Chamber and committees

I thank the petitioners: Roseanna Clarkin, a mesh-injured woman who has suffered chronic debilitating pain and life-altering injury after a procedure for a hernia; and Lauren McDougall, whose mother Michele McDougall suffered 18 years of pain as the result of a surgical mesh procedure before dying of a rare cancer. Neither Roseanna nor Michele had given their assent to mesh being used. Having met both Roseanna and Lauren, I know the pain and damage that mesh has caused in their lives and why they now seek the support from the Scottish Government that they deserve. Roseanna and Lauren have met a number of politicians, but they have not yet met the cabinet secretary. I ask that he consider meeting them to hear of their experiences at first hand. I asked Roseanna Clarkin what her top ask from the debate would be. She said that it was for patient pathways to be provided for all those who have been injured by mesh, rather than each individual having to fight for medical support.

The petition that they lodged in the Scottish Parliament is backed by powerful testimonies from more than 70 mesh patients and their families. It is clear what action they are asking from the Scottish Government. We need to accept that people are still having mesh implanted in Scotland. The Scottish Government must suspend the use of all surgical mesh and fixation devices while an independent review takes place.

Mesh is a cheaper option, but there are other options—the petitioners believed that pig skin should have been used in their procedures. The Scottish Government must provide greater healthcare support for patients who are mesh injured. It must increase access to specialist care, including mesh removal surgery and alternative treatments.

Has the cabinet secretary had the opportunity to look at the report published earlier this week by the University of Edinburgh, which reviewed the experiences of victims and witnesses in domestic abuse cases since the passing of the Domestic Abuse (Scotland) Act 2018? The report found that, despite that legislation, domestic abuse victims still find the justice system traumatic. What further action does the cabinet secretary believe can be taken to reduce the trauma that domestic abuse survivors experience in the justice system?

I thank the member for that helpful intervention. Yes, we should look at what is happening there and around the world. Jackie Baillie already mentioned the decision in Canada to suspend the use of mesh.

The Scottish Government must apologise for its failure to date to act on the concerns of mesh patients and should establish a compensation scheme to support those individuals as they attempt to overcome the pain and damage that mesh has caused them. Many of the campaigners on the issue now live with life-changing conditions that are directly linked to the mesh procedures that they underwent.

Although transvaginal mesh and its complications affected the lives of so many women, as we have heard, the use of other products to treat conditions such as hernias affect women, men and sometimes children, too. However, despite the testimonies that the Citizen Participation and Public Petitions Committee received from patients affected by the use of mesh, the true extent of the damage caused by those products remains unclear. Indeed, there have already been several calls in this debate for more data and for evidence to be obtained.

In her evidence to the Citizen Participation and Public Petitions Committee back in June, the Minister for Public Health, Women’s Health and Sport admitted that it was not easy to trace what products had been used in all procedures and which were causing harm. However, despite the lack of regulation on its use, NHS Scotland continues to use mesh in surgical procedures. From 2016 to 2020, 62 per cent of all hernia repairs carried out by NHS Scotland used mesh. That is why I join campaigners in their call for an independent review of mesh and fixation devices.

We cannot establish the true scale of the damage that those mesh products have caused to the lives of so many patients across Scotland until we get the data and the evidence. Until that review is completed, the Scottish Government must order health boards to suspend the use of surgical mesh and fixation devices and to use other procedures instead.

We need to put protections for patients in place. There needs to be clear guidance governing the surgical use of mesh. I believe that we need to suspend the use of mesh, but there may well be situations where its use is essential and no other alternatives are available. That must happen only when patients have given their informed consent to its use. It is disturbing that so many of the patients who contacted the Citizen Participation and Public Petitions Committee did not give their consent.

I am very grateful to the Citizen Participation and Public Petitions Committee for giving us the time to explore the issues today. I hope that the cabinet secretary will agree to meet the petitioners to take forward the issues that have been raised in the debate.

Will Richard Leonard take an intervention?

I welcome the debate and the work of the Scottish Drug Deaths Taskforce. We all know that Scotland consistently has the highest drug deaths rate in Europe, and we all appreciate that the drug deaths crisis is complex and caused by a range of factors, including the types of drugs that are used and the high levels of poverty and deprivation in Scotland. We must also be honest about the fact that Scotland faces similar challenges to those of many other countries and the response has been slow.

Safe consumption facilities have operated in many parts of Europe for about three decades. They offer the opportunity to reduce the risk of disease and death. I say to Conservative members that the evidence is that such facilities do not increase drug use or the frequency of injecting.

On 3 November 2021, the Lord Advocate noted in evidence to the Criminal Justice Committee that any proposals for drugs consumption facilities would require to be

“precise, detailed and specific, underpinned by evidence and supported by those who would be responsible for policing such a facility”—

in particular,

“Police Scotland.”—[Official Report, Criminal Justice Committee, 3 November 2021; c 20.]

The Crown Agent wrote to the Criminal Justice Committee this week and said:

“the pilot presents significant operational challenges in relation to policing any facility; no doubt made more difficult by the lack of a clear legal framework. Prosecutors continue to work closely with the police to ensure that there is a clear plan for the policing approach to such a facility. There has been recent and ongoing correspondence with the Chief Constable of ... Scotland in relation to outstanding issues which require to be considered.”

