Meeting of the Parliament

Meeting date: Tuesday, March 5, 2019

Official Report 1057KB pdf

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Mesh Implant Removal

The final item of business is a members’ business debate on motion S5M-15475, in the name of Neil Findlay, on Scottish Government declines help of mesh expert. The debate will be concluded without any question being put.

Motion debated,

That the Parliament notes with much disappointment reports that the Scottish Government has declined an invitation from the St Louis-based obstetrician-gynaecologist, Dr Dionysios Veronikis, to travel to Scotland to help safely remove transvaginal and other mesh implants from people in Lothian and across the country who are experiencing life-changing pain and disability and to train other surgeons how to do this safely; understands that Dr Veronikis has developed specialist skills and instruments that allow entire mesh implants to be removed with positive results; believes that full mesh removal is currently unavailable in Scotland, and notes the calls for the Scottish Government to reconsider this invitation and to do all that it can to help facilitate the offer that Dr Veronikis has made.

18:06  

I thank all members who signed the motion and allowed it to be debated, and my staff for their assistance with the event today.

For the past seven years, I have been campaigning alongside women who have been victims of the debilitating impact of mesh implants—women who have seen their careers end and their relationships break down, who have lost their ability to walk, who are forced to use wheelchairs, who have lost organs and who live in constant, chronic pain that affects every aspect of their lives. Some of those remarkable women are in the gallery tonight, and I salute their determination to be here today. [Applause.] All through the campaign, they have acted in the interests of others. They have tried to get mesh banned so that no other woman would suffer as they have suffered. There was no real hope, however, of any improvement for them—but there is now, and they are rightly calling for action.

Many of those women have asked their general practitioner or their consultant for help. When they do, they can be referred to consultant urogynaecologists based in Glasgow and Edinburgh at what have been described as Scotland’s mesh “centres of excellence”. Those centres, however, are often staffed by the very surgeons who implanted the mesh in the first place and who may be subject to litigation by the same patient. Therefore, they will not operate.

Women who are accepted for remedial surgery want and expect full mesh removal, and many have been told that that is what they will get. However, the reality is that, despite today’s press release from the Scottish Government, full mesh removal is not available in Scotland. Instead, mesh that is accessible to the surgeon when they operate is removed, with the rest left inside the body. I repeat to the Cabinet Secretary for Health and Sport that full mesh removal is not available in Scotland.

Unlike in the rest of the United Kingdom, surgeons in Scotland favoured the type of mesh implant that has caused the most crippling of injuries because of where it was placed and the fact that it is so much bigger.

In the United States, Dr Dionysios Veronikis has developed new techniques and specialist medical instruments that allow him to carry out successful full mesh removal. His pioneering methods, developed over a decade, mean that the entire mesh implant is removed carefully and in one piece. He then photographs the mesh and measures it to ensure that it corresponds with the medical record of what was put in. He does that so that he can confirm by photograph that the entire piece has been removed.

Previously, the Scottish national health service sent patients to see Dr Elneil at the University College London Hospitals NHS Foundation Trust. Dr Elneil carries out full mesh removal, but her list is closed and she has a huge backlog. Right now, we have a small window of opportunity to act—an opportunity that, if we do not take it, will be lost. That opportunity is the genuine offer from Dr Veronikis to come to Scotland to work up to six days a week to carry out full mesh removal procedures, and, critically, to train Scottish surgeons in his techniques. That is a serious and genuine offer that I urge the cabinet secretary to take up.

In correspondence with me, the cabinet secretary has rightly said that Dr Veronikis must be “of appropriate professional standing” and

“recognised by the General Medical Council”.

I am sure that none of us would disagree with that sentiment. It can be done. Dr Veronikis is a leading international expert in his field. Many surgeons want to learn from him, including Christopher Harding, who is one of the chairs of the British Association of Urological Surgeons and one of the UK’s top specialists.

Dr Veronikis has specialised in obstetrics and gynaecology since 2000 and female pelvic medicine and reconstructive surgery since 2013. He was awarded the distinguished surgeon award by the US Society of Gynecologic Surgeons in 2018 and he has a hugely impressive CV. He could quickly be registered as what the GMC calls a “visiting eminent specialist”, which would mean that he could complete the GMC registration process. Therefore, registration is not a barrier to his coming here.

The national health service would then need to cover his costs and provide an operating theatre for him to work in. It is my opinion that that could be financed by using some of the additional £27 million that the cabinet secretary recently allocated to waiting times reduction; after all, mesh survivors have been waiting not weeks but years for such treatment. These are exceptional circumstances that require an exceptional response.

If members are wondering what such an action would deliver, they need look no further than the Parliament’s public gallery, because Dr Mary McLaughlin, a law lecturer from Ireland, is here. She has flown over because she wanted to be here to prove the impact of the full mesh removal that Dr Veronikis carries out. On 14 January, she paid £15,000 out of her own savings to go to the US for surgery. She had all 28cm of the mesh that had been implanted removed from her body. Within a few days, she had much more mobility and, within a few weeks, she was walking again. Today, she is so free of pain and suffering that she has travelled to Edinburgh as living proof of what the procedure can mean.

