Health, Social Care and Sport Committee

Meeting date: Tuesday, December 14, 2021

Official Report 630KB pdf

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Transvaginal Mesh Removal (Cost Reimbursement) (Scotland) Bill: Stage 2

Our third agenda item is consideration of the Transvaginal Mesh Removal (Cost Reimbursement) (Scotland) Bill at stage 2. We have a substitute member: Marie McNair is substituting for David Torrance, who has given his apologies. I welcome the Cabinet Secretary for Health and Social Care to the meeting.

Before we start, I will briefly explain the procedure for everyone who is watching. There will be one debate on each group of amendments. ?I will call the member who lodged the first amendment ?in that group to speak to and move that amendment and to speak to all the other amendments in the group.? I will then call any other members who have lodged amendments in the group.? Members who have not lodged amendments in the group but who wish to speak should make a request to speak by typing R in the BlueJeans chat function at the appropriate point. Please speak only when I call your name.

If the cabinet secretary has not already spoken to the group, I will invite him to contribute to the debate. The debate on the group will be concluded by me inviting the member who moved the first amendment in the group to wind up. Following the debate on each group, I will check whether the member who moved the first amendment in the group wishes to press that amendment to a vote or to withdraw it. If they wish to press ahead, I will put the question on whether the amendment is agreed to.

If that member does not want to press the amendment to a vote, any member who wishes the amendment to be put to a vote should put an N in the chat box at that stage. If that happens, we will then proceed to a vote on the amendment.

If a member wishes to withdraw their amendment after it has been moved, they must seek the agreement of other members to do so. If any member objects, the committee will immediately move to a vote on that amendment.

If any member does not want to move their amendment when it is called, they should say, “Not moved.” Please note that any other member present may move such an amendment. If no one moves an amendment, I will immediately call the next amendment on the marshalled list.

Only committee members are? permitted to vote. Voting will take place electronically using the BlueJeans online chat function. As convener, I will provide instructions?on how and when to vote, and those will also be relayed via the chat box. If any member has requested a vote on an amendment by placing an N in the chat function when asked if that amendment is agreed to, we will then proceed to a vote on the amendment as follows.

First, we will record votes for the amendment. Any member who wishes to vote for the amendment should place a Y in the chat box when prompted to do so.? Secondly, we will record votes against the amendment. Any member who wishes to vote against the amendment should place an N in the chat box when prompted to do so.? Thirdly, we will record abstentions on the amendment. Any member who wishes to abstain on the amendment should place an A in the chat box when prompted to do so.

To enable the clerks to record votes accurately, please do not use the chat box for any other reason during votes. If you need to communicate with me or the clerks for any other reason?during that time, please use the private messaging group that we have set up.

Once voting has been completed, the clerks will check the result and pass it to me to read out.? Once I have read out the result of the vote, should you consider that your vote has been incorrectly recorded, please let me know as soon as possible. I will pause to provide time for that.

The committee is required to indicate formally that it has considered and agreed to each section of the bill, so I will put a question on?whether?each section is agreed to at the appropriate point.

I now begin stage 2 proceedings.

Section 1—Power for Scottish Ministers to reimburse costs relating to the removal of transvaginal mesh

Amendment 1, in the name of the cabinet secretary, is grouped with amendments 2 and 5.

We cannot hear the cabinet secretary. I can hear a bit of crackling, but that is about it.

Can you hear me now?

Yes.

Forgive me—I am not sure what is happening with my headphones. If there are problems, I will log out and log back in again, perhaps without the headset. I will not touch the set-up that I have now, so I hope that you will be able to hear me fine. Thank you, convener. I hope that you and all the other members are doing well this morning.

Section 1(3) of the bill currently defines “qualifying” mesh removal surgery as surgery for a person who,

“at the time the surgery was arranged”,

was

“ordinarily resident in Scotland”.

During the evidence sessions at stage 1, concerns were raised that the criterion was too narrow in scope. It was felt that the eligibility criterion should be widened to allow those who were not ordinarily resident in Scotland at the time that they arranged mesh removal surgery but were ordinarily resident at the time of the insertion of the mesh. During my appearance before the committee on 2 November, I gave an undertaking to consider that point further. In response to the stage 1 report, the Government agreed that the residence eligibility criterion is too narrow, and it undertook to lodge amendments on that.

