Meeting of the Parliament (Hybrid)

Meeting date: Wednesday, November 24, 2021

Official Report 891KB pdf

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Transvaginal Mesh Removal (Cost Reimbursement) (Scotland) Bill: Stage 1

I remind members of the Covid-related measures that are in place. Face coverings should be worn when moving around the chamber and across the Holyrood campus.

The next item of business is a stage 1 debate on motion S6M-02234, in the name of Humza Yousaf, on the Transvaginal Mesh Removal (Cost Reimbursement) (Scotland) Bill. I invite members who wish to speak in the debate to press their request-to-speak button now.

14:57  

I am pleased to open the debate on the Transvaginal Mesh Removal (Cost Reimbursement) (Scotland) Bill.

I would like first to thank the Health, Sport and Social Care Committee, which is so ably convened by Gillian Martin MSP, for its thoughtful consideration of the bill, its report and its support for the general principles of the bill. I am also grateful to the Finance and Public Administration Committee and the Delegated Powers and Law Reform Committee for their consideration of the bill. I want to take this opportunity to thank everyone who has taken time to express their views on the bill in evidence to the committees and to me directly.

In particular, I thank the number of affected women who have taken part in focus groups about the bill. I know that every member will agree with me when I say that it is because of the courage of the women affected that we are at this point. It should not have taken them having to retell their stories to get us here, but I am grateful to all those women who have, over the years, shared their experiences and helped to shape the bill.

It would be churlish of me not to mention the excellent cross-party efforts that have highlighted the plight of those women, in particular those of Jackson Carlaw, Alex Neil and Neil Findlay, the latter two of whom are no longer in the Parliament.

The bill that the Government presents today is a narrow bill with a limited function which, in all likelihood, will be directly relevant to only a very few people. However, it would be equally fair to say that the impact on those very few people will be very significant indeed.

The bill brings the Parliament’s attention back to the traumatic experiences of the substantial number of women in Scotland who have suffered pain and distress after having mesh implanted. Many of us have heard directly from women about the physical symptoms and mental distress that they suffered, which was often made worse because they felt that their experiences were not taken seriously enough when they sought help.

The Government and the national health service are working to improve the care that we offer to those women. In particular, in Glasgow, there is now a national specialist mesh removal service, which has been offering full mesh removal since July 2020, and, so far, has provided 33 women with mesh removal surgery.

At the Glasgow centre, new surgeons have been recruited, and there are now four urogynaecologists, which allows women more choice over who they are treated by and the option to be treated by a surgeon who was not previously involved in their care. The service also benefits from contributions from dedicated nurses, physiotherapists, pharmacy staff and a clinical psychologist.

I say clearly and unequivocally that I completely understand that a number of women have lost trust in our NHS. I will work hard, as will the service, to rebuild that trust. However, from having talked to a number of mesh survivors, I know that they feel that it is broken beyond repair. I am sorry for that.

Alongside the national specialist service, the Government and the NHS are working to make it possible for women to be referred for surgery in NHS England and in the independent sector. Therefore, women who are seen at the national centre who do not want surgery in NHS Scotland will have the choice to be referred to a specialist centre in NHS England or to independent providers. In July, I announced that two providers—Spire Healthcare in Bristol and the Mercy hospital in Missouri—had been selected to provide those choices.

Since the summer, NHS National Services Scotland has been working to finalise contracts. In particular, NSS has been seeking to make sure that arrangements for surgery are supported by other services that will meet emergency and wider medical needs. I appreciate that the wait since July has undoubtedly been frustrating for women who have already had to wait for a considerable time. However, I hope that the Parliament agrees that it is essential to have all the right care in place, particularly when women might have to travel some distance.

I know that I have now spent a fair bit of time talking about matters that are outside the scope of the bill, but those issues are important to the women affected and to members across the chamber.

With arrangements for referral to the independent sector planned, it seemed to the Government right to reimburse women who had already arranged mesh removal privately and paid out of their own pocket. Therefore, the bill before Parliament gives ministers power to reimburse the costs borne by women who, in the past, entered into private arrangements for transvaginal mesh removal surgery. Section 1 of the bill establishes that power. It gives power to reimburse the costs of the person who underwent the surgery and those of a companion, where there was one.

Together, sections 1 and 2 give the Government power to develop a scheme by which payments will be made, and they provide that the scheme be laid before the Parliament and published.

I will now address some of the issues that are raised in the committee’s report, to which I responded on Monday. The committee proposed that women who had mesh implanted in Scotland but then arranged to have it removed having moved out of Scotland should be eligible for reimbursement. The Government agrees with that view in principle and will lodge appropriate amendments at stage 2.

The committee has also asked the Government to consider whether there might be some change to the cut-off date before which arrangements for private surgery have to have been made in order to be eligible for reimbursement. At present, the proposed date is 12 July of this year, because that is the date on which the Government confirmed which providers had been selected as preferred bidders to provide surgery in the independent sector. However, I promised to further reflect on the matter, and I will do so in good faith. In the Government’s response, I explained that I will consider whether it is reasonable now to adjust that date, and I will confirm the Government’s position at stage 2.

I have also considered the committee’s implicit recommendation that the reimbursement scheme be made in regulations. On that point, the Government is not convinced. Making the scheme in regulations would involve further delay for women who we all acknowledge have already had to wait—in some cases for years—for reimbursement. In this case, I am not convinced that the merits of greater parliamentary scrutiny outweigh the priority of offering assistance to the women involved as quickly as possible. However, I appreciate that members and the committee want to understand how the scheme will operate in practice and, therefore, if the Parliament agrees to the bill at stage 1 today, as I suspect we will, I will make available a draft of the scheme to the committee before stage 2.

I hope that the committee finds the Government’s response to its report helpful and constructive and that the suggestions and compromises that we have made show our good faith. I should add that the Government will also reflect on today’s debate before we finalise our position on our stage 2 amendments. I look forward to considering important points of detail with the committee at stage 2.

I can only imagine the distress that has caused women to use their own funds—the amount of money involved has often been quite considerable—to seek private surgery for mesh removal. I have met a number of the women, both in my capacity as the Cabinet Secretary for Health and Social Care and as a constituency MSP. I suspect that every member who speaks in the debate—and probably every member of this Parliament—has had, at the very least, correspondence from a constituent about the matter. I am sure that every single one of us has been moved by the plight of the women.

I think that all of us can agree that it is wrong that women felt that their only option was to dig deep into their pockets for treatment. Some of them had to take out loans, and some of them had to borrow from friends and family. The Government is determined to ensure that women never have to feel that way again.

The successful passage of the bill will put in place a scheme that will ensure that the costs are met and that the women involved are no longer at a financial disadvantage. I very much look forward to working with colleagues across all parties to make that a reality. I appreciate the co-operation of the committee and its members.

I move,

That the Parliament agrees to the general principles of the Transvaginal Mesh Removal (Cost Reimbursement) (Scotland) Bill.

I call Gillian Martin to speak on behalf of the Health, Social Care and Sport Committee.

15:06  

Over the years, we have all heard countless accounts of the complications of transvaginal mesh surgery and its lifelong effects, even after the mesh has been fully or partially removed, as well as countless accounts of physical damage and countless accounts of psychological trauma. Many women have had countless years of suffering, and, for many, that suffering will be experienced for years to come.

As the convener of the Health, Social Care and Sport Committee, I am pleased to speak today on our report on the Transvaginal Mesh Removal (Cost Reimbursement) (Scotland) Bill.

I want to say up front that the bill could not, and does not, undo the physical or psychological trauma that the women have faced and continue to face as a result of mesh complications. The bill has been introduced for a specific purpose, as the cabinet secretary has just outlined. We, as a committee, support that purpose, which is to reimburse individuals who have paid to have transvaginal mesh removed from their body in private healthcare settings.

It is apparent to anyone who has listened to those who have been affected that, as a result of their experiences, the women have lost trust in a system that is meant to care for them. Those women have not experienced the compassion, choice and control that they should be entitled to expect from the system. In the past, they have not felt empowered to discuss the complications or treatment options, or to be actively involved in decisions about their care. As a result of that, many have gone down the road of seeking private treatment.

We have heard that the Scottish Government is taking steps to ensure that, in the future, women will have that choice in and control over their care, including the option of having transvaginal mesh removal surgery undertaken by independent providers. We welcome that.

The key principle of the bill is fairness for all individuals in relation to transvaginal mesh removal services in Scotland, and the committee considers that it is unfair and unreasonable to expect women who have already had surgery to meet the financial cost of that surgery themselves, given that that option will be available to women free of charge in the future. The bill seeks to rectify that unfairness. The committee supports that intent and, more broadly, we support the general principles that underlie the bill.

Our report concentrates on areas in which we think that the bill, as drafted, might need to be clarified to make sure that it achieves that fairness for the women who are affected. In some areas, we have made suggestions to strengthen that intent.

Before going into detail about the committee’s recommendations, I will take a moment to thank all those who assisted us in our scrutiny—those who responded to our calls for views and those who gave evidence in person or online. I would particularly like to thank the women who spoke to us about their experiences of transvaginal mesh complications in a private session that was facilitated by the Health and Social Care Alliance Scotland. We are very grateful to them, and we are in absolutely no doubt about how difficult it must be to have to recount those experiences time and again.

Evidence from that meeting and following our call for views suggests that there are still areas of uncertainty around the bill that continue to be a source of anxiety. In particular, our report recommends that greater clarity is needed around the residency criteria that are set out in the bill. As it stands, women who were not resident in Scotland at the time of their original mesh surgery but who lived here when their mesh removal surgery was arranged would be eligible for reimbursement. In contrast, women who were resident in Scotland at the time of their original surgery, when the mesh was put into their bodies, but who lived elsewhere when they arranged mesh removal surgery would not be eligible.

The Scottish Government has told us that it has not received any correspondence from women in that situation, but it acknowledges that the number of women who may ultimately apply for reimbursement under the bill is unknown. It is reasonable to assume that the Scottish Government might not have heard from everyone who might be covered by the bill. It is also reasonable to assume that some women who are affected do not yet know about the bill. The committee believes that, if it means that even just one more woman can be helped, the bill should be amended to include all those women who are seeking reimbursement for mesh removal surgery who originally had their mesh implanted by the NHS in Scotland irrespective of where they were living when that mesh removal surgery was arranged.

