Chamber and committees

Research has shown that the burden of cancer is not felt equally across society. The cabinet secretary has noted that people living in deprived areas are more likely than folk who live in less deprived areas to get cancer and, sadly, to die from the disease. Will the cabinet secretary reaffirm what steps the Scottish Government is taking within its powers to tackle the root causes of poverty and associated health inequalities?

I have, too.

We have talked about mesh this afternoon, but we havnae really talked about titanium fixation devices, which are also part of Roseanna Clarkin and Lauren McDougall’s petition. Does David Torrance agree that further discussion might be necessary and further evidence might need to be taken on that? We now have biodegradable fixation devices, which are being used more often.

I am speaking in the debate because there are two points that I want to make. I also have some additional information that I want to share after hearing other members’ contributions.

First, as a former operating room nurse in Scotland, England and California, I have experience of inguinal hernia repairs and other hernia surgery using surgical mesh, and I have seen the amazing results achieved with repair of anatomical defects using mesh. Surgical mesh is a crucial tool in surgery.

Secondly, and notwithstanding that, I completely understand the chronic, serious and total distress that some women experience as a result of transvaginal mesh. I was a member of the Health and Sport Committee in the previous session, when the mesh legislation was being taken forward. The testimony from women who had had complications was extremely powerful, as were the campaigning efforts of mesh survivors. Again, I put my thanks to them on the record. Anyone experiencing mesh complications must be listened to with kindness, compassion and care, and they need a great team of health professionals. It distresses me to hear that some folk have had their pain ignored.

I welcome the steps that the Scottish Government has put in place to allow women to take whichever course of action is most suitable to them for their mesh complications, so that they can be rectified. I look forward to updates from the cabinet secretary on how the complex mesh surgical service is progressing.

Recent studies, including from the Royal College of Surgeons, suggest that the risk of chronic pain following an inguinal hernia repair is similar, regardless of whether mesh is used. Prior to the use of mesh in hernia surgery, recurrence rates of herniorrhaphy were extremely high—10 to 20 per cent in some studies—and there is little doubt that mesh use has dramatically improved statistics and outcomes for patients. According to the Royal College of Surgeons, most of the negative coverage of surgical mesh has focused on post-operative pain issues. The RCS says that there is a danger that the coverage of the issue may be taken out of context.

The original reports of mesh complications featured gynaecological surgery, which is entirely different from patients having a groin or other abdominal hernia repair. In a report published by the Scottish Health Technologies Group, there are a number of recommendations for NHS Scotland, which are underpinned by evidence.

The clinical evidence supports the continued use of surgical mesh as an option for elective repair of primary ventral, incisional and primary inguinal hernias in adults in Scotland. Although patient preference might be for a non-mesh or suture-only hernia repair, access to alternative hernia management options should be available. Those will depend on the patient, the size of the defect—or even the size of the patient—the assessment, the diagnosis and the specific surgical or non-surgical recommendations that need to be made.

The report makes it clear that all elective hernia repairs should be preceded by detailed discussion between the patient and the surgeon as part of an informed consent process. I agree with Alex Cole-Hamilton on that. It is important to ensure that such discussions include the benefits and risks of surgical and non-surgical approaches to hernia management, including the fact that neither mesh nor non-mesh repairs such as the suture method are risk-free procedures. It is also necessary to ensure that the risk of developing chronic pain following hernia repair, especially for patients with pain as their main presenting symptom, is put to patients. Such communication is absolutely crucial in enabling them to make informed consent decisions on their treatment options. The decision to use laparoscopic or open mesh repair should be based on the patient’s medical history, the characteristics of their hernia and the level of the surgeon’s expertise.

In addition, it is crucial that we monitor the effectiveness of surgical mesh data. Data on long-term outcomes from hernia repair in Scotland must be recorded at national level to inform future decision making. It must be aligned with the UK medical device information system—MDIS—and should include collection of patient-reported outcomes. I would welcome an update from the cabinet secretary on whether such data will be collected and, if so, how it will be reported.

It is also worth noting that the NICE guidelines recommend laparoscopic surgery as one of the treatment options for the repair of inguinal hernia. I underline that the choice between unilateral and bilateral methods involves assessment and diagnosis of the patient. Section 1.2 of the NICE guidelines states that to enable patients to choose between open and laparoscopic surgery by either the transabdominal preperitoneal or the totally extraperitoneal procedure—the latter is my favourite, by the way—patients should be fully informed of all of the risks. The international guidelines for groin hernia management, which have been developed by the HerniaSurge Group, show that it conducted a thorough review of hernia repairs, leading to 136 statements and 88 recommendations on best practice for hernia repair. It is worth exploring its evidence and guidelines.

Last Thursday, I spoke to Mr David Sanders, consultant upper gastrointestinal surgeon at North Devon district hospital in Barnstaple, who is also president of the British Hernia Society. He gave me lots of information to take away. When the deputy convener closes the debate, I will be interested to hear whether the committee will go on to seek the input of the society, one of whose members is right here on our doorstep in Edinburgh.

I thank the petitioners for bringing the issue to the Parliament. I underline that any decision that we might take in future must be based on the best available clinical data and evidence.