Let us compare that to Mary’s previous condition: she was unable to carry on with her job and was virtually bedridden; indeed, she was in so much chronic pain that she could not even sit to enjoy Christmas dinner with her family. Just two months after her surgery with Dr Veronikis, she is well enough to travel here to be with us today. Her situation contrasts with that of Lorna Farrell, who is also in the gallery, Claire Daisley from Greenock and the many others who have ended up in even more pain and in wheelchairs following so-called full mesh removal in Scotland. They still have mesh inside them, despite being told that they would have full mesh removal. There are others who have been told that the mesh implant that they were given cannot be fully removed here. The reality is that Dr Veronikis can do it and he is offering to come to Scotland to train our surgeons in how to do it.

The decision whether to take up that offer lies with the cabinet secretary and no one else. I never beg Government ministers, but I implore the cabinet secretary to do the right thing and give these injured women the best treatment that is available. They have lost so much, and they should not have to travel to the US or elsewhere, as some are having to do. They are having to beg, borrow or steal, or to use their life savings, to buy treatment. The cabinet secretary has the opportunity to act and to change lives. She has the chance to do the right thing. The alternative is that the women we are talking about will be left living a life of pain and misery, with careers and relationships lost, and they will face a lifetime of medical costs. I believe that, collectively, those costs would far outstrip the cost of bringing Dr Veronikis to Scotland.

These women had the meshes implanted in Scotland. The recommendation for the procedure was made in Scotland. All they ask for is the realistic opportunity to have this dreadful material removed from them in Scotland. [Applause.]

Thank you very much. I say gently to members of the public in the gallery that I understand why they are applauding but it is not permitted in the Parliament.

Many members wish to speak so I ask members to restrict their speeches to four minutes to allow us to get through everybody and to allow the cabinet secretary time to respond.

18:15  

I congratulate Neil Findlay on obtaining this members’ business debate on this vital and serious issue. I think that everybody in the chamber is absolutely united around the need to make sure that the NHS in Scotland does the right thing by these women, whose lives have been so badly affected as a result of botched mesh implant procedures or botched devices—or, in some cases, both.

It is estimated that about 1,000 women are in a very bad place as a result of mesh implants, and most of them think, probably rightly, that the only way to deal with the problem is to remove the mesh. I think that a lot of clinicians agree with that. I have a constituent who has suffered for the past 10 years and has been told that she cannot have the mesh removed because no one can be sure how and where the mesh has embedded itself internally in her system.

The issue is very serious indeed. The key point is that, for many women, removal of the mesh is the last-chance saloon for them to try to recover at least some of their health. The question is how best we can address that.

Some women have had the mesh removed—partially or even entirely—in Scotland. However, it appears that the new technology and techniques pioneered by Dr Veronikis in St Louis in the United States are on a level of their own. Performance appears to be consistent, of a high quality and extremely effective. Clearly, we need to be sure that such procedures can happen for our people here in Scotland.

Dr Veronikis uses microsurgery, and an important point is that he also uses translabial ultrasound, which can locate the mesh before surgery. In the absence of that particular type of ultrasound, mesh removal surgery is essentially being done blindly and only partially.

There are other major benefits to the new techniques and technology. The operation can be conducted through the groin in addition to the vagina; in many cases, that allows for better access to full mesh removal in one operation.

My worry is that if we do not do something in Scotland, many women will be so desperate they will end up spending their life savings and getting into debt to go to America to get the procedure done. Every avenue should be explored with their health boards, their consultants and the NHS to make sure that they can get access to the service in Scotland through Dr Veronikis.

Whether or not Dr Veronikis does procedures here, it is really important that he comes to train people in Scotland on the new techniques and technology so that, after he goes home, we have the capacity—where appropriate and where required—to continue to provide full mesh removal for women in Scotland using the new techniques.

We need to look at how we can achieve that, because we owe it to these women to try to improve their lives. In many cases, that can happen only with full mesh removal.

18:20  

I thank my Lothian colleague Neil Findlay for securing the debate. Once again, I commend him, Jackson Carlaw and Alex Neil for their campaign and their on-going work to deliver justice for mesh survivors. I welcome to the public gallery many of the women who, along with their families, have been affected by the mesh scandal. As a co-convener of the Parliament’s cross-party group on chronic pain, I have met many of the women who have been affected, as they have attended our meetings and shared their personal stories. We should pay tribute to each and every one of them.

The debate is a welcome opportunity to consider how the Scottish Government and our NHS should work to meet the needs of mesh survivors and, for those seeking full surgical removal, how that is being achieved in Scotland today and will be achieved in the future. When I was preparing and researching for the debate, more and more questions seemed to arise when I looked at the details of the proposals in Scotland and the availability of operations to achieve full mesh removal. TVT-O mesh implants were historically used in Scotland twice as much as anywhere else in the UK, and the issues with removal are well known and documented.