The committee also heard from a number of women who described themselves as the in-betweeners—women who are in the process of arranging treatment privately or who?are currently waiting?for their private surgery to take place. The introduction of the bill has caused some confusion and concern among those women. In short, they are unsure whether they will be eligible for reimbursement. Additional costs from travel restrictions and delays imposed by the Covid-19 pandemic have added to that anxiety. They want reassurance that their?costs will be reimbursed if the bill is passed.

According to the bill, a cut-off date for qualification for reimbursement will be specified in the details of the scheme. We are told that that date is likely to be 12 July 2021. The Scottish Government has suggested that that is a date on which individuals could reasonably be expected to have been aware of the availability of the new specialist mesh service as the preferred route for mesh removal surgery. However, there is a gap between 12 July, when the outcome of the procurement exercise for that service was announced, and the conclusion of contracts with independent providers, which remain under negotiation.

There is a risk that a relatively small number of women will fall through that gap and therefore be judged ineligible for reimbursement. The committee does not think that it is fair that those individuals should be obliged to cover the cost of their surgery themselves. We thank the cabinet secretary for indicating today, and when he appeared before the committee, that he is willing to look at that. We understand that there cannot be an open-ended period and that there must be an end date, but we would like the proposed end date to be reviewed, given what I have just said.

I very much welcome Gillian Martin’s powerful speech in support of the bill.

With regard to the end date, did the committee consider whether the date of commission of the alternative methods that will be recommended should be the cut-off date? By then, women will have certainty that there is an alternative route to having the vaginal mesh removed surgically.

I guess that that is implicit in what I have just said, because there is a gap. The committee has not specified what we think the date should be, but we have asked the Government to look at it again, just in case there are any women caught in that gap. I take the member’s point.

The committee recognises that much of the detail is due to be set out in the scheme itself rather than in the bill. Our report highlights areas where we consider that a flexible approach is needed to ensure that the spirit of fairness is achieved, including how and what costs will be reimbursed, what evidence will be required and who can apply. We hope to see that reflected in the final scheme.

As a Parliament, we also want to ensure that we are given appropriate opportunities to scrutinise the details of the scheme before it comes into force. I am grateful to the cabinet secretary for committing to provide Parliament with a draft version of the scheme prior to stage 2. My committee will want to look at the details of that draft and ensure that they reflect the stated objectives of the bill and the underlying principle of fairness. We realise that that is not something that the Government is compelled to do by parliamentary process, so we appreciate the extra level of scrutiny that is being offered to us.

We have also highlighted areas where we would like to see further clarity for the women concerned and the scheme administrators. The process of applying for reimbursement should not cause additional stress and anxiety for those who are either applying to or managing the scheme.

Although the bill is not about the specialist mesh removal services or referral pathways that are currently in place or under development in Scotland, it is inextricably linked to them. We have heard that there is still a long way to go to rebuild faith and trust between NHS Scotland and the women who have been affected. We would like to see public campaigns to publicise both the reimbursement scheme that the bill will create and the complex mesh national surgical service. The committee plans to take an active interest in both of those aspects as we move forward.

In conclusion, the committee supports the general principles of the bill. It is a necessary and important step in ensuring fairness for women who have been affected by transvaginal mesh and addressing the breakdown in trust that they have experienced during their treatment by NHS Scotland.

We are keen to ensure that the bill progresses through Parliament quickly so that the women can be reimbursed as soon as possible. I am grateful to the cabinet secretary for providing such a quick response to the committee’s stage 1 report. We look forward to seeing at stage 2 the further improvements to the bill that are set out in that response, which reflect the committee’s key recommendations.

15:15  

I point members to my declaration of interests; I am a practising doctor.

It is not every day that parties on opposite sides of the chamber see eye to eye, and it is even rarer for us to find common ground twice in one week. Today, there is every reason why Parliament must stand united, in order to fully support Scotland’s brave women who have suffered so greatly following complications from transvaginal mesh surgery. The very least that we can do, together, is ensure that any women who received that treatment in Scotland will be compensated for the money that they have paid out for mesh removal surgery, even if they were treated overseas.

Mesh, which is usually made from synthetic polypropylene, was supposed to reinforce damaged tissue in treatment of pelvic organ prolapse or stress urinary incontinence, which is usual after childbirth. The procedure has been used across Europe, in the US and further afield since the 1990s, but the failure rate that is associated with its use is a gynaecological scandal. Complications from mesh include nerve damage, chronic pain and vaginal scarring resulting from erosion by the product inside the body. There have been cases of organ perforation when mesh has been exposed inside the vagina, and some women have died.

As complaints from patients and families turned into lawsuits, authorities around the world began to act; by late 2017, Australia and New Zealand were the first to ban use of transvaginal mesh. Since 2018, no vaginal mesh implants have been carried out in Scotland. However, over a 20-year period, in Scotland alone more than 20,000 women underwent mesh surgery. It is believed that thousands have, to varying degrees, suffered from the effects. Some 600 women resorted to legal action.

The Health, Social Care and Sport Committee has heard from women in person; I record my thanks to those brave women who have harrowing experiences of mesh surgery. Many faced scepticism or were simply not believed when they were crying out for help. On matters including debilitating pain, infections, reduced mobility, autoimmune issues, difficulties with intimacy and psychological strain, they were simply not believed.

It is no surprise, therefore, that so many women sadly lost trust in our NHS and are out protesting in Glasgow right now. Even when they were offered mesh removal surgery, many turned their backs on our NHS and went elsewhere—understandably so. In practice, that meant using private healthcare providers in the UK and abroad. That is because until this year, there was no referral route from our NHS system to independent healthcare providers. My only plea to the cabinet secretary is that we speed through the next stage, which is to get women who have not had surgery quickly through assessment and removal surgery, rather than their having a long wait.

Until very recently, women have had to arrange everything themselves. Some have had to use up family savings, to borrow money or to crowdsource funds—anything to stop the agony. Since the summer, however, we have at last been making headway. In July, the Scottish Government agreed to meet the costs of private treatment to remove transvaginal mesh. Costs will cover the procedure and travel expenses, up to an amount that is somewhere between £16,000 and £23,000. The Scottish Government is now in the process of procuring the services of private providers to remove mesh from women who want it removed. They will have the choice to have surgery outwith the NHS in Scotland, which will be funded by their home health board, although I hope that women take the opportunity to have the surgery in Glasgow.

We on the Conservative side of the chamber strongly support the bill; I think that members in all parts of the chamber are in agreement. However, legislation can have unintended consequences, which is why we spend so much time, in the chamber and in committee, on the details.

I want to highlight a few points, for clarification. As it stands, the bill covers only women who currently reside in Scotland, and not women who now live in another country. That said, I am reassured by the fact that the cabinet secretary has just said that he agrees that that is too narrow a requirement and that he will consider lodging an appropriate amendment at stage 2.

As this is a compensation bill, we need to ensure that fair and proper claims are reimbursed. We need to avoid unintentional rendering as ineligible of claims for reimbursement.

I want to put on the record a clarification. Dr Gulhane referred to an amount of money per surgery. He is right to say that we specify amounts in the financial memorandum, but for the benefit of any women who are affected by the issue who are listening, I make it clear that if the bill is passed there will not be a cap on the amount of compensation for reasonable eligible costs. There is no £23,000 cap; the figure is there only for the purposes of the financial memorandum.

When the health secretary came to the Health, Social Care and Sport Committee, he made it clear that there will be no cap; I did not intend to imply that there would be one.

Many women have been trying to cope with the personal and financial consequences of undergoing expensive private medical treatment. We need to get down to business as quickly as possible, so that they can apply for compensation as soon as possible after the act comes into force. There are questions, however, including about whether executors of a deceased person can make a claim.

I understand that the cabinet secretary does not consider that it would be advantageous to the women affected for the compensation scheme to be specified in regulation, and that he prefers that there be an administrative scheme, which is quicker to implement and easier to amend, where appropriate. Given the urgency around moving the bill into law, I support that position.

I look forward to hearing from members across the chamber this afternoon. It is my wish that we find—for the second time this week—common ground when we come to vote.

I want to make it absolutely clear that the Scottish Conservatives support the principles of the bill, and that we will work together to speed it through Parliament.

15:21  

I thank my fellow members of the Health, Social Care and Sport Committee, who are all here today, for their work on the bill over recent weeks.

I welcome this opportunity to open the debate for Scottish Labour, as our party has been at the forefront of this issue for years. I afford particular recognition to the efforts of the former Lothian MSP Neil Findlay to get justice for the women who have been affected by mesh. He and members of other parties across the chamber recognised early that they were dealing with an unspeakable injustice, and that we simply could not let it pass.

Before I begin my comments on the bill, I want to share my recognition of the women who have campaigned relentlessly to keep the issue on the agenda in Scotland. Their efforts have increased awareness of this serious problem not only here, but across the UK. Their campaigning has meant that, unlike many other people who never receive the compensation that they deserve, the women are close to justice. It is a brilliant story of courage and tenacity, and one of which Scotland should be proud. However, only by saying that we got it wrong in the first place and by rectifying mistakes can we truly embrace that pride. Certainly, we can do so only after those who are out of pocket have the record set straight.

Every member should take time to recognise the efforts of the women, and to reflect on the steps that have been taken to get us to this point—not least, so that we do not make the same mistakes again. We can never celebrate enough serious democratic engagement by the people who are at the sharp end in our society, so I encourage other groups who feel that they have been treated unjustly to come forward. This is their Parliament and it is our duty to help them.

As others have, I want to thank again the women who forced us to listen to them. I thank them for coming forward, I thank them for making us listen and I thank them for sharing their stories. I know that that must have been difficult.

The Health, Social Care and Sport Committee is recommending that the general principles of the bill be supported; my party shares that recommendation. As a member of the committee, I have been impressed with the detail in, and the care that has been taken over, the bill. We can all agree that the general principles are moral and just.

A quick timeframe for getting the bill over the line is necessary, because the women who have been affected by mesh have suffered more than enough. I will be looking for guarantees on that, as we proceed. It is now our duty to make certain that the bill delivers on its promise of fairness.

