Chamber and committees

In the responses that we have received, there is a general acceptance of the desire for more community representation and involvement on the boards, and the minister has talked about providing information on the efforts that have been made to solicit applications for such representation. Against the background of those assurances and that suggestion, what is your impression of the public perception of the lack of any momentum to realise such an ambition?

We will keep the petition open. If the petitioners are watching us today, I say to them that they will be invited to address the committee after the summer recess. It can be decided in due course whether they want to do so online or to come here. Thank you, Dr Allan.

PE1865 was lodged by Roseanna Clerkin and Lauren McDougall, from whom we have heard previously. This long-standing petition calls on the Scottish Parliament to urge the Scottish Government to suspend the use of all surgical mesh and fixation devices while a review of all surgical procedures that use polyester, polypropylene or titanium is carried out, and guidelines for surgical use of mesh are established.

We are joined, once again, by our parliamentary colleagues, Jackie Baillie and Katy Clark, both of whom have followed the petition with interest as we have debated it. We last discussed the petition some time ago, on 28 September 2022, when we agreed to write to the Scottish Government and seek a parliamentary debate on the issues raised. Members will remember that debate on 17 January 2023, as they probably all participated in it.

Ahead of that debate, we also received a response from the then Minister for Public Health, Women’s Health and Sport, which highlighted the Medicines and Healthcare products Regulatory Agency’s

“proposals ... to increase the classification of surgical mesh implants”.

The minister’s response also states that

“the Scottish Government is taking forward improvements in the recording of procedures and implanted devices”

and that the Scottish Association of Medical Directors has been asked

“to report on the availability of non-mesh surgery in individual Health Board areas”.

We have also received another submission from the petitioners, which offers their reflections on the evidence that the committee has gathered to date and the debate that took place in January. They have also highlighted the difficulties that patients continue to face in making an informed choice about their treatment and where to seek support when experiencing complications resulting from surgical mesh.

I have also received representations in that regard, including on the question whether a urologist should have been part of the national centre for chronic pain and mesh services in Greater Glasgow and Clyde health board, as well as from individuals who are still experiencing difficulty in taking advantage of the opportunity to have mesh removed by a surgeon of their choice at a location of their choice.

This might be a slight characterisation, but, as with the previous petition, although there has been a lot of good will and concrete action along the way, there are still clear deficiencies in the actual outcome of all that work.

Would Jackie Baillie and Katy Clark like to say a few words to the committee? I normally go alphabetically, but I saw Jackie Baillie defer to Katy Clark, so I invite her to speak first.

Thank you. I call Jackie Baillie.

Two questions follow from that. First, how is a post mortem determined as being essential? Secondly, by what means are the views of the relatives of the deceased taken into account? What is the process for establishing and assessing their preferred wishes?

Good morning and welcome to the 10^th meeting of the Citizen Participation and Public Petitions Committee in 2023. We have a particularly busy meeting this morning.

Agenda item 1 is consideration of continued petitions, the first of which is PE1911, on a review of the Human Tissue (Scotland) Act 2006 as it relates to post mortems. This continues our discussion on a petition that was lodged by Ann Stark to call on the Scottish Parliament to urge the Scottish Government to review the Human Tissue (Scotland) Act 2006 and relevant guidance to ensure that all post mortems can be carried out only with permission of the next of kin, do not routinely remove brains and offer tissues and samples to the next of kin as a matter of course.

We have convened this morning’s session on the back of evidence that we have heard to date. It is not just a matter of routine or fancy—members of the committee have been drawn to the evidence that we have heard already and believe that there are issues of substance that we wish to pursue. That included taking evidence from witnesses based in England when we heard about the ways in which their approach to post mortems and tissue sample retention differs from ours. They shared their experience of setting up a scanning service for post mortems and—accepting that cases where the procurator fiscal will be involved because there are suspicious circumstances would require a different route—outlined the ways in which that reduces the requirement for full invasive post mortems.

We also heard that the next of kin are offered a range of options for how tissue samples are handled. Despite our having received written evidence that those issues might be insurmountable, they seem to have been dealt with in passing in England—without us even questioning the witnesses about it, they volunteered the alternative solutions as a matter of course.

We would quite like to pursue those issues this morning. We are delighted that the petitioner is in the gallery today. It is worth reminding everyone that the petition was lodged by Ann Stark, whose son Richard died suddenly at the age of 25. Unlike many other Scottish Parliament committees, there is no party-political agenda driving our inquiry—our inquiry is happening because a petitioner decided to participate in the public process open to them to bring a petition to the Parliament. In essence, all of us sitting on the committee are representatives of that petitioner in the way in which we seek to take forward the substance of the issue that she raised.

I am delighted to welcome the Lord Advocate, Dorothy Bain KC, to our proceedings this morning, as well as the head of the Scottish fatalities investigation unit, Andy Shanks. Thank you both for giving us your time. I understand that you would like to make an opening statement, Lord Advocate.

To whom are they accountable?

I understand that distinction. I am grateful to you for that.

You touched on the issue of retention. The Royal College of Pathologists explained that

“small tissue samples taken for microscopy and diagnostic purposes are retained as part of the medical clinical record”.

It said that such samples

“could theoretically be returned to relatives, but the gain would be marginal and would need traded off against further complexities in the authorisation and consent processes, which are already difficult.”

We took evidence from Dr Adeley, a senior coroner in England, who said:

“What happens with any sample that contains even a single cell is that the family are asked what they want to be done with the sample when it is finished with. The family are given a number of choices. The coroner’s officer will ask whether the sample could be retained by the hospital for medical research and teaching, or it can be returned to the family and their undertaker.”

Indeed, Dr Adeley outlined a process whereby there can be a second funeral proceeding for the additional tissue. All that happens regularly and as a matter of course in England. Dr Adeley continued:

“Alternatively, they can elect for the sample to be disposed of by the hospital in a lawful and sensitive manner. Those are the three choices.”—[Official Report, Citizen Participation and Public Petitions Committee, 17 May 2023; c 18.]

It seems that there is an operational practice elsewhere in the United Kingdom that is executed with no complications and without any professional obstacles being put in place, yet such obstacles seem to be routinely put in place by the processes that apply in Scotland. Is that any longer appropriate? Could Scotland seek to operate in a much more transparent and humane manner, consistent with practice elsewhere in the UK?

Thank you—

I promised that we would consider another aspect of the petition, which is the proposal for a national memorial. Alexander Stewart has questions on that.