Chamber and committees

Colleagues across the chamber will not be surprised to hear me speak on the subject of mesh in the 10th anniversary year of that issue first being raised in a public petition to the Parliament by Elaine Holmes and Olive McIlroy. However, I do so today on behalf of fresh petitioners. Roseanna Clarkin and Lauren McDougall have lodged a petition for the Parliament’s attention on behalf of all those affected by the issues raised. Members will recognise the similarities between the issues raised in that petition and those raised in our previous debates in the chamber on the subject of transvaginal mesh. I hope that they will appreciate, and be patient with, the need for plain and uncomfortable discussion of the facts.

Our previous discussions focused on the experience of tension-free vaginal tape and women’s health. Roseanna Clarkin and Lauren McDougall have highlighted significant additional concerns about the wider use of mesh, and they have made it clear in their petition that our attention should also be focused on the use of mesh in other surgical procedures—for example, hernia repair—and the effects that that has had, is currently having and will continue to have if the use of mesh continues for men, women and children throughout Scotland.

In raising the issue, Roseanna Clarkin and Lauren McDougall have urged us to be cautious about the use of surgical mesh until more information is gathered and we have a better understanding of the complications and adverse outcomes resulting from those procedures. In their view, that should include investigation of the concerns about potential cancer risks associated with the use of titanium staples to secure the mesh.

In considering the issues raised by the petition, the Citizen Participation and Public Petitions Committee heard from individual members of the public, including members of the Sling the Mesh campaign. We have been able to explore the experience that they have shared by gathering further information from the Scottish Government and from clinical specialists who are familiar with the alternative options for hernia repair. I will say more about that shortly. The committee is also grateful to colleagues who joined us at various points in our consideration to offer contributions on behalf of their constituents. I see several of them in the chamber this afternoon and look forward to hearing further from them.

We also heard from the Minister for Public Health, Women’s Health and Sport, who, in the Government’s initial response to the petition, said that she did not believe that there was evidence to justify a pause in the use of relevant devices. She stated that

“using mesh resulted in lower rates of recurrence, lower rates of serious adverse events and similar or lower risk of chronic pain.”

It struck me, at our first consideration of the petition, back in September 2021, that that was almost exactly the same as the testimony that we had heard in relation to the previous petition, on transvaginal mesh. In that case, people had been dealing with their issues individually; information on their experiences and outcomes was not centrally gathered, held or reviewed; and, until people knew that there was a wider issue to speak out about, there was not much information available in the public domain.

Since then, the committee has received more than 85 written submissions. The majority of them are personal testimony from individuals detailing the life-changing effects that mesh complications have had on them.

Yes, that is a fair summary of the position. It is redolent of the experience of those who suffered because of transvaginal mesh, who were told that it was a psychological condition and not a real expression of pain and discomfort.

Figures from Public Health Scotland and the Scottish Health Technologies Group suggest that around 10,500 hernia repairs are carried out in Scotland each year—for all I know, there may be some people with them in the chamber—with mesh being used in approximately 62 per cent of those procedures. Official statistics also suggest that there are, on average, 32 procedures to remove mesh from previous hernia repairs each year. What is not yet available is data on the reasons why the mesh has been removed. In comparison with the number of hernia repairs that are being carried out, those numbers may appear small, but we must keep in mind the fact that individual patients are behind each of those statistics.

The committee also heard from the chief medical officer that the complex mesh surgical service deals only with TVM removal and that there is no similar service for the removal of other types of mesh. We heard of difficulties in getting mesh removal surgery on the national health service, which were attributed to a lack of knowledge about the issue in primary care and the complex mesh surgical service accepting only gynaecological referrals. Some individuals resorted to going private to get their mesh removed and some travelled abroad to have that done. We heard that there is no clear pathway for patients and that general practitioners are not aware of where to send them.

The testimony that we have received details the pain that many individuals who had mesh implanted during hernia or rectal prolapse repair surgery have experienced. The people behind those statistics have told us that their symptoms occurred very quickly after surgery and have worsened over time. They have been left in constant pain—I apologise here—and have nerve damage, sexual pain, issues with their bladder and incontinence. One patient described the pain as feeling like

“a cheese grater rubbing against my groin.”

Another patient told us that the pain feels like they are

“wearing a tampon dipped in acid.”

Some people told the committee that they had been told that the hernia or rectal prolapse mesh had eroded into their vagina wall, bowel and bladder or had adhered to their bladder, ovary, fallopian tube or bone. The committee heard that complications had led to mobility issues and had significantly reduced people’s mental health and quality of life. Some people reported improvements after mesh removal surgery, but others were told that the mesh was too enmeshed in their body to be removed without causing serious ramifications, such as the loss of their rectum or testicles.