Although the financial implications might seem to be relatively small, for those who will be helped the bill is worth an unimaginable amount. It represents recognition of their fight and of the fact that they were right all along.

During committee meetings, I was struck by the lengths to which many women have gone in order to get their mesh removed. We have heard some examples of that. For a good number of women, it involved travelling across the world. The committee heard stories of women travelling across the world who had to live in hotel rooms before their operation and after their surgery because they required to stay for treatment. We can all imagine how much, in those circumstances, we would have wished to be home with our loved ones while we were recovering. People did not commit to such steps lightly; as a result, we cannot approach the issue lightly.

That is not to say that there are not concerns that need to be addressed. There has been some recognition of that, but we need greater clarity and it being made plain who will qualify for mesh removal reimbursement and who will not. Throughout the process, I have been contacted by women who find the proposals either difficult to understand or imprecise. We can make adjustments to ensure that no one misses out. That point has been addressed by the convener and the cabinet secretary. A bit of peace of mind can go a long way, so I am glad that we addressed many such worries during the committee hearings, and that we are doing so again in the debate.

We are considering in the chamber some of the hidden complexities that many people who are observing the debate from afar might not have considered. There is a strong case for individuals who had their original mesh surgery done by NHS Scotland, but who were not ordinary residents in Scotland at the time of their removal surgery, being eligible for reimbursement. I hope that the cabinet secretary will reassure us on that, and that the bill will include such a provision.

The last thing that anyone wants is for us to end up with the women again feeling ignored or short changed by the system. I, and others, made that clear to the cabinet secretary in committee, and I have been assured that that will not be the case. However, the Government can equally be assured that any deviation from those expectations will not be accepted by Scottish Labour or the women involved.

The cabinet secretary has committed, quite rightly, to being flexible in determining what costs will be reimbursed under the terms of the bill, but the committee has argued that much greater detail is required—perhaps to be included at later stages—for cross-party support to be gained. However, we have been reassured by the cabinet secretary’s acceptance of the points that have been made by members, so I trust that that will be realised.

Scottish Labour will support the bill at stage 1. However, if the reasonable expectations of the women are not sufficiently met, we will, before the bill can be passed, lodge amendments to ensure that the principles that have been laid out today are delivered.

Again, I thank everyone who has been involved in the bill for their hard work. I look forward to its next stages and to passing serious and life-changing legislation of which we can all be proud.

15:28  

It gives me great pleasure to speak for the Liberal Democrats in support of the bill’s general principles at stage 1. When it comes to domestic health scandals, in my short career as an MSP, I cannot remember another issue that has captured the universal support, concern and horror of members in the way that this issue has done.

I recognise the valiant work of Jackson Carlaw, Alex Neil and Neil Findlay in bringing the issue to our attention and introducing us to some of the survivors of the mesh scandal. Nobody who met those survivors when they came to the Parliament can forget their abject pain or the profound dignity with which they conducted themselves.

I welcome the bill. It has the potential to provide further closure to women at the heart of the issue who have already taken the step to have mesh removed privately.

I want to take a moment to remember why we are here in the first place and why the bill is so necessary. Four years ago, I was contacted by a constituent of mine, who has given me permission to share her story.

In 2010, after suffering very mild issues with incontinence, Cathy was referred by her physiotherapist to a consultant who suggested that she should undergo a marvellous new procedure. Somewhat bewildered, she was asked to sign a consent form then and there. She said that it felt like she was entering some kind of clinical trial—a feeling that is characteristic of many women’s stories—although it was never quite spelled out to her in that way. In fact, nothing was properly spelled out to her. Despite being booked for the most invasive transobturator tension-free vaginal implant—secured via spikes through the obturator muscle—she received little information other than that her procedure would cure her of her incontinence.

When Cathy woke after surgery, she could not move. The nerve damage that she had sustained to her obturator muscle radiated pain through her abdomen, legs and back. Her condition was so bad that, after she was discharged, she would not allow her son to drive at more than 30mph along the bypass. She tried to call the hospital for three days and through the following week after being discharged, but never received a call back from nursing staff or doctors.

When Cathy visited her doctor, they told her that the pain might be related to her having stopped smoking at the time of her operation, and that she should try cutting out fat from her diet to help. However, at no point did any medical professional suggest that there might be a physical problem with the mesh implant. Cathy went a full five years of trying to cope with abject pain before its cause was identified as the mesh implant itself.

A routine check-up with her gynaecologist revealed that the tape was in too tight on the right-hand side and, as such, was constantly tearing at her obturator muscle. On seeking the advice of her surgeon, she received the devastating news that, because tissue had grown around it, the implant could not be removed without further significant nerve damage—imagine her horror at receiving that news.

Had someone taken her call at the hospital in the days after her operation, a reversal or correction could perhaps have been performed then and there. Let us consider that she, like several others, had been told at the time of surgery that mesh plastic would simply melt away over time.

Once the cause of Cathy’s pain was identified as the physical obstruction inside her, she was heavily medicated with gabapentin, which had such a soporific effect on her daily life that it forced her to retire from the job that she loved long before she had planned to do so. Cathy’s implant has had a significant impact on her mobility, intimacy with her partner and mental health, and has devastated her quality of life. She is left with a Hobson’s choice of making do or having the implant removed, with potentially far greater nerve damage and resulting pain.

She is far from alone in feeling that way—we have heard countless other cases that are like hers. I am saddened that it has taken us so long just to get to the point to reimburse those people who have taken the step to have harmful mesh removed privately. Even the bill will not give back to my constituent the quality and the period of life that she has lost.

I do not want to downplay the importance of the bill; it is important and we will support it. The financial reimbursement is an essential part of regaining the trust of so many victims of that scandal and recognising its harm. Carol Mochan was absolutely right to say that the bill sends an important signal to those mesh survivors that we see them, hear them and recognise what has been done to them.

Members have recognised that the uncertainty around who might be eligible for reimbursement as a result of the bill is a cause of concern. We are also concerned that the bill might impact only a limited number of people. We will work to improve the bill as it goes through the Parliament.

I want to explore whether the reimbursement could be extended to survivors of hernia mesh removal who paid for the procedure privately. I might have a meeting offline with the cabinet secretary, if he is willing, as I raised with his predecessors a number of cases of people in equally debilitating pain as a result of hernia mesh implants, which at present are not in the scope of the bill. I do not imagine that to be a huge number of people, but the issues are much the same.

We have to offer more than warm words but, until now, that is all that we have been able to do. It is fair to say that we have talked about the matter for years—we have known about Dr Veronikis for years. The removal procedures have only recently started to take place, and it is a shame that we have managed to do only 33. Although I recognise the limitations that we face, I hope that we can increase the rate at which we help people.

To the survivors of the scandal, I say that what you have been through is an outrage. No one should have to suffer so much physical or emotional pain because of a procedure that they were reassured would increase quality of life. You deserve so much more, and I am so sorry that the Governments that were supposed to protect you have successively let you down.

This is one of the worst medical scandals in the history of this country. We must offer more and we must do so urgently.

15:35  

I welcome the bill and pay tribute to everyone who has campaigned on the issue, including, most importantly, the women who have campaigned for justice. I thank the Scottish Government for listening and acting, and I congratulate the members of the Health, Social Care and Sport Committee for their excellent stage 1 report. They have captured the bill well and their recommendations are welcome.

I have dealt with three constituents who have had mesh complications. Every one of those ladies has had their lives adversely affected in many ways. I have had a great deal of correspondence with the Scottish Government on behalf of one lady in particular. She is called Michelle, and I have her permission to highlight her case today.

The bill offers a great deal of hope for Michelle and many other women. The physical pain and mental challenges that those women live with each day cannot be imagined. Added to that is the loss of trust in our NHS, as referenced throughout the report. It is no wonder that many women looked beyond our NHS to try to reclaim something of their old lives. Not one of my constituents with mesh problems believes that they will get their old life back fully, but a life of less pain and progress towards reclaiming their lives will be a positive outcome for some.

That is where the first sentence in the recommendation in paragraph 92 of the report is so important. It reads:

“The Committee supports the principles of fairness, equity and parity which, in its view, underpin the Bill.”

If those are the bill’s aims, which they clearly are, the discussion about how women have funded or will fund mesh removal treatments is redundant. Not every person has tens of thousands of pounds in their savings bank accounts, so they will have to raise finance somehow. For some, that will mean borrowing from friends or family and, for others, it will mean taking out a bank loan or maxing out a credit card. For others still, it will mean selling items or organising fundraising nights to bring in extra resources. Another example that could be used is a crowdfunding platform.

I know that Michelle used many of those examples, but she was struggling to deal with the pain and wanted to reclaim some of her life. At some point in time, just about every member of the Scottish Parliament, as a candidate to get elected to the Parliament, will have undertaken a crowdfunder. Why is it that we can do that, but there appear to be concerns that women who are in pain should not? That makes absolutely no sense to me. I therefore welcome the recommendation in paragraph 69 but also note the comments that were attributed to the cabinet secretary in paragraph 68.

It is clear that there are many unknowns around the bill, such as how many women will be eligible for the scheme, how many women will pursue the mesh removal treatment and the actual cost for each woman and their travelling companion. That is why it is extremely challenging for the cabinet secretary and the Scottish Government to produce a financial memorandum that contains absolute financial clarity, and it is why the stage 1 report asking for a reassessment of estimates is perfectly reasonable.

Paragraph 87 of the report makes a recommendation about

“an appropriate level of scrutiny”

of future subordinate legislation for the proposed scheme. As the convener of the Delegated Powers and Law Reform Committee, I can see how using the affirmative procedure would be beneficial in this instance, but I also accept, as the committee itself did in paragraph 10, that:

“The Committee has been keen to ensure an appropriate balance between enabling effective scrutiny of the Bill, while not unduly delaying reimbursement to those affected.”

That is why I note the cabinet secretary’s comments today and those in his reply to the committee that, if there were regulations, they could be time-consuming and that an administrative scheme could be a lot quicker.