Amendments 1 and 2 will therefore extend the eligibility criterion to include people who were not ordinarily resident in Scotland at the time of arranging their mesh removal surgery but who were ordinarily resident in Scotland when the mesh was inserted. I hope that the committee will welcome those amendments.

In respect of amendment 5, in the name of Carol Mochan, the bill is intended to allow reimbursement of those who have arranged and paid for mesh removal surgery. Where mesh removal surgery is arranged by a health board, it is, of course, provided free of charge, and a health board would not normally arrange surgery for a patient who was not ordinarily resident in Scotland. For those reasons, the Government cannot support amendment 5 but, as always, I am keen to continue to liaise and engage with Ms Mochan on her explanation of the amendment. We can, of course, revisit the issue if that is required at stage 3.

I move amendment 1.

I thank the minister for lodging amendment 1.

In moving amendment 5 and speaking to all the amendments in the group, I want to be clear that I am happy with the spirit of the bill and the collaborative nature of the approach that the Parliament has taken in moving forward through each stage to ensure that the women involved are reimbursed at the earliest possible time.

My amendment 5 would ensure the broadest scope for the qualifying residence element of the bill. As the minister stated, the committee has always agreed that that is the correct approach. Amendment 5 would ensure that any women who had mesh implant removal undertaken by the NHS but who were not ordinarily resident in Scotland would be included in the eligibility criterion, so that they could seek expenses and so on.

Towards the end of our discussions at stage 1, the committee touched on the rights of all women who have been adversely affected by transvaginal mesh surgery and who had any surgery in Scotland. Therefore, I lodged amendment 5 in the interests of clarifying the bill and ensuring that parts of it are not unclear for those who are affected.

As no other member wishes to speak, cabinet secretary, would you like to wind up and say whether you wish to press or withdraw amendment 1?

We have lost you again, cabinet secretary, so you might want to give that wire a wee shoogle.

What I could do—[Inaudible.]

We will pause the meeting for a couple of minutes to allow the cabinet secretary to log off and log back on again.

10:54 Meeting suspended.  

10:55 On resuming—  

We have the cabinet secretary back. I believe that you do not wish to sum up, cabinet secretary.

I am happy to waive that right, other than to say that I am happy to speak to Ms Mochan later if her amendment is not agreed to, to see whether we can give any further reassurance in relation to stage 3.

Amendment 1 agreed to.

Amendment 2 moved—[Humza Yousaf]—and agreed to.

Amendment 5 moved—[Carol Mochan].

The question is, that amendment 5 be agreed to. Are we agreed?

Members: No.

There will be a division.

For

Mochan, Carol (South Scotland) (Lab)
O’Kane, Paul (West Scotland) (Lab)

Against

Callaghan, Stephanie (Uddingston and Bellshill) (SNP)
Gulhane, Sandesh (Glasgow) (Con)
Harper, Emma (South Scotland) (SNP)
Mackay, Gillian (Central Scotland) (Green)
Martin, Gillian (Aberdeenshire East) (SNP)
Torrance, David (Kirkcaldy) (SNP)
Tweed, Evelyn (Stirling) (SNP)
Webber, Sue (Lothian) (Con)

The result of the division is: For 2, Against 8, Abstentions 0.

Amendment 5 disagreed to.

Amendment 4, in the name of Jackie Baillie, is grouped with amendment 3. As amendment 4 pre-empts amendment 3, if amendment 4 is agreed to, I cannot call amendment 3.

11:00  

I am grateful to the committee for the opportunity to move amendment 4 and to speak to amendments 4 and 3 in my name. The amendments flow from the evidence that the committee took prior to stage 1 of the bill.

The policy intention behind amendment 4 is straightforward. It extends the eligibility period for women who have arranged surgery for mesh removal. Members will recall that the original cut-off date that was suggested by the Government was 12 July 2021, and the committee was clear that, to capture as many women as possible, we needed to be as generous and flexible with eligibility criteria as possible, and we did not want any unnecessary barriers to be placed in the way of women accessing reimbursement. At the time, the cabinet secretary said that he would give the matter further consideration, so here I am with my two amendments.