I therefore ask the cabinet secretary to confirm a number of key points in responding to the debate. How many mesh removal operations have been undertaken in NHS Scotland to date, and have those operations involved partial or full removal? In relation to a point that Neil Findlay made, how many of our health boards are putting aside funds for the surgery? In addition, how many surgeons in Scotland today can undertake full mesh removal?

Our Scottish NHS needs to build capacity now and in the future to deliver surgery to achieve full mesh removal. I fully understand and appreciate the disappointment and anger that exist among mesh victims, which have been caused by the Scottish Government’s decision to decline the offer by Dr Veronikis to travel to Scotland to work with the NHS here. As Neil Findlay outlined, Dr Veronikis has developed techniques for carrying out full mesh removal, and NHS Scotland has an opportunity to learn from that work and to develop new procedures for the complex removal of mesh, which is a rapidly developing area. As Alex Neil said, in such a vital area, we cannot fall behind. We cannot—and must not—let Scottish patients be at the back of the queue for mesh removal.

Does the member agree that part of the issue is about rebuilding trust and confidence in the health service, as a lot of women feel very let down, and that, in carrying out the procedures, the confidence that would come from having an expert to support the system is important?

I absolutely agree. The fact that we are having this debate shows that we need to do more. We have had debates on the scandal, but we need to right the wrongs.

Neil Findlay’s motion calls on the Scottish Government to reconsider the invitation and to work to facilitate the genuine and positive offer that has been made. I hope that, in closing, the cabinet secretary will respond positively to that offer.

Another important issue that has been raised with me and that has been mentioned in the debate is the need for progress on translabial ultrasound scans.

It is clear, from the on-going issues and debate, that the Scottish Government needs to develop a sustainable plan for the surgical removal of mesh implants. We also need significant improvements in the help that we provide to mesh victims and their families. I therefore hope that the cabinet secretary will genuinely rethink the offer that has been made to NHS Scotland. We must never lose sight of the fact that Scottish mesh survivors are seeking solutions to address the life-changing injuries and chronic pain that mesh implants have caused them. SNP ministers should consider every offer of support and the extension of the hand of friendship to start the process of righting the wrongs of the mesh implant scandal.

18:24  

I thank Neil Findlay for securing this important debate and for his tenacious campaigning alongside the courageous women who have spoken out about mesh implants, many of whom are in the public gallery today. I pay tribute to them all. I also thank my colleagues Alex Neil and Jackson Carlaw for their cross-party commitment to the issue.

I was at the press conference that was held earlier today, and I am not embarrassed to say that I was moved to tears by the women’s painful and harrowing stories. I join others in pleading with the cabinet secretary to accept help from the surgeon who is offering to treat them. Scotland’s mesh survivors are locked in a living nightmare, but, despite their own pain and loss, they have been campaigning for years so that other women do not suffer the same fate as a result of the use of barbaric mesh implants. Many have debilitating symptoms including chronic pain and loss of mobility. As Neil Findlay has said, today—after years of selflessly campaigning for other women—they are asking for something for themselves. There is a glimmer of hope. However, it is galling that the women have been put in the position of having to ask—or beg—for help. As one of them said earlier today, in committee room 3:

“They got these implants in Scotland, and the damage was done in Scotland, so the damage should be repaired in Scotland.”

The mesh survivors have been let down time and again. They have had to become experts in their own conditions when medical advice has failed and Government interventions have been lacking. Today, one campaigner described her feelings of frustration and—even more upsetting—of having no self-worth. When her mesh symptoms were explained to a doctor, they were dismissed and she was told that she had mental health problems. Understandably, mental ill health can occur as a result of chronic pain, but it is simply cruel to blame it as being the root cause of the pain.

I am the convener of the cross-party group on women’s health, and I have heard many women, including campaigners on endometriosis and lipoedema, say that they, too, have had their symptoms disregarded. If the mesh survivors have taught us anything, it is that, as a society, we must start valuing women, believing them and listening to them.

With Dr Veronikis offering to come to Scotland to treat women by completely removing mesh, the campaigners now have a real chance to see their conditions improve and to have hope for the future. Alex Neil is absolutely right in saying that the issue is not simply about Dr Veronikis coming to perform the operations: we would have to take the learning from his visit and use it to train our own staff. As we all know, the problems that are caused by mesh are not just an issue in Scotland but constitute a global scandal.

The mesh campaigners—not just those who are here tonight, but hundreds of women across Scotland—have been holding each other up. We have heard at first hand from Dr Mary McLaughlin, who has come over from Northern Ireland, about the transformative difference that the treatment can make. To Scotland’s mesh survivors, her story is one of hope. Like Neil Findlay, I am not too proud to stand here and beg the cabinet secretary to use her power to make that hope a reality for those women.

In conclusion, I pay tribute to the campaigners and their families. I add my voice to Neil Findlay’s and to those of other colleagues from across the chamber. The mesh survivors deserve to have the treatment. I hope that, in her closing remarks, the cabinet secretary will commit to allowing that to happen.