The final point that I want to address is about the self-titled “in-betweeners”, as described in paragraph 33 of the report. I note and welcome paragraph 35 of the report highlighting the cabinet secretary’s intention that

“anyone who made their own arrangements for treatment outside of the NHS on or before the announcement on 12 July 2021, will be able to apply for reimbursement, regardless of whether or not that treatment has already been carried out.”

However, the committee’s recommendations in paragraphs 39, 40 and 41 are really important, particularly the call in paragraph 40 asking the Scottish Government to

“demonstrate appropriate flexibility in the definition of ‘making an arrangement’ for mesh removal surgery.”

I hope that clarity on “making an arrangement” will provide absolute clarity to Michelle and other women.

I know that dialogue and other communication took place between Michelle and the professor who did her operation prior to 12 July, but the agreement was signed—and the operation was performed—after 12 July. I welcome the cabinet secretary’s statement that greater clarity will be provided on the post-12 July situation, the procurement exercise, which was announced on 12 July, and the dates for the establishment of the contracts and the opening of the pathways to referrals.

My considerations in relation to the bill were solely for Michelle and the other constituents who I have spoken to. Nothing will be able to change the experiences that they have had to suffer and endure, but with the greater clarity that I hope that the passing of the bill will bring, I hope that they can have a more positive future. As a Parliament, we owe them that.

15:40  

As a new member, I am pleased to be able to speak in this debate about what is a short but landmark piece of legislation. Although it is a bill that has taken too long to come, I hope that it might still stand out as an example of what the Parliament can achieve when we work with and on behalf of our constituents.

I pay tribute to the women who have got us to this point and to colleagues such as Jackson Carlaw, and previous colleagues such as Alex Neil and Neil Findlay, who became their voice in the Parliament.

As we have heard, the bill establishes a scheme to reimburse women who have made their own arrangements to have transvaginal mesh removed. From the outset, let us recognise that those women faced scepticism when they complained about adverse effects, felt that they were not believed, experienced distress and often had to wait very long periods of time before remedial surgical intervention could take place.

Many elected representatives, whether MSPs, MPs or councillors, have been contacted by constituents who are living with the terrible consequences of the use of transvaginal mesh, which was used to treat problems that are often linked with childbirth, including stress urinary incontinence and pelvic organ prolapse. Shockingly, the worries over mesh were all too often dismissed by some in the medical profession as “women’s problems”. That was lax, negligent, insensitive and wrong, yet, in some cases, it continued for more than 20 years. We should be in no doubt about the fact that the action of some in the medical profession exposed women to avoidable harms for too long.

In July 2020, in her review of the avoidable harm that had been caused by the use of mesh, Baroness Cumberlege looked into the pain and suffering that women—often, very young women—were forced to endure. As we have heard, that included severe and chronic pain, recurrent infections, mobility issues and incontinence. The inquiry highlighted complications that included prolapse, bowel problems, sexual difficulties, fatigue, depression, post-traumatic stress disorder, suicidal feelings and—sometimes—death.

Tragically, women also reported that mesh complications led to a relationship failing and family breakdown, the loss of employment and families losing their homes, and financial hardship. All those effects were life changing, and all of them were avoidable.

I thank the cabinet secretary for his thoughtful and open-minded response at stage 1, and I welcome his willingness to consider any enhancements or amendments to the bill at stage 2.

I commend the many women concerned and the support groups that they established around the world. They were tireless, brave and committed campaigners who spent years raising the alarm about the consequences of the use of mesh implants and who did not give up or go away, even when, deep down, they felt shut out and ignored.

Their commitment eventually led to a breakthrough in the Scottish Parliament: the petition that was presented to the Parliament by Elaine Holmes and Olive McIlroy on behalf of the hear our voice campaign has led to our considering the bill at stage 1 here today.

The petition called for a suspension of the use of transvaginal mesh and a full evaluation of the safety concerns. As well as making the case for the introduction of fully-informed consent throughout Scotland, it called for improved reporting of complications after surgery and the setting up of a national register of all mesh procedures, which should be linked to international registers.

In 2017, the Scottish transvaginal mesh implants independent review recommended stopping the process altogether and, since then, transvaginal mesh surgery for pelvic organ prolapse has been restricted to being used only in connection with research trials.

However, let us not forget the tragic and justifiable loss of trust that many women felt and that some continue to feel towards some in the medical profession and our NHS. They felt isolated, their concerns were dismissed and many then sought removal surgery outwith the NHS and often well beyond its boundaries. They went to private providers at home and abroad, and they secured funding through a range of means.

It is worth noting that there was no available referral route to independent providers and that today the Scottish Government acknowledges that and recognises the lack of trust and the reasons behind it. Through the bill, the Government rightly concedes that the circumstances are exceptional and that reimbursement for the costs of surgery and associated travel and other costs is fully justified.

The bill’s consultation process raised several concerns about eligibility to apply for the scheme, many of which have been touched on. As Stuart McMillan noted, there is a question mark about some of the sources of funding for private treatment. For example, there is a question whether women should be eligible for reimbursement if they received money via crowdfunding.

The Scottish Conservatives strongly support the bill, but we believe that further clarity is needed on the eligibility criteria. I welcome Gillian Martin’s call for wide promotion of the reimbursement scheme once the bill is passed.

We should never lose sight of the fact that we are dealing with women who were badly let down and who faced devastating and life-changing consequences as a result. We have a responsibility to ensure that they receive the best and most appropriate treatment available. We have a duty to help them to rebuild their lives. I look forward to the concerns that were raised at stage 1 being addressed as the bill makes its way through the Parliament. For mesh sufferers, the legislation cannot come a moment too soon. Now is the time to fully deliver the care, compassion, compensation and, I hope, closure that the victims of transvaginal mesh so rightly deserve.

15:47  

I was a member of the Public Petitions Committee back in 2014, when the issue of polypropylene mesh medical devices was brought to the committee’s attention by Scottish Mesh Survivors. To this day, I vividly recall the passion and the strength of feeling of all the women who gave their time to attend our meetings to give evidence and to recount their stories and personal experiences. It is thanks to the tenacity and bravery of those women that we are here today to discuss the introduction of the Transvaginal Mesh Removal (Cost Reimbursement) (Scotland) Bill and the significant steps that the Scottish Government has taken to offer assistance and to better help women who were harmed by vaginal mesh and the complications arising from it.

As a current member of the Health, Social Care and Sport Committee, I am delighted that a bill has been introduced that aims to give powers to the Scottish ministers to reimburse persons who entered into private arrangements to pay to have the transvaginal mesh removed from their body, and that the reimbursement will relate to the costs of removal surgery and reasonable connected expenses.

Before it was halted in 2018 by NHS Scotland, the use of polypropylene mesh medical implants to treat pelvic organ prolapse and stress urinary incontinence left many women with life-changing complications and facing multiple operations to remove it from inside their bodies. The Government’s recognition of the suffering and considerable harm that has been caused as a result of complications arising from the use of transvaginal mesh, and the Government’s determination to do everything within its powers to help those affected, are hugely encouraging. We have already taken decisive action on mesh and now Scotland will be the first UK country to reimburse people for private treatment that was previously sought.

Before I came to the chamber today, I spoke with a constituent who, for more than five years, has been dealing with the trauma that was caused by mesh implants. She was fitted with the implants following a front and back prolapse in November 2016. By February 2017, the mesh had come loose, resulting in her uterus hanging outside her body. That started a chain of visits back and forth to gynaecologists to attempt to find someone to help. Everyone recognised the impossible situation that she was in, but no one could offer a solution.

In her words, her life “effectively ended in 2017”. Because she was living with extensive daily bleeding, double incontinence, constant exhaustion and sizeable uterine tissue building outside her body, she had to give up work and lost contact with family and friends. She went from being an outgoing sociable woman to someone who physically could not leave the house. I do not think that any of us can truly appreciate the mental strain that that must have caused.

After many years of solitude, in a bid to live a normal life by attending a family function, she reports fasting for an entire day and night beforehand in the hope that she might be able to enjoy the occasion. Despite that, she lasted only one hour before having to call family and friends to assist her to leave discreetly for an incident of bowel incontinence. Needless to say, she did not attend any more events. She has recently found a surgeon who has offered her some hope and she is now on the first steps of a journey that she hopes will see her quality of life begin to improve.

It is clear to see why some women felt let down by the NHS and felt the need to seek private arrangements to have transvaginal mesh removed. The daily stress caused by unimaginable pain, accompanied by the difficulties posed by incontinence, have led many women to pay in the region of £20,000 to travel to private clinics for treatment. Although I highlighted someone’s story, it is easy to get lost in numbers. We must look past the data, statistics and costs to see the real people beneath—to see the personal experiences of mothers, daughters, sisters and families all across the country whose lives have been negatively affected by life-changing complications and pain. Many of them have ended up in wheelchairs and endured multiple-organ trauma or extensive nerve damage. All have a story to tell, many of them harrowing, but it is our duty to listen.

Earlier this year, a case record review began, which is looking into concerns raised by patients about their medical records. As we move forward, the continuing work of the review for women who have raised concerns about whether their case records accurately reflect the treatment that they have received, specifically in relation to full and partial removal of mesh, will be a vital tool in ensuring that affected women’s voices are heard. It will give women an opportunity to set out their concerns, have their records reviewed by clinicians and allow for discussion, explanation and mutual understanding. I truly hope that those women get the answers that they need about their situation.

I am delighted to see the bill introduced. I fully support the recommendations in the report and hope that the Government will take them on board—in particular, the recommendation that any scheme must include

“a flexible approach to reimbursement that takes account of individual circumstances”.

The women concerned have already been through so much and I believe that the time is long overdue for all women who need their mesh to be removed to have that done and for us to compensate affected women for the cost of private mesh removal surgery. I pay tribute to the hundreds of women who have come together and campaigned tirelessly to highlight the suffering caused by the effects of polypropylene mesh implant surgery. I look forward to the progress of the bill and to working alongside all colleagues to ensure that no other women will have to endure the dreadful experience that mesh survivors have endured.

15:52  

It is a pleasure to speak in the debate and I welcome the bill. I congratulate all those who have campaigned for the legislation over such a long time. I also welcome all the contributions that have been made so powerfully to the debate.

