Chamber and committees

I register my interest as a fellow of the Chartered Institute of Personnel and Development.

My question is for Professor Sengupta. You said that it will be real only if we can pay for it. Most staff—76 per cent—are employed by private sector providers. The current model involves outsourcing to the third sector, and it focuses on cost and the lowest price for those providers. One of the consequences of that has been that, historically, wages have been kept low—if there is competition on price, wages are kept low. In your view, how does that conflict with fair work and ethical commissioning? Does the new model need to involve a significant change?

The buck has to stop somewhere.

I will ask one final question. In relation to accountability and responsibility, if the assets, staffing and budget stay with councils, is there not a huge concern that there is a difference and that one party will be responsible and another accountable?

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.

I, too, pay tribute to our hard-working NHS staff. In February this year, Aberdeen royal infirmary declared a major incident due to a perfect storm of staffing pressures, bed blocking and ambulance stacking. Other hospitals were on the brink of doing the same. The reality is that our healthcare system is already at breaking point even before the pressures of winter put greater strain on services and staff whose morale is at rock bottom. How can the Scottish National Party Government expect things to be different this time round when the wheels are already off the bus?

With lives tragically lost, homes destroyed and livelihoods in jeopardy, communities in Angus do not want warm words; they want reassurances that Angus Council will have the funds that it needs to support people who have lost everything, shore up the flood defence scheme and expedite urgent structural repairs. That is the Scottish Government’s responsibility. When will the money that the cabinet secretary has mentioned be coming?

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.”

To ask the Scottish Government whether it will provide an update on cladding remediation in Scotland. (S6O-02607)

The reality is that progress on removing dangerous cladding has been pitiful. The Scottish Government has the financial resources that it needs but has spent barely 4 per cent of the United Kingdom Government’s allocation for cladding remediation, and we now hear that more powers are needed in order to make progress. Can the minister provide a timeline for the proposed cladding remediation bill and explain what action will be taken to expedite the process in the meantime?

Further design faults have again delayed completion of the Baird family hospital and the Anchor centre in Aberdeen. Those projects are now three years late and almost £100 million over budget, with costs expected to rise further. Has the First Minister met NHS Grampian to discuss those deeply concerning delays? What financial support will the Scottish Government provide to the health board to ensure that those much-needed projects can go ahead?