Chamber and committees

I will bring in Michael Kellet to give you a bit more information about the cross-Government work that is going on. However, one of the things that we in the Scottish Government have always recognised but which has become even clearer with the pandemic is that siloed working will not serve the citizens of Scotland. As a result, a great deal more cross-Government work is going on than there ever was before, and the Deputy First Minister, in his Covid recovery role, has a cross-portfolio role to ensure that policies join up across Government. There is work going on across Government on such issues.

On the universal basic income, health inequalities are, as I have said, related to wealth inequalities, so the solution to health inequalities lies in ensuring that people have an adequate income. We need to tackle individual disempowerment, and there are undoubtedly people and groups in our communities who are easy to ignore. It is not just a simple matter of tackling poverty, although that would go a long way towards tackling health inequalities.

My party is very sympathetic to the idea of a universal basic income, but we are not convinced that we can introduce it without the full powers of independence. As a result, we are exploring ways of assuring people in Scotland that they can have a dignified level of income, although I realise that that falls short of a universal basic income.

I think that you can see our commitment to such an approach in, for example, our handling of school lunch provision during the pandemic. It was quickly recognised that we should get money into the pockets of parents so that they could feed their children adequately. That was brought in all over Scotland quite quickly, because that is the best thing that can be done to support families and the most effective way of ensuring that children are well fed.

Michael Kellet will say a little more about the cross-Government work that he is involved in.

All over the UK, we found that people who drank heavily drank more during the pandemic, which I think largely explains the alcohol deaths. Twenty-three people a week die as a direct result of alcohol. As part of the national mission to tackle drug deaths, there has been increased investment, which is used by alcohol and drug partnerships all over the country. Those services are not separate on the ground—the alcohol and drug partnerships are the structure that is in place.

The investment to tackle the national drug crisis also supports people with alcohol addiction problems, and additional investment of £100 million to increase the availability of residential rehabilitation will benefit people with problematic alcohol use.

We recognise that more can be done to reduce the harms and increase help with treatment and recovery, but since 2008 we have invested more than £1 billion in tackling problem alcohol and drug use. This year, we are spending £140.7 million on the issue of alcohol and drug use.

The 20-minute neighbourhood is a win-win for public health. If people only have to go 20 minutes away and are easily able to access public services, active travel becomes more possible. If we design public services to be within walking distance of where people live, we are likely to have a more active nation than we would if we designed public services so that folk had to hop in a car and go to a centralised point.

That active nation agenda is vitally important. It ticks every box. The Government’s priorities right now are to tackle inequality and climate change and to improve health. The active nation agenda improves every one of those. If people are more active, we reduce the number of cars on the road and the level of pollution. We will tackle climate change and will have healthier people.

The 20-minute neighbourhood is an important part of what we are trying to achieve. As ever in Scotland, that may be trickier to achieve in my part of the country.

Absolutely. I am more than happy to write to the committee in more detail not only on the steps that we are taking but on what we are up against.

Thank you. I am grateful to the committee for having me here today. At the outset, I want to acknowledge the efforts of those who have brought forward the petition; I commend them for doing so.

As members know, we have taken decisive action on transvaginal mesh. That action is well documented elsewhere, so it is important today to focus on the use of mesh in other situations.

We are acutely aware that there is concern about the use of mesh in other sites, not least from those who are experiencing complications. I am very sorry to read of the impact that those have had on individuals and their families. I was sorry to read in a submission on this petition that people felt that their symptoms were “dismissed” when they presented for help. Some people did not feel that they were informed of the risks of the procedure that they underwent, and it is only natural to feel let down in those circumstances.

If I may, I will for a moment focus on the use of mesh in hernia repair, which is a very common procedure in NHS Scotland. The Scottish Government asked the Scottish health technologies group to review available evidence on the use of mesh in hernia repair, first in adult inguinal hernia and secondly in abdominal wall hernia more generally. The group published a report on adult inguinal hernia in January 2020 that concluded that, compared with non-mesh procedures, using mesh resulted in lower rates of recurrence, fewer serious adverse events and similar or lower risk of chronic pain. We await the publication of the second piece of work, which considered the more general use of mesh in hernia repair and is expected imminently.