Like others, I have met mesh survivors and I have found that even hearing about some of the experiences of the women who have been directly affected is harrowing. The details of the massive and life-changing implications, which they have often said ruined their lives, and the considerable pain that the women have endured as a result of the use of mesh are difficult to forget. Therefore, the bill is clearly very welcome. I hope that it will help the women who have been affected and, in particular, I hope that it will be welcomed by the Scottish Mesh Survivors. I hope that all the women who have been affected by the use of vaginal mesh will receive treatment and the appropriate expenses in the way that I believe members of the Scottish Parliament wish to happen.

However, there are many other mesh survivors who are not covered by this legislation and we must not forget them. Another petition has been lodged with the Scottish Parliament, which refers to some of the other women, and also men, who have been affected by the use of other mesh procedures such as

“hernia mesh, rectomesh and mesh used in hysterectomies”.

I have been contacted—as I suspect other members will have been—by constituents who have been adversely affected by those types of procedures and are asking for action similar to that proposed in the bill. I hope that the Government will listen to what they are saying and agree to the request for a review of all those procedures, too. I also hope that the Government will adopt a similar approach to those individuals as it has to the women affected by vaginal mesh who we are discussing today.

This issue was first raised in this Parliament in 2013 and has been raised regularly since then. That it has taken so long to get to a point at which we have a bill before us is an important point.

The independent medicines and medical devices safety review, which Baroness Cumberlege led, looked at the issues, and much of what the Scottish Government is putting into effect is based on the recommendations in the review report.

An issue that the review group considered was the way in which women are treated when they raise health concerns. We have heard how women were not believed or listened to. Of course, that is not just an issue in relation to the mesh procedure; it is an issue of which many of us are aware—indeed, it is something that many of us have experienced over the years. There are many lessons that we must all learn, and which Government must learn, about the way in which the women who were given vaginal mesh were treated that are relevant to many other situations that women face in the health service.

Another recommendation in the review report was that manufacturers should contribute to the cost of redress. However, it does not look as though the Scottish Government will get any money from manufacturers. Let me use Ethicon, which is one of those manufacturers, as an example; the company is a subsidiary of Johnson & Johnson. We know that it is losing court cases and that at one time it faced more than 40,000 lawsuits, based on its negligence in relation to not just transvaginal mesh devices but bladder sling complications. A number of those lawsuits have been successful. According to the company’s 2020 annual report, 14,900 pelvic mesh lawsuits were still outstanding. In October 2019, the company agreed to pay $117 million in 41 states and the District of Columbia, in the United States of America, to settle claims in relation to deceptive marketing of pelvic mesh products.

The bill is in its initial stages. During its passage, I very much hope that we will consider all the issues that have been raised in this debate, including manufacturers’ responsibilities and how we ensure that women who were affected by the procedures and are in difficult situations get justice from the Government and from other parties that were negligent and failed to respect them and provide them with adequate services. I hope that we will be able to explore those issues and strengthen the bill.

15:58  

As a member of the Health, Social Care and Sport Committee, I am pleased to take part in this debate, and I welcome the cross-party support for the bill’s general principles that has been expressed in the debate.

I thank the women who came forward to share their experiences, which could not have been easy. Without their assistance, we would not have been able to uncover the serious damage that transvaginal mesh surgery caused.

We are talking about not just physical damage but emotional, mental and financial damage. As members said, the damage and pain that women have endured as a result of mesh implants cannot be overstated. Lives have been turned upside down, mental health has been destroyed and finances have been stretched to the brink, all while the women were putting up daily with excruciating pain.

For the women at the centre of the crisis, following medical advice seemed the obvious thing to do. We would all have done the same thing; we accept the advice of our medical professionals, who act on the best information that is available to them. Women who were living with issues such as stress urinary incontinence and pelvic organ prolapse trusted the medical guidance to have mesh, or transvaginal tape, implanted into their bodies. That mesh can cause severe pain in the lower abdomen, which sometimes leaves women unable to walk.

We must accept that, occasionally, our health service professionals will get things wrong. That is inevitable, so it was absolutely right to permanently halt the use of TVT and apologise to the women who were affected. When something goes wrong, the most important thing is to put it right with due diligence and care and as fast as reasonably possible.

Over the past few months, I have heard heartbreaking testimonies detailing not only the physical pain but significant mental and emotional trauma. For some women, the pain has been so severe that they have been forced to fund private healthcare through remortgages, bank loans, credit cards, borrowing from family and friends or crowdfunding.

For those women, many of whom are still in substantial debt, time is of the essence. There can be no further delay. I, like other members, have listened to them. More importantly, the cabinet secretary and the Scottish Government have listened. I am sure that every member in the Parliament will support the bill and its fast tracking so that the women do not have to wait any longer, as they have waited long enough.

The Government has confirmed that women who arranged mesh removal surgery will be eligible to apply for reimbursement and that it does not matter whether the surgery was successful. I completely understand that, for the women who have been through such traumatic experiences, compensation for corrective surgery might not be enough. We must do more to right those wrongs and build back the trust.

To ensure that patients receive treatment in which they have confidence, a procurement process is under way to allow appropriately qualified surgeons from outside the NHS to perform removal for patients in Scotland. This is clearly an exceptional situation. Our brilliant and dedicated staff in the NHS have learned from those past mistakes. The complex mesh removal service is now established in NHS Scotland to allow everyone who was affected to get the treatment and care that they need.

I am also pleased that the Health and Social Care Alliance will undertake a patient focus group to understand patients’ views on how the reimbursement scheme might work in practice. The feedback from that will play an important role in shaping the scheme.

I welcome the Scottish Government’s response to the committee’s stage 1 report, in which it accepted the bulk of the committee’s recommendations, as the cabinet secretary outlined. I also note the urgency with which the Government wants to act.

I note the Government’s intention to take a proportionate and flexible approach under the bill to the provision of evidence of costs incurred. That will provide much reassurance to the women who are involved. I also note that some points will be considered in the draft scheme and I look forward to seeing it.

Sadly, transvaginal mesh was used regularly in Scotland before 2014. It was also used in the rest of the UK and throughout the world. Scotland is the first UK country to reimburse people for private treatment and I am pleased that the Scottish Government is, once again, leading the way and taking decisive action to make people’s lives better.

I thank my colleagues in committee and around the chamber for welcoming the bill to Parliament.

16:03  

As a member of the Health, Social Care and Sport Committee, I am pleased to speak in support of the bill at stage 1.

I thank all the women who came to give evidence at the committee and all those who have campaigned tirelessly for justice. I cannot imagine the impact that it has had on their lives and those of their families, and I am in awe of their continued determination.

I also thank the MSPs and former MSPs who supported the women in the previous session of the Parliament, including those who are affectionately known by mesh survivors as the meshkateers: Alex Neil, Neil Findlay and Jackson Carlaw.

As I am sure many members are, I am keen that we get a reimbursement system that is flexible enough to ensure that no one is unfairly penalised. Many of the women who paid for their own mesh removal did not anticipate being reimbursed, which means that many of them will no longer have food receipts or proof of taxi journeys, for example. The committee also raised concerns about the potential restrictiveness of the proposed cut-off date of the scheme and the residency requirements. I was pleased to hear the cabinet secretary’s commitment on the residency element.

We heard at committee that Covid has delayed some of the women going to America for surgery. I hope that there is a contingency in place to ensure that no one falls through the gap between the cut-off date for the reimbursement scheme and the start date of the new private surgery contracts. That point was well made at committee by Jackie Baillie. Some of the so-called in-betweeners may not be able to wait for the new contracts to begin if the mesh is compromising organs or causing unbearable pain.

If the legislation is to achieve its intended purpose, we must not let women fall through the cracks. As the committee’s report notes,

“the Bill documentation does not address the question raised by the Law Society of whether cases where private removal surgery has not been fully or partially successful will be reimbursed.”

Survivors should not be penalised for not having had a successful surgery. For some women, full mesh removal will not have been possible. Emma Harper made the excellent point at committee that it would be difficult to measure success—is it 40 per cent, 60 per cent or 90 per cent mesh removal? Some may have had private exploratory surgery only to be told that the mesh could not be removed, and I believe that they, too, should have their costs reimbursed.

We must ensure that women are not excluded from the scheme due to circumstances that are outwith their control. We have to take account of the fact that some women could not afford the cost of private removal surgery and did not expect to be reimbursed, so they did not pursue private treatment. As the committee’s report notes, those women

“may have experienced the same breakdown in trust in NHS Scotland”

and may understandably be upset that they have been further disadvantaged by their inability to pay up front.

We must ensure that trust is rebuilt between them and the health services. Some women have borrowed money from family and friends to pay for their surgery, and I strongly feel that they should not be excluded from any reimbursement scheme. Some women had to leave employment due to the debilitating effects of mesh implantation, and some of their partners have become full-time carers. They may not have been able to secure a loan and should not be penalised for having had to turn to family and friends for help. I appreciate that there may be difficulty in securing evidence for informal donations as opposed to a bank loan, and I would appreciate comment from the minister on how those issues could be worked through.

In committee, I raised the importance of supporting mesh survivors’ mental health and asked whether consideration had been given to reimbursing private medical costs related to mental health treatment. Mesh survivors might have lost confidence in NHS Scotland and might want to seek private treatment for what has been a traumatising event for many of them. If the bill aims to right a wrong, we need to consider the other forms of treatment and support that women who have been affected have had to seek as a result of their mesh surgery.

I have concerns about the residency requirement. Women who received their original mesh surgery when they were resident in Scotland should qualify for reimbursement under the scheme. Some women may have moved away from Scotland after their original surgery due to a breakdown in trust between them and NHS Scotland, and they should not be penalised for that. As the committee’s report notes, “greater clarity is needed” around that if the bill is to

“adhere to the principles of fairness and equity.”

I will close by saying that I look forward to working with members across the Parliament as the bill progresses. We have all heard about the devastating impact that mesh implantation has had on many women. It is vital that the bill establishes a comprehensive and fair scheme that does not result in mesh survivors falling through the cracks. We owe them that, at least.

16:09  

I thank the cabinet secretary and the members of the Health, Social Care and Sport Committee for their work in introducing the bill. More than anyone, though, I thank the women who have campaigned tirelessly on the issue. It is no exaggeration to say that the bravery that they have shown has been inspiring.

