thing that we know works in prevention terms is those prevention centres and this pilot is critical. We need to get sight of the timescales, so could the minister please update the chamber on that?

Given the rate of drug deaths, which is currently running at around one drug death every seven hours, does the member not agree that we need to proceed with a degree of urgency rather than caution and that, although I acknowledge those concerns, there are quite clear solutions to addressing all those concerns, which have been well known for some years now?

Scotland’s drug deaths crisis is the most important and pressing issue that this country faces today. I have said before and I say again that we must not shy away from the crisis, and the action that we take to tackle it must be bold, radical and, most important, swift.

That action will take many forms, including the roll-out of the MAT standards; ensuring that access to treatment and rehab is available to anyone and everyone who needs it; the overhauling of a criminal justice system that criminalises and warehouses vulnerable people in Victorian prisons; and the roll-out of overdose prevention centres. There is no one silver bullet, and I acknowledge and applaud the Government’s recognition of that simple fact, which has been shared across the chamber this afternoon.

It is against that backdrop that I turn to the Scottish Drug Deaths Taskforce and its report. There is a lot to be welcomed in the report. I particularly welcome the emphasis on treating the drug deaths crisis as a public health issue and tackling the scourge of stigma that is faced by those who are battling addiction, and also the report’s unequivocal backing for overdose prevention centres. It is filled with recommendations, many of which we have seen before, and that simple fact goes to the very heart of the issue. We can have all the reports in the world with the best recommendations possible, but, if there is a failure to implement them, they are a waste of time.

Take overdose prevention centres as an example and as a litmus test. We have been talking about those for almost a decade now and we are generally all in agreement as to their efficacy, but we are still waiting for so much as a pilot to be initiated. They are not some fanciful idea that is way outwith the scope of the Government to implement. Indeed, the Scottish Drug Deaths Taskforce chair has said:

“We believe that safer drug consumption facilities can be implemented now under the current legislation”.

So why the hold-up? I understand that a proposal for a pilot in Glasgow was submitted to the Lord Advocate more than six months ago, yet here we are—no further forward and with no mention of that in the minister’s opening speech this afternoon.

The Crown Office and Procurator Fiscal Service is saying that it is too complex to do, that there is a myriad of issues, that the chief constable is not up for it, that that is such a shame and that we do not have a timeframe for it yet. I am afraid that that is just not good enough. It is a disgrace when we have people dying and when we have seen the efficacy of that approach in Glasgow through the unofficial pilot run by Peter Krykant. Eight lives have been saved—what more context do we need? Let us get on with it; let us bang those heads together and get it sorted. If it needs to be the First Minister who does that, so be it.

Those prevention centres are far from the only area where the Government’s actions have not aligned with the expectations set. Let us look at the MAT standards. The minister came to the chamber in the autumn to inform us that the Government’s implementation of the MAT standards 1 to 5 by April last year had failed miserably, with just seventeen per cent of the standards being fully implemented and just one of the ADPs fully implementing MAT standard 1 by the agreed time.

It does not stop there. The Scottish Drug Deaths Taskforce report talks about the importance of implementing all 10 MAT standards by May 2024, yet the Government’s target for full implementation of those 10 is not until 2025, and we are no further forward on the commitment made two years ago by the First Minister on the widespread roll-out of diamorphine or heroin-assisted treatments. Those are still basically statistically irrelevant in the front to tackle Scotland’s drug deaths emergency.

The report also talks about funding fit for a public health emergency, yet we know that the budgets of local authorities, who are largely responsible for the delivery of many of the services relating to drug death prevention, have been decimated and continue to be cut every financial year. As I said, the report is full of welcome recommendations, but we have seen it all before and, frankly, actions speak louder than words.

Before I wrap up, I will make a more general point, which is that, unfortunately, a vacuum has been created when it comes to drug policy, which is deeply concerning. In the past year, we have seen proposals for legislation from Opposition members but nothing whatsoever from the Government. I do not say that to score points or to grandstand, and I certainly do not say it to decry the laudable work being done by the minister. I simply say it because it is emblematic of a structural inertia that seems to exist at the heart of Government, despite the efforts of the minister to turn it around.

It has been said to me that if this was about any other group of people, the crisis would have been fixed a long time ago. Although I do not want to believe that to be the case, it is an unfortunate and observable reality that the longer it drags on and the more time we waste, the more difficult it becomes to dispute that there are certain people in certain positions of power in this country who just do not think that it is worth the hassle.

I do not envy the scale of the task that the minister has in front of her. Scotland’s drug deaths crisis existed for a long time before she was responsible for the portfolio. However, my worry is that, based on the current trajectory, flatlining as it is but still at a sky-high rate relative to any other comparable country and jurisdiction, and despite the efforts that she is making, it will exist long after she ceases to have responsibility for it. That is a national tragedy.