18:28  

I, too, thank Neil Findlay for giving us the opportunity to debate the subject. I also thank Alex Neil and Jackson Carlaw for their long-standing commitment to the issue.

I will never forget meeting the mesh survivors when they came to the Parliament in 2017. A group of women who had undergone surgery to address incontinence had found themselves requiring crutches and wheelchairs, and they were no longer able to lift their beloved grandchildren. I met a woman and her husband who spoke openly of having to deal with 24-hour-a-day incontinence. I also spoke to women who had had to resign from important jobs or who could no longer care for the people they loved. Such personal impacts and experiences, which were shared openly with politicians and others, cannot be allowed to fall on deaf ears.

Today, Irish mesh campaigner Dr Mary McLaughlin came to the Parliament to share her story. As we have heard, she was operated on by Dr Veronikis and the outcome has been transformative. As party spokespeople, parliamentarians and empathetic human beings, we need to act. When there is an increase in knowledge, experience and developments in techniques and instrumentation to remove implants, we must use those. We cannot rely on individuals finding the money—it is a prohibitive sum for far too many—so the Scottish Government must step in and help. We can all appreciate how infuriating and frustrating it must be for women to know that there is now a potential solution and that the excruciating pain that they live with might end but to have to watch, wait and hope that, somehow, they, too, might be helped.

It is clear that there is consensus across the chamber that we must do all that we can to help women whose lives have been destroyed by implants. There is also debate about how comprehensive mesh removal in Scotland is. Neil Findlay said that women whom Dr Veronikis treats are given evidence of full mesh removal—it is measured and they see photos. Given how psychologically damaging it must be for a person to have something inside them that they want to be removed, I can see why that evidence is really important.

I would be grateful if the cabinet secretary were to confirm whether full mesh removal is available in Scotland and how much evidence those who have that procedure receive. I would also be grateful if she were to confirm that any barriers that there might be to learning from Dr Veronikis can and will be removed. In this age of global knowledge exchange, surely we must strive to learn from experts in all fields.

Mesh survivors have had to campaign too long and too hard for a ban on mesh. I have absolutely no doubt that these inspirational and brave women and their families will campaign for access to full removal, but have we not already asked far too much of them?

18:31  

I thank Neil Findlay for giving me the chance to raise Bobbie Dailly’s case. She is a very brave woman who lives in the north of Shetland. For 20 years, she has lived with mesh inside her body. She cares for her son, who is 32 and has Down’s syndrome, and she puts up with excruciating pain—Alison Johnstone rightly referred to that—every day of her life.

I cannot be the only constituency member for whom everything else is put into perspective when someone such as Bobbie comes to see me. All the stuff that we deal with as politicians is as nothing in comparison with the hell that someone who has had mesh inside them for 20 years of their life has gone through.

Bobbie is in Aberdeen this week for a magnetic resonance imaging scan and she has an appointment at a Greater Glasgow and Clyde NHS Board hospital later this month. She wants all that stuff—all of it—out of her body. When she most recently came to see me, she said that, like thousands of other women, she never gave consent for medical procedures that involved mesh; she was never informed of the possible and actual consequences of mesh; she never gave consent to be in constant pain all her life and for her life to be made a misery; and she never consented to lacerations of vessels, nerves, organs including the bladder and the bowel, transitory local irritation of the wound, mesh extrusion and so it goes on. She gave me a really tough list to read.

Has Tavish Scott’s constituent even guesstimated how much all her treatment has cost the NHS to date?

I am not sure whether this applies to Mr Scott’s constituent, but I ask members not to get into cases that might be the subject of civil actions. I caution members that cases might be sub judice.

You do not need to caution me about legal action in this case, Presiding Officer.

That is fine—thank you.

I take Neil Findlay’s point, but the answer is no—Bobbie has better things to do than worry about how much the treatment has cost. She has to worry about how to care for her son, never mind dealing with all that.

My point was that the cost that the NHS has incurred could easily pay to bring the doctor to Scotland to carry out procedures.

I entirely take that point.

I will make two other points, both of which are on issues that Neil Findlay reflected on. First, individuals are facing not only physical pain and pressure, but psychological pressure. I am really concerned that the NHS is trying to force women to see the same clinician in the same hospital where they had the treatment that caused all the difficulties in the first place. If someone who is going through such pain in these circumstances asks for a different clinician at a different hospital, that is what should happen. If the cabinet secretary were to help people to do that, that would be a very important step.

Secondly, Neil Findlay mentioned the Government statement. I was concerned when I read:

“we would be happy to discuss with both health boards and professionals funding of additional education and training where a specific need is identified.”

I am a great admirer of Jeane Freeman—she is a very able politician and a great operator, which is badly needed in politics at the moment. I hope that she will reflect on her spokesperson saying in the statement:

“where a specific need is identified.”

That is what this Parliament has done. It has done that through the campaigning of Jackson Carlaw, Alex Neil and Neil Findlay; it has done that through colleagues across the political parties. We need leadership from the Government. Bobbie Dailly deserves to have all that mesh out of her body. Will the Government please make sure that that now happens?