A Scottish Government-commissioned review on hernia mesh stated that most common adverse events following mesh-based hernia repair are pain, infection, hernia recurrence, scar tissue forming between separate surfaces of the body and blockage of the bowel. The complications that people are being forced to live with mean that they have had to give up working, their relationships have broken down and even something as simple as going out for a meal with their family has become impossible due to the pain that they experience.

They have told us of their concerns about informed consent—the point that Mr Cole-Hamilton raised—and the challenges they faced in having their pain taken seriously. In one case, we heard that a patient was not given any other choice of treatment, was not informed that the surgery would involve mesh and, despite reporting pain in their hips, legs and pelvic area, was met with a dismissive response from the surgeon.

Similar stories have emerged throughout the submissions. Over and over, people have told us either that they were not informed that mesh would be used or, if they were informed, that they were told that the only risk was that the mesh could be too tight, which could be resolved by snipping it. Unfortunately, the testimony that we have heard clearly and, at times, graphically demonstrates that that has not been the case. People have told us about having developed autoimmune diseases, which they believe was linked to having mesh inserted into their bodies.

Those are all themes that we have explored with the Minister for Public Health, Women’s Health and Sport during two separate evidence sessions.

It was encouraging to hear from the minister and the chief medical officer about the progress that is being made on embedding shared decision making as part of the patient journey. The CMO indicated that a

“shared decision-making approach has ... been whole-heartedly embraced by the profession”—[Official Report, Citizen Participation and Public Petitions Committee, 8 June 2022, c 5.]

and is supported by education delivered by the NHS. He told us that part of that approach includes sending letters to out-patients, encouraging them to engage with the clinical team and to ask questions about the benefits, risks and alternatives, as well as about what happens if no action is taken.

Will the cabinet secretary give way?

I think that politicians across the chamber, including those in the Government, accept that patients who have suffered in this way need to be believed. Rona Mackay, who is the convener of the cross-party group on chronic pain, has, along with me and others, heard repeatedly from individuals that, unfortunately, that is not always their experience when speaking to clinicians.

Being candid, I admit to having had a significant prostate cancer concern at the start of the pandemic, which had a bearing on decisions that I made in my personal and professional life at the time. Notwithstanding the constraints of the pandemic, the treatment that I received was comprehensive, professional and timely. I think that the key thing—I hope that the cabinet secretary agrees—is that men who have any of the symptoms that are associated with prostate cancer must not be concerned about any embarrassment that they might feel arising from that, and that they must present themselves to the health service at the earliest possible opportunity. By doing that, I hope that they can, like me, expect to survive safely. [Applause.]

I have now heard Dr Gulhane say that he has inserted mesh into other people. Were he to be diagnosed with a hernia and told that it must be repaired, would his preference be to have mesh inserted into him or to have a natural tissue repair?

Bludgeoning ourselves on the divisive issue of independence is setting aside all the work that we could do on those priorities for Scotland.

As I do not get out much any more, I welcome the opportunity to contribute to this first, and extremely good-natured, debate of the new year.

I begin by saying that I do not think that it is enough to say “bad SNP”. I think, charitably, that at the heart of the Government motion is a question: what is the legitimate and democratic route to a second referendum? What I absolutely believe is that eight years of trading insults across the chamber, which is largely what we have done since 2014, has not advanced the argument one iota or one jot.

I agree in part with Michael Marra that there are democratic routes towards another expression of Scotland’s opinion; they just do not happen to be ones on which we agree. First, since the Supreme Court has determined that responsibility for the constitution rests at Westminster, it is for MPs elected from Scotland, as Mr Gray and Mr Robertson were, to argue in the House of Commons in favour of a second independence referendum and to seek, as Mr Marra did, to persuade and to construct a consensus around the argument that that second referendum should take place. They say, inevitably, that that is not a prospect that can succeed; I do not fundamentally agree.

Finally, does this Parliament have a future that is based on the model that its creators and pioneers envisaged for it? That model was for this Parliament to evolve the greatest possible consensus on issues.

Time is short, but I may come back to Mr Gray.

The second thing is to respect the view of the First Minister and others at the time, which was that it was a once-in-a-generation vote. Never in the eight years since has there been a discussion as to what a generation is—a negotiation as to what, in this chamber, we could agree that a generation might be.

It is typically argued in print that a generation is between 20 and 30 years—25 years, typically. It is said that there are three or four generations in any 100 years. Arguably, that might say that this Parliament could legitimately, on the words of the First Minister, look to another referendum in 2039, but it is a subject about which the Government has never sought to engage other parties in the Parliament in any discussion whatsoever.

What Mr Robertson did in the debate was to keep returning to the concept of mandate. He said again that the Conservatives have not had a mandate in Scotland since 1955. I think that he said that votes matter—“votes count”—without a shred of irony, but sitting in his Government are members of the Scottish Green Party, which is participating with the lowest share of the vote of any governing party in the history of the United Kingdom: 91.9 per cent of the people of Scotland rejected the Scottish Greens and all they stand for at the 2021 election.