Amendments 4 and 3 have the same effect, but achieve the desired outcome in two different ways. It is very much for the committee to decide which it would prefer.

Amendment 4 places a provision in the bill to say that, in order to qualify, any removal surgery must have been arranged before royal assent. Amendment 3 stipulates that the date will be specified in the scheme but that it can be no earlier than the date of royal assent. Ultimately, the difference is whether members want to put the qualifying date in the bill or in the scheme.

I move amendment 4.

As no member wishes to contribute, I invite the cabinet secretary to speak.

I thank Jackie Baillie for lodging her amendments—and for being the only member whose backdrop shows that she is clearly in the festive spirit.

I am genuinely grateful to Jackie Baillie for lodging the amendments. Along with others, Jackie Baillie pressed the Government to consider whether it was right to have a cut-off date of 12 July, which is the date that we had in mind when I announced publicly the completion of the first stage of procuring an NHS referral route to private removal surgery. I thought that the arguments of committee members and, most importantly, the affected women from whom the committee took evidence were persuasive. I have always said that, ultimately, if the primary purpose of the bill is to bring justice to those women, their voices must be central to any of our deliberations.

I absolutely appreciate that there has been a delay since the announcement in July and that it has taken some time for contracts to be completed. That is not because of any lack of good will on the part of the parties involved—far from it; they have been engaging well and helpfully in negotiations. However, the fact is that the contract negotiations are complex. Having met a number of the women involved, I accept that the delay in completing those contracts has undoubtedly caused anxiety for women who have suffered for far too long, and the Government does not want those women to be penalised. The contract negotiations continue to make progress, but it is taking time to work through the intricacies around them.

I confirm now that the Government wishes to add its support for Jackie Baillie’s amendment 3. We hope, too, that there is a consensus in the committee and more widely that the scheme should not be open-ended. After the cut-off date passes, all the options put in place by the NHS, including referral to private providers, should offer women the support and choices that they need. We therefore need a date so that the scheme is not open-ended—I think that the committee would probably agree with that. The Government considers that it is reasonable for there to be an extension to the cut-off date so that the scheme can include time since July to around the time of royal assent.

I took notice of amendment 4, which Jackie Baillie summed up well. However, I think that amendment 3 is better, because it retains some element of flexibility. Given the uncertain times that we are in, it would be sensible to keep open the option of adjusting the cut-off date in case there is some unanticipated development.

As I said, good progress has been made on contracts with the two private providers, and we are confident that surgery in the independent sector will be available from early next year.

I thank Jackie Baillie for lodging amendment 3. I confirm again that the Government will support it and I hope that that support allows Ms Baillie to withdraw amendment 4.

I ask Jackie Baillie to wind up and press or withdraw amendment 4.

An important lesson in politics, as in life, is to quit while you are ahead, and I thank the cabinet secretary for his support.

Amendment 4, by agreement, withdrawn.

Amendment 3 moved—[Jackie Baillie]—and agreed to.

Amendment 6, in the name of Carol Mochan, is grouped with amendments 7 to 9.

In moving amendment 6, I clarify again that my amendments 6 to 9 aim to be helpful in ensuring that the spirit of the bill and the committee’s discussion are captured in the bill as passed.

Amendments 6 and 7 seek to add wording that will give clarity to section 1. The committee sought to ensure eligibility for someone who incurred costs in supporting a person to have treatment, and my amendments 6 and 7 would allow that to happen.

Amendment 8 would extend the bill to cover those who might have begun the process and, therefore, incurred costs but for whom, unfortunately, the process has been halted due to travel or surgery restrictions “relating to coronavirus”.

Amendment 9 is a simple amendment that lays out the meaning of coronavirus.

I seek the committee’s support for this group of straightforward amendments.

I move amendment 6.

I echo what Ms Mochan said about the collaborative and constructive approach to the passage of the bill. I will resist Carol Mochan’s amendments, and if they are not agreed to, I am more than happy to work with her between stages 2 and 3 to see whether we can resolve some of her concerns.