18:36  

I thank Neil Findlay for bringing this members’ business debate to the chamber and pay tribute to his passionate support of mesh victims not just in Scotland, but throughout the world.

Tonight, we are debating an issue—I think that this is beyond dispute—that will go down in history as one of the greatest medical injustices ever suffered by women. Cross-party consensus has existed since the horrendous problems with mesh implants came to light, which resulted in the ill-fated moratorium on implants in 2014, instigated by the then health secretary Alex Neil, who continues to fight long and hard for justice for mesh victims. We now have a ban on implants, brought in by the current health secretary Jeane Freeman, which was warmly welcomed by campaigners. However, this is not the time to dwell on the history of this scandalous issue.

Neil Findlay’s motion says that the Scottish Government is refusing to bring renowned mesh specialist Dr Veronikis to train surgeons and perform mesh removal operations in Scotland. I look forward to hearing the cabinet secretary’s response to the motion.

Nothing should be off the table. This should not be a political issue, and I am glad that we have always had consensus across the chamber on this matter. The many women in the gallery today could not care less about politics; they just want respite from the daily struggle that they have endured since their operation was performed.

The journalist Marion Scott did not get involved with the campaign because it is a good story; she got involved in order to get answers about why a procedure that women were told would help them has ruined their lives.

The women have been badly let down by health boards, the medical establishment and a disgraceful flawed review. In the past, I have called the women brave and courageous—which they are—for taking on this fight, but I do not think that that is any comfort, because I am sure that most days they do not feel brave or courageous.

Last Friday, when I met directors at Greater Glasgow and Clyde NHS Board about a constituency matter, I raised the issue of Dr Veronikis coming to Scotland. They told me that exchange training visits between surgeons happen regularly, and are reciprocal; our top specialists go abroad to train surgeons in other countries and many come here to do the same. I was also told that the visits take place under the chief medical officer’s direction, and that there is a budget for such visits. I found that to be very encouraging. However, as Neil Findlay said, anyone who is providing assistance to health boards must have appropriate GMC clearance. Dr Veronikis is not registered with the GMC, but I hope that a solution can be found to resolve that issue. I was encouraged by Neil Findlay’s comments in that regard.

I urge health boards to consent to finding a way to bring Dr Veronikis here for the sake of the sufferers and the benefit of our surgeons who wish to expand their knowledge and skills. The bottom line is that we should be performing such operations in Scotland.

The member makes extremely interesting points. Does she agree that the chief medical officer should take an interest, particularly since she has recently set out her feelings on women’s health inequalities in Scotland?

I agree. This is an ideal opportunity for the CMO to demonstrate that she means what she says about women’s health inequalities. There could be no greater cause than this one.

I echo Alex Neil’s call for a global conference to be held in Scotland. We can lead the way in the fight for justice. We have the best campaigners in the world in the mesh survivors group, our country has a reputation for fairness and we must always stand united with mesh sufferers here and throughout the world.

Due to the number of members who still wish to speak in the debate, I am minded to accept a motion without notice, under rule 8.14.3, to extend the debate by up to 30 minutes. I ask Neil Findlay to move the motion.

Motion moved,

That, under Rule 8.14.3, the debate be extended by up to 30 minutes.—[Neil Findlay]

Motion agreed to.

18:40  

I want to record my thanks to Neil Findlay, Jackson Carlaw and Alex Neil for their commitment to campaigning for justice for mesh victims. Of course, it goes without saying that I thank all the campaigners who have worked tirelessly and passionately to get these women the justice that they deserve, and I welcome them to the public gallery.

As shown by the strength of feeling in the chamber, there is a great deal of disappointment among mesh victims over the Scottish Government’s decision to decline the offer that has been made by Dr Veronikis. One can only imagine the pain that victims face on a daily basis, and the worry that is experienced by those who are yet to learn whether the mesh will have the same life-altering impact on them that it has had on the women whom they have met and read about.

I hope that, today, we can have a frank and honest discussion about the best way forward for mesh victims. If it is feasible for Dr Veronikis to make the journey to Scotland, that option should of course be fully explored.

No one wishes to see mesh victims suffering needlessly; I have no doubt that we are all in agreement on that today. The journey to the stage that we are at, at which we are beginning to consider solutions, has been a long and difficult one. The mesh, which can be used in relation to pelvic organ prolapse and incontinence in women, has been used in more than 20,000 women in Scotland over the past 20 years. Although there have been a number of high-profile cases in the media, the number of women who have been affected is, unfortunately, unknown.

The potential side-effects of the mesh are truly awful. They can range from chronic pain and loss of sexual function to major complications such as the implant intruding through the bladder or bowel, which can necessitate the removal of organs. The mesh can shrink or move inside the body, slicing through nerve endings, tissue and organs, and it is very difficult or sometimes impossible to remove it.

The offer that has been made by Dr Veronikis is, therefore, appealing, and I can completely understand why it would no doubt have given hope to people who have been affected and those who are worried about the future.