Does Meghan Gallacher agree that anyone who is experiencing complications of inguinal hernia repair or any mesh implant should be looked after by a caring, compassionate, kind and competent multidisciplinary team? We need to consider that issue and move forward on it.

We are talking about mesh. There is so much choice of mesh that is implanted. Does Sandesh Gulhane agree that the data that we would get from that might—based on the properties of the mesh that is used, such as the type of filament, the tensile strength and the porosity—help us to determine which mesh leads to specific complications such as pain?

The Shouldice clinic has caveats around issues such as weight loss and stopping smoking and alcohol—it is very selective about the patients that it takes for its non-mesh repair. Do you not agree that it is kind of difficult to compare that with the patient population in Scotland?

Will the member give way?

Absolutely. From the conversation that we had in the Health, Social Care and Sport Committee, I picked up that issue directly. We have taken action locally, and the alcohol and drug partnership team is well aware of the issue. It took action, and that issue has been dealt with. I thank Sue Webber for raising that issue.

I am keen to explore whether mandatory education related to stigma will add to Scotland’s work to ensure that people can access the treatment that they need without prejudice and judgment, and I hope that we can make progress. That is really important, based on my experience as a nurse and a nurse educator and on hearing conversations involving people whom I worked with in the past.

Peer navigators and peer support workers are also crucial in supporting people in treatment and in overcoming stigma. Those workers can and do make a difference to people’s lives. The “Changing Lives” report notes that the

“provision of navigator services across Scotland is patchy. Coverage in the central belt is good, but rural areas are less well catered for.”

I know that the minister is very much aware that issues in rural areas must be addressed, and I know that she has engaged with the Dumfries and Galloway and Scottish Borders alcohol and drug partnerships and NHS boards. I welcome that.

The expansion of navigator services nationally, supported by a comprehensive framework, standards and guidance, might help to remove the postcode lottery that many individuals now face in accessing services. Community-based services that link to the hospital navigator service are necessary, and knowledge of local areas is imperative for navigators.

I absolutely welcome and endorse the vital work that We Are With You is conducting. It uses the peer support model. I met the local team at the Buccleuch Street centre in Dumfries just last year. I ask the minister for a commitment that peer support services will be supported and expanded, particularly in rural areas.

In the minister’s statement to Parliament in November, she stated that she wanted to expand the scope of the MAT standards so that they include treatment options for benzodiazepines. I am aware that there is current research regarding a naloxone equivalent for benzodiazepines, and I would be interested to hear an update from the minister on treatment options for benzos. Obviously, that doesnae have to be today—I know that we are meeting soon.

The Westminster war on drugs has been an abject failure. Instead of solving problems, it has made them worse by stigmatising people who use drugs and creating barriers to tackling substance addiction.

The UK Government’s latest white paper—“Swift, Certain, Tough: New Consequences for Drug Possession”—sets out a three-tier framework for adult drug-possession offences. Those proposals are contradictory to the public health approach that is being taken in Scotland, and they could undermine aspects of the national mission if they are implemented here. I know that the Minister for Drugs Policy has written to the UK minister to express opposition to those policies being operated in Scotland. I challenge Conservative members to do all that they can, by making representations to their Westminster colleagues, to ensure that that policy does not impact on our approach in Scotland.

Without reform of the law, efforts to tackle the drugs crisis in Scotland will always be impeded. That cannot happen, so I welcome the steps that are being taken by the minister. I know that it isnae a quick fix; long-term work needs to take place. I know that the minister is working hard to reduce the number of drug deaths in Scotland, and I look forward to my continued engagement with her.

Any life lost as a result of drug harm is a tragedy, and the Scottish Government is absolutely committed to implementing approaches that we know work to save lives and reduce harm. The Scottish Drug Deaths Taskforce’s report, “Changing Lives”, contained 20 recommendations and 139 detailed actions for the Scottish Government to consider. The report represented almost three years’ work, with contributions from a broad range of people with expertise in the area, including those with living and lived experience—I know that the minister is focused on listening to examples from those people.

One of the areas that I have a particular interest in is tackling drug-related stigma, which requires action from all levels of government and, indeed, the wider population. The “Changing Lives” report states that “Stigma kills people”. The report focuses a lot on tackling stigma and discrimination. Stigma is not only damaging to individuals’ mental health and sense of self-worth; it discourages people from coming forward to seek the help that they need.

Stigma is particularly harmful in rural areas, in which communities are often very tight knit—Alex Cole-Hamilton has just mentioned that—and in which it can be harder to seek treatment because of the fear of prejudice and discrimination.

Section 3 of the “Changing Lives” report states:

“Primary care settings offer a key environment in which direct care and treatment can be offered to people”

who are affected by harmful drug use. Treatment services that are offered by, for example, GPs, dentists, community nurses, pharmacists and pharmacy technicians can also help to address issues around access to drug treatment services in rural areas and, therefore, reduce stigma.

I picked up the issue of stigma with NHS Education for Scotland and asked whether mandatory education could be created and delivered, perhaps in an online module, for all health and social care staff, including pharmacists and allied health professionals, as opposed to stigma education being provided just for those working in alcohol and drug services.