I know that the minister advised the joint committee meeting—of the Criminal Justice Committee, the Health, Social Care and Sport Committee, and the Social Justice and Social Security Committee—that she was still awaiting advice from the Lord Advocate on the legality of such facilities, and I would be grateful if she could provide the chamber with an update on whether advice has been obtained and what the timescales are for progress on that issue.

I refer members to my entry in the register of members’ interests and congratulate Richard Leonard on securing this important debate, which is part of a wider discussion about public transport, the climate challenge and how we get people to move from cars and planes to rail, in particular, as the greenest form of transport.

We need to compare where we are in Scotland and the rest of the UK with other European countries. In Germany, it is possible to travel by train throughout the country for €9. In Spain, most train travel will now be free for another year. France has recently obtained permission from the European Commission to ban domestic flights on routes where the train is available. I listened to Liam Kerr’s speech and it is clear that we need big decisions to be made by the UK Government as well as the Scottish Government.

Serco has operated the Caledonian sleeper franchise since March 2015. Prior to that, it was integrated into the ScotRail franchise and, due to the Covid-19 pandemic, in March 2020, the sleeper was transferred on what is called an emergency measures agreement—now a temporary measures agreement—so that all cost and revenue risk was transferred to the Scottish Government and Serco received a fee for running the service.

Therefore, the risk is already with the Scottish Government, and Serco is eligible to receive fees, which it has been doing. This debate is to encourage the Scottish Government to take the Caledonian sleeper back into public ownership.

I suspect that the member has not spoken to as many Caledonian sleeper employees as I have. We could have a debate in its own right on some of the practices that have been operated in the Caledonian sleeper service. We have already heard from Richard Leonard about some of the alleged bullying that has been taking place, but some of us have a dossier on some of the problems with the way that the service is operated.

The Green Party member who spoke has already talked about some of Serco’s behaviour in relation to people seeking asylum and bespoke accommodation. We also know about its track record on the test and trace system. Therefore, there are some issues of principle with regard to the kinds of organisations to which the Government awards contracts, but there are some very specific issues with regard to how Serco has operated sleeper services. It is discredited and it is not fit to receive public money from the Scottish Government, but that is a wider debate that we could focus on in detail.

The issue before us today is whether that is the best way for a public service to be operated. I do not think that we have the specific figures, but we believe that nearly £2 million in fees has been given to Serco as part of the current contract. I ask the Scottish Government to confirm how much money Serco is receiving. I hope that, over the coming months, as the minister makes decisions, she will take into account the very strong support that she has from the Scottish Labour Party in particular to bring the sleeper service back into public ownership.

I thank the member for that helpful intervention. The reason that I have raised that issue is in order to make the point that the progress that we are making is too slow. I know that the minister has been awaiting that advice and I appreciate that she has probably been pushing for it, but I have to say that we need to see action.

In 2020, the First Minister said that it was her Government’s responsibility to deal with that crisis and that she would not shy away from that. However, despite the fact that we declared a public health emergency three and a half years ago, at a minimum, there have been a further 11,500 deaths and 26,000 drug-related hospital admissions.

As a member of the Criminal Justice Committee, I would like to focus on the justice section of the Government’s response. Like others, I have not had much opportunity to consider the full document, but it would be fair to say that the approach that is outlined in the response is quite different from many current practices in the justice system. I know that the minister has worked in the justice system and will have first-hand knowledge of that. Drug abuse and use in prisons is endemic. We know that many people who were not drug users before they went into prison are introduced to drugs in prison. The task force recommendation is that

“the Scottish Government should make key changes to fully integrate a person-centred, trauma-informed public health approach to drug use in the justice system.”

I support that approach and I support what the Government says in its response. However, I am not clear how that relates to the justice legislation that is currently being brought before this Parliament. We know that Scotland has the highest jail population in western Europe and the highest numbers of people on remand. The number of people who are on remand in prison is now approaching almost 30 per cent of the prison population. It is far from clear what the public safety test—in the Bail and Release from Custody (Scotland) Bill that is currently being considered—will be, and it is far from clear that it will result in what the report is asking for, which is that bail should be available and that remand should be used only as a last resort.

I very much welcome the worthy ambitions that are in the response, but I think that we face massive challenges. The justice budget is facing real-terms cuts, and many of the recommendations in the report will require significant resources. I look forward to what the minister has to say and I welcome what is in the report, but I think that we need to do a lot more work.

The witnesses will be aware that the bill will bring in a new concept of public safety, which is not something that the criminal courts have dealt with before. There is concern about a lack of clarity about the concept and the potential for lots of court appeals and arguments about what it means. It might be helpful if it was better defined in the bill. Kate, is the introduction of the concept helpful? Do you have thoughts on how it might be better defined?

I think that the committee would agree with you on the need for better data; we would find that extremely helpful.

Dr Graham, when you spoke initially, you mentioned the need for clarity and more detail on the public interest test in particular, but perhaps also more generally. Could you answer the part of my question about whether there are lessons to be learned from comparable European countries and jurisdictions? The Government’s aim appears to be to reduce prisoner numbers and to ensure that the most serious offenders are in custody. Bail is given to people who have not been convicted of anything, yet. Do you think that there are lessons to be learned, given that the approach taken in Scotland appears to be different from the one taken in many other European countries?