The Scottish Conservatives have been on the side of victims from the start, led by Jackson Carlaw. In 2017, 97 MSPs signed a pledge opposing any whitewashing of the mesh report. Scottish Conservative MSPs have called for an end to damaging mesh procedures in Scotland, and we welcomed the halt to mesh procedures that was announced by the cabinet secretary last September. That support will continue, which is why we call on the Scottish Government to give full consideration to the offer that has been made and, if feasible, given the necessary checks, to proceed.

I, too, attended Neil Findlay’s press conference this afternoon, and it was truly heartbreaking to hear the stories of how the mesh has completely ruined these women’s lives. One lady told us that she was on the list to have both her bowel and her bladder removed. Another informed us that, having been told that she would go back to work in a university six weeks after having the operation, it is now 10 years later, and she has never returned.

Hearing the story of Dr Mary McLaughlin, a mesh victim from Belfast who paid for an operation on herself by Dr Veronikis, was eye-opening, and I can completely understand the frustration of the women who want the same. It is only right that we explore the option in full and listen properly to the concerns of the women who are affected so that they do not feel that they are fighting a constant uphill battle to be heard.

I finish by again thanking the campaigners who have fought hard on this issue. This is a really difficult situation and, although we are entering uncharted territory, it is important that decisions are made with caution and care. All of us in the chamber want the best possible course of action to be taken, which is why the Scottish Conservatives are calling for the offer to be fully explored. We owe that to mesh victims. Hearing their stories again this afternoon reaffirmed that for me.

18:44  

I commend Neil Findlay for securing the debate, and for his tireless work to uncover this women’s health scandal and get help and justice for the women victims. Other members, including Jackson Carlaw, Alex Neil and members of the Public Petitions Committee, have also worked for justice on behalf of mesh survivors and campaigners.

The survivors have been fighting for others; now they have hope for themselves. I reiterate that important point, which has already been made in the debate. I particularly commend the Sunday Post reporter Marion Scott, for her fearless determination to expose the issues and to support the brave women who are involved in the mesh campaign.

We know that mesh is supposed to be banned from use following the lengthy campaign, but we still hear stories about it being used—in some cases without the knowledge and consent of the patient, which is worrying. We need to remind ourselves that the mesh that we are discussing can carry with it serious complications, including chronic pain, sexual problems, mesh exposure through vaginal tissue and injury to nearby organs including the bladder and bowel.

As Miles Briggs said, a few months ago, Marion Scott and some of the mesh campaigners spoke at the cross-party group on chronic pain, of which I am a co-convener, to highlight the on-going problems that women are suffering, and to seek help and support. For many women, that must now mean having the mesh properly and fully removed.

The Scottish Government today said that full mesh removal is already being provided by specialist staff working in Scotland. We really need clarification on that, because it is strongly disputed and, it seems, the only option that is currently available in Scotland for many women sufferers is partial removal, which often makes the situation worse and can cause autoimmune disorders. I am sad to say that we know how autoimmune disorders are treated as a result of the thyroid scandal, which is another women’s health scandal to add to the list that Monica Lennon put on the record.

Removal did not go well for Lorna Farrell, from whom we heard at the press conference today, and whose story was in last week’s Sunday Post. Lorna is now a wheelchair user, following supposed removal of mesh by surgeons in Scotland. She says that her specialist admitted that they cannot fully remove mesh implants of the type that has been most used in Scotland. Not only does Lorna now have increased pain, but has mesh left inside her.

Claire Daisley’s story was also outlined in the Sunday Post. She, too, is in a wheelchair after removal surgery, and is waiting to have her bowel and bladder removed. She hopes that it is not too late for other options.

Many women have been crippled with pain following mesh implants. I understand that some mesh was not even thoroughly tested before it was used on women. Now women are being further damaged by botched efforts to remove it.

Safe removal is the very least that our NHS should be providing, and it could do so, because, as we heard from Neil Findlay and others, Dr Veronikis, who is an eminent specialist from the US, could not only perform life-changing surgery to reverse the damaging procedures that were performed on Scottish women, but could train surgeons here to perform the procedure. That is important. There does not seem to be anything standing in the way of that except the Scottish Government not having agreed to it.

As we heard, Mary McLaughlin from Northern Ireland had a successful removal procedure by Dr Veronikis. She has her life back. At today’s press conference, mesh survivors said that they want to be Mary. Of course, Mary had to pay for the procedure herself: there is a divide between those who have personal funds that they can get together and those who do not. Women who have lost their livelihoods and depend on benefits cannot pay to go to America for surgery. Surely, in that case, that surgery must come to them. Mesh survivors campaigned for seven years to have mesh banned. They cannot be expected to campaign for another seven years for life-changing surgery to remove the mesh.

Jeane Freeman can stop this scandal: she can give women their lives and jobs back. She must do that. Not only would it be right for the individual women, it would be much more cost effective in the long run for the NHS, and for society as a whole.

18:49  

I congratulate Neil Findlay on securing this members’ business debate.