There are, of course, other gynaecology procedures for which the use of mesh has not been halted. In those circumstances, a high-vigilance protocol is in place across the whole of NHS Scotland. It is important to remember that some of those procedures are complex and long established, with few—if any—viable alternatives. To suspend their use would leave a cohort of people with limited or no treatment options.

I know that this is a very difficult and emotive subject. I welcome being questioned on it and I want to reassure the committee and anyone watching that the Government is absolutely committed to ensuring that everyone with mesh complications gets the care and treatment that they deserve.

That is a clinical decision, on which I will defer to Mr O’Kelly. Comparing the two techniques is way beyond my level of expertise. I ask Mr O’Kelly to give you some information about whether a process is under way to gather evidence on pioneering techniques and to compare them with existing techniques.

Medicine is slow to change practice. You will know that, in my past life, I was a clinical pharmacist. When I first started out in my practice, there was a gap of about 15 years between evidence and practice. The internet has speeded up the ability to obtain and review evidence from all over the world. We are faster at gathering evidence.

We have seen a brand-new virus that nothing was known about. During the pandemic, scientists and clinicians from all over the world collaborated to find a way forward in the emergency in which we found ourselves. I am very hopeful that some of that collaborative effort will survive into future practice and mean that we will solve some of the big questions. I also hope that, at the heart of that, there will be fewer commercial concerns and more altruism when it comes to solving some of the medical problems.

That was a bit of a philosophical answer. I will let Mr O’Kelly give you the clinical answer.

I think that we do. Perhaps Terry O’Kelly can confirm this, but my understanding is that more than 5,000 procedures a year are carried out in NHS Scotland, and I think that the rate of complications is somewhere between 0 and 5 per cent. I will ask my clinical colleague to confirm that to ensure that the committee gets the correct information.

I will pass to Terry O’Kelly to go into the issue in detail, but we are certainly aware that, when women came forward with concerns about transvaginal mesh, they had to go through a long process of feeling that they were not being listened to and that their concerns were being dismissed. Again, that partly reflects the power imbalance that operates throughout healthcare, but there was a feeling that it was difficult to raise concerns.

I am sure that every MSP around the table will have received mail from constituents who feel worried about raising concerns about their medical treatment and who worry that, if they do, they will somehow suffer in their passage through healthcare. Some of the experiences that we have heard about with regard to women who had transvaginal mesh implanted will be common to that situation, but I would like to think that, since 2018, we have put procedures in place and communicated well with healthcare professionals to ensure that that is not the case any more. Moreover, as I have said, the general thrust in NHS Scotland for a number of years now has been towards realistic medicine and holistic and patient-centred care. I would like to think, therefore, that that sort of thing will be less problematic than it might have been in the past.

I will ask Mr O’Kelly to talk you through the process of presenting with complications and then accessing surgery to remove mesh.

Research will be on-going all the time. The Scottish Government has asked for a review of the evidence. The Scottish Health Technologies Group has already published a report of a review of evidence on primary inguinal hernia repair in men. Following that, we asked the group to examine hernia more broadly, to include men and women and to review the outcome of mesh versus non-mesh surgery in a variety of abdominal wall hernias. We have asked the group to look at the published evidence on that and to come back to us, and we are waiting for publication of that report. We expected it at the end of summer this year. That is quite a broad term, but we are hopeful that it will be published very soon and that it will give good-quality evidence. Without high-quality and well-reviewed evidence, it is not possible for patients to make an informed decision.

You are absolutely right—the pandemic has placed immense pressure on the NHS. We talk about that in almost every parliamentary committee and regularly in the chamber. Undoubtedly, after 18 months of impact on NHS capacity and how we work, there is pent-up demand for surgery in a number of clinical areas such as orthopaedics. Cancer surgery has been prioritised throughout the pandemic.

An NHS recovery plan is in place. Work is being done to ensure that we can tackle the pandemic and keep the number of hospitalisations at a level at which the NHS can function. There are plans in place for the NHS to recover from the pandemic. National treatment centres are being developed where surgery can take place. The process will not be instant or overnight, but there is a recovery plan in place that will benefit everyone who is waiting for treatment, not just the people whom you mentioned.