Prior to my election, I followed the issue closely, whether at Westminster or Holyrood, and I listened with concern, disbelief and anger to the accounts of those women who have suffered and continue to suffer as a result of transvaginal mesh implants. I read testimonies from the women who informed Baroness Cumberlege’s inquiry, and I found their accounts striking. They highlighted wider issues in how patients are communicated with, such as

“‘No-one is listening’—The patient voice dismissed”

and

“‘I was never told’—the failure of informed consent”.

It is therefore important to acknowledge the invaluable work of advocacy groups such as the Scottish Mesh Survivors group and the Health and Social Care Alliance Scotland for their role in progressing the issue. The reports that were published by the alliance in 2019 and 2021 provided a platform for mesh survivors to collate their lived experiences and present their irrefutable findings. It is safe to say that their voice is heard loud and clear in this chamber. Indeed, listening to mesh survivors is central to today’s bill.

It has taken too long to get here, but I am pleased that the steps that have been taken to reach this point have resulted in the number of mesh surgeries in Scotland dropping from 2,267 in 2009 to the current number—no further vaginal mesh surgeries have taken place in Scotland since 2018. The Scottish Government is now seeking to continue its work in redressing the wrongs that have been suffered and rebuilding the trust that has understandably been lost.

I am thankful that today’s debate moves the conversation forward again. It is now focused on how best to expedite satisfactory resolutions for those women who are still suffering the consequences of treatment, whether they be physical or financial.

The costs in each case are substantial: they are estimated to be between £16,000 and £23,000. Those are significant sums by anyone’s standards, let alone for the women, many of whom could not afford that amount but, in desperation, absorbed a heavy financial burden in the hope of alleviating the daily agony that they endured. The bill not only aims to assist the women who still require corrective surgery to receive it in a manner with which they are comfortable; it allows for reparations, which is something that transcends political affiliation. I welcome the cross-party support for the bill.

I welcome the bill at stage 1 and the Scottish Government’s continued commitment to ensuring that every woman in need of corrective surgery due to transvaginal mesh receives it from a surgeon in whom they have full confidence. I also welcome the commitment to removing the financial burden that so many women who merely sought to take back control of their lives have been left with.

16:12  

I am honoured to be contributing to the debate. It is important that the women who were forced to seek private arrangements to remove transvaginal mesh are reimbursed for the costs incurred, and that the scheme moves forward as soon as possible.

I thank those who stepped forward in an act of courage and provided evidence about complications with mesh and the arrangements that they made to have it removed. Taking such an act could not have been an easy thing to do, but those people’s strength and conviction have led to this important issue being debated in Parliament today. I am grateful to follow on from the excellent and heartfelt speeches that we have heard from members of all parties.

The bill before us does far more than just reimburse women who have suffered from this procedure. It corrects a wrong, particularly for those women whose painful side-effects and complications were not taken seriously. Concerns about the severe and painful complications arising from the use of mesh have been reported since the mid-2000s. Just today, a survivor told STV News:

“It feels like you’re getting sliced and I would sooner go through childbirth again with no gas and air and no drugs. The pain is chronic, it’s there all the time and you can’t switch off, it exhausts me. Some days I don’t get out of bed. I’ve got to use walking sticks and I have a chair, and when I get up I’m off balance.”

Although those words might make many of us uncomfortable, the simple fact of the matter is that those women went through years of pain with no support, and we must not forget them.

I am happy that the specialist service has been in operation and has established a multidisciplinary team of skilled professionals, and I look forward to reading the service review next month. I fully support the bill and the objectives that underpin it, which seek to ensure fairness and consistency of treatment for all individuals in relation to the mesh removal service in Scotland and the following scheme for reimbursement. However, there certainly must be more clarity in the bill to ensure that its objectives are met, beginning with residency criteria and timescales.

On residency, the bill currently excludes those who had their mesh fitted in Scotland and later had it removed while residing in another country. I welcome the cabinet secretary agreeing to lodge an appropriate amendment at stage 2 on the residency criteria, because those people deserve to be reimbursed. At the end of the day, they suffered, were ignored and had to take matters into their own hands. It is the Scottish Government’s responsibility to ensure that they are compensated.

In relation to timescales, at stage 2, the bill must address the issue of people who are currently awaiting, or are in the middle of organising, private treatment. It is our duty to ensure that we begin to build back, and not break, the trust between those individuals and the NHS.

Across the chamber, there is broad support for the bill, as there should be. However, that does not mean that we cannot discuss concerns about the detail of the scheme. I fully support the bill and its objectives, and I welcome the cabinet secretary’s comments about considering adjusting the cut-off date and lodging appropriate amendments to the residency criteria at stage 2.

It took a decade for the women to be recognised and believed, and we must not wait years to deliver the support and pain relief that they desperately need. Therefore, we look forward to working on a cross-party basis to ensure a timely and smooth delivery.

16:17  

I welcome the bill before Parliament today.

“I have been attempting to navigate through the absolute nightmare of living with mesh for 12 years.”

That is the heartbreaking testimony of Isobel from Prestwick, one of my constituents. She got in touch when there was nowhere else to turn, after years of suffering due to the mesh implant. She has given me permission to tell her story today.

Twelve years ago, Isobel received the implant in the hope that it would improve her quality of life after the birth of her second child. The mesh, which had been around for a number of years before that, was hailed as a revolutionary treatment for women suffering from stress incontinence or a prolapse, issues that arise from having children. Isobel’s surgery was to correct a prolapsed bladder. Fast forward to now, and Isobel has had to have six surgeries to correct the damage and remove the mesh, and a hysterectomy. However, every day, she continues to live with chronic pain in her legs and buttocks, bladder complications, erosion of tissue and, sadly, the original problem of the bladder prolapse. The pain was so great that she had to call time on her 30-year career in education.

It is not just Isobel—today, we have heard countless stories of women who have severe and constant pain in their abdomen, stomach, bladder or limbs. We have heard stories about women in wheelchairs and, sadly, about deaths.

The women going through that living hell have had to fight every step of the way to get help. Through evidence sessions and inquiries, they shared the most intimate details of their medical history, while still being in pain, and having nowhere to turn.

Only 5cm of mesh was ever removed from Isobel, with the mesh centre in Glasgow discharging her, saying that there was nothing more that it could do.

Earlier this year, women were promised surgery in England and the US to correct the wrongs that were caused by the mesh implants. We must do more, and we must act quicker, because women say that they feel like they have been forgotten about. Sometimes, the wait to see a specialist can be up to two years. Women are suffering day to day, and two years is an eternity. We must be prepared to pay for the damage that has been caused.

Day-to-day living is getting harder for Isobel. She has left no stone unturned in her pursuit of a better quality of life. Finally, Isobel turned to me. It is important that I am the last in the chain. I need to find a solution for her. I am acutely aware that the solution is money.

For some women, the Government’s announcement gave them hope, which is a feeling that they thought that they had given up on a long time ago. However, we need more than hope and promises—we need action.

The bill seeks to reimburse women who have paid for the procedure themselves, including the travel costs, whether that be to Bristol or the US. As has been mentioned, the cost of the procedure can vary between £16,000 and £23,000. Many people like Isobel just do not have the money to pay those costs up front. We must remove all barriers to the surgery that seeks to give back some quality of life.

Isobel told me:

“Because of the ongoing complications and chronic pain ... my youngest daughter has never met the real me.”

She describes that as the worst of all the side effects.

We cannot turn back the clock, but we can correct matters going forward. We need to streamline the pathways that will, ultimately, give Isobel her life back. We need a concrete achievable timeline. Her daughter cannot afford to wait another two years to meet the real Isobel.

I am grateful that the Scottish Government, through the bill, will help the women. However, today, I ask that we go further, and that we make referrals and decisions more quickly, that we put in place contracts for the removal of mesh and we put in place funding across the board, not just for those who can afford to pay for the surgery up front.

I welcome the committee’s recommendation to request further detail from the Government on campaigns to publicise the complex mesh national surgical service, on the training for primary care staff on mesh complications and on the person-centred approaches to supporting individuals through treatment, including pre and post-operative support.

I ask the cabinet secretary to comment on cases such as Isobel’s. If my constituent does not wish to have further surgery in Glasgow and wants to choose her own consultant, such as Dr Veronikis, to carry out the procedure, would the Government consider supporting such women, to bring peace of mind and a conclusion to their ordeal?

It is only fitting that I end with Isobel’s words:

“Many ‘older’ mesh survivors who have been through the system have been discriminated against and ignored. Time is running out.”

I welcome stage 1 of the bill as we move to rectify the situation.

Before calling the final speaker in the open debate, I remind members that anybody who has contributed to the debate needs to be in the chamber for the closing speeches.

16:22  

I extend my thanks to the committee for its report. I, too, want to put on record my admiration for the women who have fought with dignity and determination to get Parliament to where we are today. I know that the debate would not be taking place but for the bravery of the Scottish mesh survivors and, indeed, their demand for the bill and their willingness to share their phenomenally powerful personal stories.

I congratulate Siobhian Brown on her speech and thank her constituent Isobel, who has allowed her story to be shared. It is through such stories that we see the significant impact of events that began more than a decade ago and have carried on since. That willingness to share is important, as it allows people who are unaware of the suffering to empathise and see what has happened.

We are fortunate to have a national health service that is free at the point of use. Throughout the pandemic, we have seen the very best of our NHS and its heroic workforce. However, we must hold up our hands and accept that mistakes were made, with many—far too many—women being failed when they had transvaginal mesh devices inserted by NHS doctors. As a result, and to this day, many women are reluctant to return to those same surgeons to have devices removed. I sympathise with them—I understand their position. It will take a long time for trust to be rebuilt between the NHS and those women.

For that reason and many more, I support the overall aims and principles of the bill. Women have gone through a traumatic experience since having their mesh fitted and it is right that the Scottish Government covers the related costs that have been incurred in removing devices. After all, it has taken us a long time to get to this point—perhaps too long.