In my nearly 12 years as an MSP, constituents have raised many difficult and challenging issues with me, but I will certainly never forget what one constituent told me in 2017 about the pain that she lives with daily because she had a transvaginal mesh implant. It has affected my constituent’s ability to do simple tasks that most of us take for granted. It has become very problematic for her, and she would not wish the pain and suffering on anyone.

Other women in Inverclyde have contacted me about the issue and informed me of similar things that they have to deal with day-to-day. I acknowledge and appreciate the devastating impact that mesh implants can have on a person’s life. However, even in the most difficult of situations, politicians sometimes need to take a wee step back to try to take a balanced view. As the briefing for today’s debate by the Scottish Parliament information centre notes, it has been acknowledged that damage from transvaginal mesh is not inevitable and that, for some women, the procedure has been successful and they continue to be pain free.

Notwithstanding that, I highlight the suffering that I have mentioned. One woman being negatively affected by a mesh implant is one woman too many. It is clear that the problems of mesh implants have affected far too many women in Scotland, so something must certainly be done to improve the situation.

In September last year, Jeane Freeman, as Cabinet Secretary for Health and Sport, took the bold decision to ban, in effect, use of transvaginal mesh in NHS Scotland for pelvic organ prolapse and stress urinary incontinence. Some people might argue that the decision should have been taken earlier, but I am glad that the Government listened to the recommendations that were made by the Public Petitions Committee, which has been referred to. I welcomed the decision then, but we now have a new challenge, which is the issue that is in the motion that Neil Findlay has lodged, with regard to Dr Veronikis coming to Scotland to support patients who have mesh implants that need to be removed.

With approximately 1,000 women potentially needing implants to be removed, it appears that there is merit in Dr Veronikis coming to Scotland to help. I am not an expert, by any means, and whether Dr Veronikis comes here or Scottish women go to America to get assistance from him, I will not take the decision. However, the argument is very strong for Dr Veronikis coming here to treat women and educate our professionals so that Scotland’s NHS could deal with the situation in the future, rather than having to rely on bringing someone from America or elsewhere to deal with it. Teaching and educating our professionals is so important, in my opinion.

I would like measures to be implemented to help not just my constituents, but all the women in Scotland who need the assistance. The contributions from colleagues across the chamber have been extremely powerful in that regard. If there is a reason for Dr Veronikis not to come here to help my constituents and all the women of Scotland, I would like to be aware of it.

I am keen that our NHS obtain the assistance of that expert and deliver improved outcomes for many women in Scotland. In politics, we sometimes talk about inputs and outcomes: inputs are the money and outcomes are how it is spent. To me, the situation is very simple: the input is to get an expert to come over to help and the outcome is for women to have a better life that is free of pain. That is an extremely strong message. I encourage the cabinet secretary: regardless of whether it is for her or the NHS boards to decide, bringing Dr Veronikis over here would be extremely useful for all the women of Scotland.

18:53  

I am grateful for the opportunity to close this very important debate, and I thank Mr Findlay for bringing it to the chamber. I recognise that very many women have suffered—and continue to suffer—a significant amount of pain, distress, immobility and deterioration in the quality of their lives as a result of mesh complications. As others have done, I express my sympathy to them, but I know that that sympathy is of little use when their daily life is so marred by something that they thought would help them but that has made their situation worse.

Before I go any further, I want to recognise the tireless work of the mesh survivors group and of colleagues across the chamber—many of whom have spoken tonight—in making sure that these issues are front of mind. I remain convinced that the decision that I took last year to halt the use of transvaginal mesh for pelvic organ prolapse and stress urinary incontinence was and remains the right one. However, I am also convinced that a great deal of the evidence and impetus to make that decision came from those women.

It is right to turn now to the question of their situation and the complications and pain that they face. Let me repeat: full mesh removal is available in Scotland and photographic evidence is used in that procedure. It is clear that there is dispute about that. Therefore, before I go any further, I offer to discuss with Neil Findlay, Jackson Carlaw and Alex Neil—the three members who have prominently led the Parliament’s work on the issue—the evidence that I have to support that against the view, which women expressed earlier today and elsewhere and which may be expressed to me later, when I meet some of them, that that is not the case.

At the event today, I used this analogy about full mesh removal. I could come along with a piece of chewing gum and stick it in the cabinet secretary’s hair. I could then come along with a pair of scissors and quickly chop it out, or I could come along with an instrument that would remove that piece of gum from one hair at a time. That is the difference that we are talking about. If we do the former, we damage people’s tissue and nerves, leaving them in chronic pain. Taking Dr Veronikis’s approach, microsurgery removes the mesh in a single piece, with very little damage. Even if the cabinet secretary provides us with the evidence, it will not be comparing apples with apples.

I hear what Mr Findlay says. I would like him to wait until I have finished, so that he hears everything that I am going to say as well.

Does she accept that point?

I take the point that he makes, but he and I are not clinicians.

I never said that I was.

Let us proceed in as calm and reasonable a way as we possibly can.