I am grateful for Carol Mochan’s explanation of the intention behind her amendments 6 and 7 and I assure her that the bill, as drafted, caters for the circumstances that she has in mind.

Section 1(4)(a) states that qualifying costs are

“as charged to or in respect of the person who underwent the surgery”.

The words “in respect of” already allow for expenditure by someone other than the patient to be taken account of and reimbursed. If a person who is not the patient has directly paid part of the cost of surgery, evidence of that expenditure can be submitted and considered for reimbursement as part of the patient’s claim.

As I noted in Parliament on 24 November, we expect that applicants might want to claim reimbursement of costs and then pay back any money that was made available to them or spent on their behalf by family members or friends. The draft scheme, which has been provided to the committee, includes some important details on that point.

Paragraph 17 of the draft scheme clarifies that money received from “public fund raising campaigns” must be declared in the application and might be deducted, but costs that have been met directly by another person may be included in an application. It will be for the recipient of any reimbursement to distribute the money that they receive. For example, if a sibling paid for the patient’s surgery, that expenditure could be included in the patient’s application, and of course, once the patient received the reimbursement, she could then repay her sibling.

I am also worried that amendment 7 could lead to people who have only a slight connection with the patient applying for reimbursement in relation to the patient’s surgery. I appreciate that that will not have been intended, but in general I think that it would make sense for applications to be made for or on behalf of the patient and their supporter and then to allow any private moneys to be repaid.

I hope that that clarification has been helpful to Ms Mochan and that, as a result, she will be content to seek to withdraw amendment 6 and not move amendment 7.

On amendments 8 and 9, I am, again, grateful for the explanation. I appreciate that the plans of patients hoping to arrange mesh surgery might well have been disrupted, particularly given the times that we live in, and my officials are aware of a number of such cases, as no doubt committee members, too, will be. However, the Government is not aware of any circumstances in which travel has been actively curtailed in the way envisaged in the amendments.

That said, we consider that—[Inaudible.]—in the draft scheme more than sufficient flexibility to deal with individual circumstance—[Inaudible.]

It looks like we might have lost—

—made impossible as a result of the decisions of foreign Governments, and it is expected that carriers will have either refunded the costs or offered—[Inaudible.]

Right. We will suspend briefly, because we have lost the cabinet secretary. We will need to check his connection and then bring him back in.

11:11 Meeting suspended.  

11:13 On resuming—  

We appear to have resolved our technical difficulties. Can I just check that we have the cabinet secretary before I move on?

Hi, convener.

Thank you. We heard your summing up on the amendments, cabinet secretary, so I call Carol Mochan to wind up and indicate whether she wishes to press or withdraw amendment 6.

I appreciate the discussion that we have had on the amendments and accept that there will be time before stage 3 to discuss the issues further and get things right for people. As a result, I seek to withdraw amendment 6.

Do you want me to go on, convener?

No, I will prompt you when we get to the other amendments.

Amendment 6, by agreement, withdrawn.

Amendment 7 not moved.

Amendment 8 moved—[Carol Mochan].

11:15  

The question is, that amendment 8 be agreed to. Are we agreed?

Members: No.

There will be a division.

For

Gulhane, Sandesh (Glasgow) (Con)
Mochan, Carol (South Scotland) (Lab)
O’Kane, Paul (West Scotland) (Lab)
Webber, Sue (Lothian) (Con)

Against

Callaghan, Stephanie (Uddingston and Bellshill) (SNP)
Harper, Emma (South Scotland) (SNP)
Mackay, Gillian (Central Scotland) (Green)
Martin, Gillian (Aberdeenshire East) (SNP)
Torrance, David (Kirkcaldy) (SNP)
Tweed, Evelyn (Stirling) (SNP)

The result of the division is: For 4, Against 6, Abstentions 0.

Amendment 8 disagreed to.

Amendment 9 not moved.

Section 1, as amended, agreed to.

Sections 2 to 5 agreed to.

Long title agreed to.

That ends stage 2 consideration of the bill.

At our next meeting on 21 December, the committee will take evidence from the Cabinet Secretary for Health and Social Care on the budget and from Public Health Scotland on the common framework on public health protection and health security.

That concludes the public part of today’s meeting.

11:18 Meeting continued in private until 11:35.