If you will allow me, Presiding Officer, I would like to pose a few questions to the cabinet secretary and the minister—not to raise disagreement, but to seek advice. Today, in Glasgow, mesh survivors felt the need to protest outside the New Victoria hospital. Part of that protest is about the length of time that they have been told they may have to wait for initial assessments—there is talk of a wait of up to two years. There are members of the mesh survivors group who are there today who have had their appointments cancelled with just a week’s notice. Those are the very women we are asking to trust our NHS again. I know that there are challenging problems—we are all aware of that—but for that particular group of women, much more should be done to bring reassurance and confidence.

In his opening speech, the cabinet secretary talked about the 33 women who have received their mesh removal operations. Can he tell us how many women are still waiting for mesh removal?

A number of members have spoken today about the challenge around the date that it is anticipated will be in the bill. I very much welcome the cabinet secretary’s willingness to reconsider the date, but will he comment on whether it could be the date on which on-going surgery is commissioned? In that way, we would know that all the women survivors were covered, up to the point at which there is an alternative, suitable and supported method to support the journey to the end of the problem.

I welcome all the speeches that I have heard today, particularly those that have included the powerful testimony of individual women who have suffered from mesh implants. We should not have been in this place, but we are. It is now for Parliament to show that there is a way out, but it has to be done swiftly, so that trust in the NHS can be restored.

We move to the closing speeches. I note that Gillian Mackay is not present in the chamber, and I expect an explanation for that in due course.

16:27  

In closing for Scottish Labour, I begin by reflecting the strong consensus that we have heard in the debate. Stage 1 of the bill marks a significant milestone in a long, painful and difficult journey for so many. The cabinet secretary rightly opened by reflecting on those who have brought us to our consideration of the bill. I, too, pay tribute to the steadfast determination of the members of the Scottish Mesh Survivors group, who have bravely told their stories and campaigned for the bill and other measures to support all those affected.

Having heard some of the testimony in committee, I am struck by the bravery of the women who have recounted the trauma that they have experienced and lived with in order to effect change not only for themselves but for the many others who have had the same experience. As we have heard, they have repeated those stories time and time again—something both hugely difficult and extremely courageous, as I am sure we would all agree.

I join colleagues in paying tribute to the MSPs, past and present, who have worked on the issue and brought us to this point, particularly Jackson Carlaw, Alex Neil and Neil Findlay.

The convener of the Health, Social Care and Sport Committee, Gillian Martin, spoke powerfully when she said that the bill

“could not, and does not, undo the ... trauma”

and that, for some, trust in our health service has been irreparably damaged. What she said about control over choices, over their bodies and over their lives for those women is key to all our considerations, whether in relation to the bill or more widely.

As deputy convener of the committee, I commend the work of all involved in scrutinising the bill and, like the convener, I thank all who gave evidence, particularly those with lived experience, who were supported by the Health and Social Care Alliance Scotland.

Sandesh Gulhane spoke about the fact that many women simply have not been believed for a long time. He was right to highlight that many took extraordinary action to fund their treatment, spending savings or taking out costly loans—anything to stop the pain.

In line with the consensus that we find across the chamber, Scottish Labour supports the overall aims and principles of the bill. My colleague Carol Mochan spoke in Labour’s opening speech of the power of our democratic process. There is a duty on us all to use the power of the Parliament for the good of those whom we represent, and Alex Cole-Hamilton echoed that view in his powerful recollections of how the Parliament has approached the issue over the years.

We heard many powerful stories from colleagues of how the experience has impacted their constituents. Stuart McMillan spoke of Michelle, and raised the issue of the lengths to which women have had to go in order to fund treatment. He made an important point about crowdfunding, which was echoed by Craig Hoy. It is clear that further clarity is required for women who funded treatment via crowdfunding or other fundraising routes. The committee has called for clarity on that from the cabinet secretary, so I hope that the minister will begin to address the matter in closing the debate.

David Torrance spoke of his constituent’s life-changing—or rather, as his constituent very sadly put it, life-ending—experience; she felt that her life had come to an end. As Pam Gosal said, it is very difficult for us to hear such stories, but that particular story brought into sharp focus the reality for so many. Siobhian Brown did something similar in telling Isobel’s story. I hope that, whatever else we do in the Parliament, we always seek to do anything that we can to—at the very least—make life more liveable for any woman who is affected.

My colleague Katy Clark, and Alex Cole-Hamilton, raised the issue of the use of mesh in other procedures, and referred to other petitions that have come before the Parliament. I believe that those petitions merit the cabinet secretary’s attention, and I am sure that he will want to reflect on that issue more widely as we move forward.

It is clear from today’s debate that, although the principles of the bill enjoy broad support, further clarity is required in some areas as the bill process moves forward. I welcome the cabinet secretary’s response, as did Gillian Mackay and other members of the committee, on the issue of residency requirements, and I hope that he will look at the timeline requirements, as he committed to do in his opening speech. Gillian Mackay also referred to the so-called “in-betweeners” and mentioned that my colleague Jackie Baillie had raised the same point at committee, when she attended as my substitute. The point is that we want a system in which no one is left behind; that point has been well made by members on all sides of the chamber this afternoon, and I am sure that the minister will cover it in summing up.

At the close of the open debate, Martin Whitfield posed some important questions for the cabinet secretary on waiting times for mesh removal and the protests that are occurring in Glasgow today. I know that the minister will want to say something on that in concluding, in order to give Martin Whitfield and other colleagues confidence that those issues are being looked at in the round and that we are trying to get it right for absolutely everyone who has been affected by them.

We should do all that we can to hold on to the consensus that has been established not only in today’s debate on the bill, but over the many years leading up to this point. We must acknowledge that there is more to do. We must never forget the pain and suffering that has been caused; the duty on us, in the Parliament, to make an attempt at reparation; and the courage of women who have fought, despite their own trauma, to try to bring light to a very dark experience in the history of our health service. We must try to ensure that it never happens again.

Given the time in hand, I invite Jackson Carlaw to wind up for a generous seven minutes.

16:33  

Thank you, Presiding Officer.

I genuinely feel considerable pride in our Parliament this afternoon. In contributing to the debate, I am not without some emotion. Over three sessions of Parliament, for eight long years, we have tried to move the issue forward and bring justice to the women who have survived the mesh scandal. Had it been—as I observed in an earlier debate—similar to the thalidomide scandal, in which the injuries and injustice suffered were all too visible, it might have been easier to get the issue thoroughly discussed. However, in the early days of this Parliament, when the issue first arose, I have to say that there was a squeamishness and a reticence to talk about what was, for many women, the most sensitive of issues. It was the heroism of those women that made the difference. Mention has been also made of the determination of Alex Neil, Neil Findlay and myself to speak in the bluntest and most graphic way possible about the issue in order to break through that reticence and make people understand the importance of Parliament facing up to the issue.

Shakespeare sent Mark Antony to bury Caesar, not to praise him. I, of course, would never suggest that I would ever talk about burying the cabinet secretary—I mean, he can scooter himself to disaster all on his own, as we know—but I am here to praise him quite unequivocally this afternoon not only for fulfilling the commitment of his predecessor, Jeane Freeman, in bringing this bill to Parliament after five health secretaries have wrestled with the issue, but also because of the way in which he addressed the issues in his opening speech this afternoon, the flexibility that he has shown, the willingness that he has had to meet the women concerned and others who have pointed out concerns that they might have with the bill and his determination to see all of those issues addressed at stage 2. I take all of that at face value and look forward to helping in any way that I can to facilitate the progress of the bill.

The bill does not represent the end of the mesh argument. As people have pointed out, Professor Alison Britton is undertaking a full mesh case review, the recommendations of the Baroness Cumberlege review still require to be implemented in full and, at the moment, the Citizen Participation and Public Petitions Committee is considering a fresh petition on the wider application of mesh—although, as the minister has identified, we should not draw an immediate parallel between the use of mesh in other procedures and the particular issues that arose as a result of the transvaginal mesh scandal. The issue has led to the expression of fundamental concern about what women in Scotland were being told.

Mention has been made of Neil Findlay, and he has been texting me during the debate. I ironically asked him whether that constituted lobbying—a comment that I hope will not be lost on other colleagues.

The cabinet secretary made reference to the Glasgow centre, which has performed perhaps two dozen or three dozen mesh removals. The affected women and those of us who have been involved with the issue have raised a concern about the exact nature of the training of those who were involved in those procedures. Where were they trained? In what removal techniques have people in the Glasgow centre been trained? By whom were they subsequently accredited as being competent in those practices?

Does the member think that that points to a wider issue about women not being believed when they come forward with health issues? Does he agree that we should be looking at that more generally?

I absolutely do. In the previous session, I sat in a meeting of the Public Petitions Committee—along with David Torrance, I think—and listened to one specialist saying that only a couple of women were involved, with 60 women sitting behind him while he said it. There really has been a fundamental disconnect.

Mention has been made of Elaine Holmes, who lodged the petition in the first instance. She said:

“I’d been discharged from NHS GG&C after two mesh removal attempts, told I was mesh free and that I’d likely lose my leg if I had any more surgery relating to the transobturator mesh implant. I’d had every test/scan possible and had exhausted all options. After much research and pleading from my family, I contacted Dr V as he was my last hope. Thank God I did! He removed 22cm of the offending mesh.”

That was after she had been told that all her mesh had been removed, and that is why so many of the women have confidence in Dr Veronikis.

Dr Veronikis contacted me ahead of the debate. I do not want to introduce any note of difficulty, but here is what he says in the conclusion of a letter that he sent today to the interim medical director of NHS Scotland procurement commissioning and facilities:

“Respectfully, I see no progress, I only see delays and detours. As stated in my email on October 28, I do not believe that we have made any progress since March 2019, when Terry O’Kelly first contacted me, or since First Minister Nicola Sturgeon personally called me. The solution is either expedite and facilitate the care of the suffering women who wish my services or just tell them that NHS Scotland cannot help them receive care outside of Scotland.”

He goes on to say that he is desperate because of what appears to be a slightly dead hand of bureaucracy that is encountered when trying to drill down to the details. He says that we need to overcome that, and it probably needs the cabinet secretary to take a personal interest in what is being done, possibly in his name, to ensure that we get to the point at which Dr Dionysios Veronikis believes that he has a contract that is fair and operable and that allows these women to go to Missouri to have the treatment concerned.