Our specialist centres offer a range of treatments and, importantly, those treatments are considered on a case-by-case basis. The shared decision making and informed consent in that process are important. We touched on some of that last year, when I took the decision to end the use of mesh for the conditions that I mentioned.

I do not have all the detail that Mr Briggs asked for, but I will make sure that that is provided to him and to other members. The information that I have is that, after mesh removal procedures, photographic evidence is taken. There remain approximately 120 referrals to the service per year, and full groin dissections are currently performed at the rate of two per month. As I say, I will make available to him the other information that he asked for.

The clinicians who are involved in those two specialist centres are highly skilled and trained. Let me be clear—because this point has been raised—that GMC guidelines make it clear that no treatment should be refused to a patient because that patient either has complained or is engaged in litigation with the clinician involved. Should that be happening, I want to know, because that is absolutely contrary to GMC guidelines.

Like clinicians across our national health service, those clinicians are engaged in continually developing their skills and practice. As Rona Mackay rightly said, there is a process by which that happens. Across our health service, it is commonplace to exchange clinicians between one country and another to enable them to learn new techniques and to study the research and data that are gathered in order to improve their skills and understanding. There is a process to ensure that that happens. It need not be a lengthy or complicated process, but it is important nonetheless.

It is not for me, as the cabinet secretary, to decide what clinical practice or clinical learning should take place. That decision is for the clinical community to make in conjunction with the health boards and, sometimes, with the involvement of the Royal College of Obstetricians and Gynaecologists. I am really clear about what my job is.

Will the cabinet secretary give way?

Give me a second.

If that is considered by clinicians to be the right thing to do, my job is to help to make that happen.

Before I take Elaine Smith’s intervention, let me be absolutely clear for the record that I have not refused an invitation from Dr Veronikis. What I have said—Mr Findlay rightly made this clear in his opening speech—is that there is a process to go through and that, if the clinicians believe, or if the health board or the royal college believes, that something would be useful to them, my job is to help to make that happen where I can.

We have moved on slightly. I certainly hope that the cabinet secretary wishes to make it clear to the health boards that she wants the issue to be pursued.

However, the cabinet secretary did take a clinical decision. If she had not banned the use of mesh, clinicians in Scotland would still be using it. The clinical decision would still be to use mesh if the cabinet secretary had not taken the decision to have it banned.

I made that decision on the basis of clinical advice and clinical evidence. The point that I am making is that none of us in the chamber are clinicians.

I did not say that we are.

I am not arguing that Mr Findlay said that we are; I am simply trying to take us through the right thing for me, as the cabinet secretary, to do and where I need to get advice from in that regard.

Since I wrote to the cabinet secretary about the matter initially, has she initiated discussions? What has been the outcome of those discussions? How much further have we moved the issue forward in the intervening time? Is it today’s parliamentary debate that will ensure that those discussions begin?

No. Today’s parliamentary debate will not ensure that we begin those discussions. Members will remember, from the last statement that I made on mesh, that I talked about accountable officers, who are, in effect, our medical directors in our individual health boards. They met on 22 February and considered some of the follow-through from the exceptional circumstance protocol, the halting of the use of mesh in the procedures that I talked about, and the high-vigilance scrutiny and registry. There have also been discussions between me and the chief medical officer about whether additional expertise and techniques could be helpful to the specialist centres involved in Scotland. I will get to that point, but we will continue to see whether that is possible.

We have pursued another issue with the Medicines and Healthcare products Regulatory Agency—I believe that Mr Findlay and others know about that. Mesh needs to be proven to be safe, and we have pursued with the MHRA, which is the UK body that approves the use of mesh and other such devices, the evidence that it can offer us. We have pursued with it what evidence it has of the procedures that it went through in order to be assured of the safety of that particular product, and we continue to pursue that evidence.

I repeat: nobody needs to “implore” or “beg” me. I completely understand that the women involved rightly want the best possible response to the situation in which they find themselves. For many of them, that will require full mesh removal. With the clinicians involved, we—and I—need to look at whether additional training, expertise and learning can be provided by Dr Veronikis or others and what we need to do to ensure that that happens.

I have heard what has been said, and I respect absolutely what colleagues say. I remember being in the Parliament’s garden lobby the first time that the women who are affected came to the Parliament. With the chief medical officer and the clinical community, I will look at what further learning and inquiries on techniques—

Will the cabinet secretary give way?

No—the cabinet secretary must conclude.

Go on, Presiding Officer. Give us a minute more.

The cabinet secretary has now been speaking for 11 minutes. I can give her a little longer, but we will need to conclude shortly.

I appreciate that, Presiding Officer. I am almost finished.

My mind is not closed on the matter. It is not entirely my decision, but I will work with the clinical community and the chief medical officer, and I will have further discussions in that regard. I have not refused Dr Veronikis’s offer. It is not for me to accept that offer, but I will discuss with the clinical community how, in its opinion, learning and techniques could be improved and enhanced. We will do that.

Meeting closed at 19:05.