I have seen Dr Veronikis’s response. We actually had a helpful response from him recently, so progress is being made. I can give an absolute assurance on two things. First, I do personally take an interest in the issue. I am involved in it and, if that means speaking to Dr Veronikis personally, I will, of course, do that. Secondly, I give an absolute assurance to the women involved that we respect Dr Veronikis’s expertise and that, when it comes to the referral process, a woman’s choice of where they want to get treated should be the primary consideration.

I thank the cabinet secretary for that assurance. We must ensure that the delivery of that assurance follows the delivery of the bill.

I thank Gillian Martin for her incredibly comprehensive contribution, which detailed some of the residual questions. She is absolutely right in saying that some women might not yet have declared that they would like to have mesh removed and that others might not yet be aware of the bill. As Martin Whitfield and others said, we have to be careful when setting the cut-off date for applications for procedures in the future.

I thank all the other contributors to the bill, including David Torrance, the veteran of the long exchange in the committee; Katy Clark; Gillian Mackay; Craig Hoy; Kaukab Stewart; and Siobhian Brown, who brought us Isobel’s experience, which was, unfortunately, an all-too-typical example of what many of the women have endured.

I thank Rona Mackay; our former colleagues Alex Neil, Neil Findlay, Angus MacDonald, David Stewart and Johann Lamont; and the Presiding Officer, who was in the chair earlier. They have all done terrific work in promoting the issue over the past three parliamentary sessions.

I thank Elaine Holmes, Olive McIlroy, Lorna Farrell, Claire Daisley, Karen Neil, Nancy Honeyball, Gillian Watt and Isobel McLafferty. I have been proud to stand with all those women, who have affection and love for one another. I have attended their Christmas dinners, at which they have provided mutual support to ensure that their morale and their efforts have been sustained.

However, let us not forgot Michele McDougall, who died of cancer and could not get chemotherapy because of the consequences of six previous hernia mesh operations, or Eileen Baxter, who was the first woman to have mesh as the cause of death on her death certificate.

This is not just something that women are currently enduring; it has led to the deaths of some women. It has opened up questions about how women are believed in the health system. It has led to many women—who, at the start, did not believe that there was hope for them—fighting for years through their pain to prevent this from happening to other women. The bill offers them the justice that they deserve.

Thank you, Mr Carlaw. I note that Neil Findlay is still making interventions from a remote, if not a sedentary, position. Fortunately, he will not be able to raise points of order through that route.

16:43  

I am pleased to have the opportunity to close today’s debate. First, it is important to recognise and acknowledge the efforts of all the women who have campaigned for better services for those who have complications from mesh surgery. Their dedication and fortitude have been admirable.

I hope that all the improvements that the cabinet secretary described earlier will mean that women will now have access to more of the help that they need. I also hope that the bill’s intention is, therefore, clear. We want to ensure fairness for the women for whom those options were not available in the past, and who paid for their treatment out of their own pocket.

As I turn to some of the detail that we have discussed today, I thank all members who have contributed to the debate. It is clear that, although some members have quite rightly raised important points and asked probing questions, we all want the same thing: we want to ensure that we do right by the women who have suffered.

As the cabinet secretary did, I extend my thanks to the Health, Social Care and Sport Committee for its consideration of the bill and for its support for the bill’s general principles.

I fully appreciate that women will be frustrated by the length of time between the Government’s announcement of the successful bidders on 12 July and the final contracts being agreed. I assure them that NHS National Services Scotland is working hard to finalise the arrangements as quickly as possible. However, I am sure that all members will understand that there is a balance to be struck between concluding the agreements quickly and ensuring that all aspects of wraparound and emergency care are provided following those agreements.

As the cabinet secretary said, the Government will consider the matter further and intends to confirm its position on the cut-off date at stage 2, should Parliament agree to the bill at stage 1.

In his response to the stage 1 report, the cabinet secretary has committed to considering further the issue of residency and to lodging an appropriate amendment at stage 2. He has also agreed to provide the committee with a draft of the reimbursement scheme that will provide details on the meaning of the term “arranged”, while still allowing scheme administrators the flexibility to take into account individual circumstances. The Government considers that approach to be preferable to a delay through making of regulations. It is intended that NHS NSS, which already administers the mesh fund, will administer the scheme. The Government will work closely with NHS NSS in the coming months, as we make more detailed plans for its administration. NSS will be given sufficient resources to manage the scheme effectively.

The intention of the bill is to reimburse the full costs of surgery, along with reasonable travel and accommodation costs, for the person who undergoes surgery and a person who travels with them as support. However, it is not anticipated that reimbursement will be given for luxury accommodation or first-class travel, for example, which is why the caveat about reasonable costs exists.

For other expenses such as food, the intention is to give women a choice of whether they want to evidence their costs—if they are able to do so—or to receive a capped rate per person per day. That approach is to ensure the flexibility that we all agree is important, and is a direct response to feedback from women who told us that they want a straightforward process.

A number of people raised issues around crowdfunding and donations from family. The purpose of the scheme is not to reimburse people who donated money to help a woman with the cost of surgery. The Government also does not intend to reimburse moneys that were received through online funding platforms, such as crowdfunding platforms, for which it would be difficult or impossible to identify donors—who would not, in any case, have expected repayment. It is the intention that applicants will be asked to declare any such moneys on their application form, and that their reimbursement payment will be reduced accordingly.

Further consideration has been given to the matter of money that was received informally from friends and family members. On reflection, the Government feels that it would be unreasonable to request details of private arrangements. Accordingly, applicants will not be asked to declare those donations when applying for the scheme. It will, of course, then be up to individuals to repay any moneys that they received, as they see fit.

The Government will make every effort to ensure that those who are eligible to apply for reimbursement are made aware of the scheme. The issue of qualifying surgery came up during the debate. Qualifying surgery has to have had the principal purpose of wholly or partially removing mesh, regardless of the outcome. We expect to undertake a range of methods to publicise the scheme, including through press releases, social media, the Health and Social Care Alliance and NHS Inform. The bill requires that the scheme be laid before Parliament and published.

On the Glasgow centre, we fully recognise that general practitioners and other local clinical staff need to be aware of the existence of the service in NHS Greater Glasgow and Clyde and of its offers, so that they are able to explain them to women who present with mesh complications. Health boards’ accountable officers for mesh have been involved in development of the centre and have a continuing role to play in ensuring that health boards are aware of the service and what it can offer.

The national specialist mesh removal centre has been, and will continue to be, developed with patients’ and the public’s input. The pathway of care, which must take into account the patient experience, will continue to be a key focus for the Government. Nursing specialists and physiotherapists from the specialist centres are linked with their counterparts in local health boards to ensure continuity from pre-operative to post-operative care.

The Government has asked the Health and Social Care Alliance to take forward work on development of a patient-focused map of the care pathway, which will be created from patients’ perspective, thus helping future patients to understand the referral process and what it means for them.

We all know that Covid-19 has had a significant impact on our health services across Scotland. It has meant that health boards have not always been able to run out-patient clinics or to provide other services in the timescales that we would want and expect. We acknowledge that that means that some women have, regrettably, had to wait for far longer than we would ever wish in order to be assessed in the services in Glasgow.

To answer Martin Whitfield’s question, I note that 17 women are waiting for surgery in Glasgow. I believe that Glasgow clinicians were due to confirm that figure to the committee, but the correspondence is not yet noted on the committee’s website. I give our assurances that we are fully committed to working with NHS NSS and the national specialist mesh removal centre to look at ways of improving the speed of referral and processing.

Hernia mesh removal was raised by a number of members, including Mr Cole-Hamilton. He is correct to say that it is outwith the scope of the bill. Jackson Carlaw referred to my appearance at the Citizen Participation and Public Petitions Committee, where I made it clear that although there is some common ground, the same situation has not arisen from use of mesh in other areas. Evidence was presented at the Citizen Participation and Public Petitions Committee, but the Government does not consider that there is evidence that might justify a pause in use of the relevant devices.

To summarise, in January 2020, the Scottish Health Technologies Group published its report on use of mesh and on primary inguinal hernia repair in men, which concluded that, compared to non-mesh procedures, using mesh resulted in lower rates of recurrence, fewer serious adverse events and similar or lower risk of chronic pain. The SHTG is undertaking more work on hernia repair in men; its report is expected imminently. Once we have a copy of that report, we will consider the recommendations and share them with relevant officials and health boards, specialist associations and the Citizen Participation and Public Petitions Committee. During my appearance there, I committed to attending the committee again if that would be helpful.

On other gynaecological uses of mesh, at the same time as use of transvaginal mesh was halted, the then chief medical officer introduced a high-vigilance protocol for use of mesh in other sites. That resulted in the appointment of accountable officers who are responsible for oversight of the protocol and have continued to meet regularly to improve services for people who are affected by mesh.

It is important to note that we are talking about complex and long-established procedures for which there are few, if any, viable alternatives. However, it is absolutely crucial that the most stringent safety measures are adopted for patients, who should be fully aware of the risks and benefits of such procedures before they decide on their treatment.

I think that it was Neil Findlay who first suggested a General Medical Council-approved credential for mesh removal surgery. The Scottish Government wrote to the Royal College of Obstetricians and Gynaecologists and the GMC to express our support for the introduction of a GMC-approved credential in mesh removal surgery. As specialist centres are established across the UK, credentialling will define the skills that are required to perform mesh removal surgery, and will set out how those skills can be acquired and assessed. By formally recognising the skills of our surgeons, credentialling will provide assurance for patients and the service, reduce the risk of harm, and help to improve public confidence.

I agree with members who made the point about women not being listened to about mesh, and I agree that that was indicative of the wider problem of health inequalities that women experience. That is one of the reasons why we have produced the women’s health plan. It is ambitious and we are making tangible progress, but we have much to do. It is a starting point, not an end.

Do I have time to make a final point, Presiding Officer?

Yes.

In response to the Cumberlege report, the Scottish Government called on Her Majesty’s Government to consider the establishment of a redress agency that would be funded by a levy on manufacturers. HMG rejected that recommendation in its response, but it is still considering its position on redress in individual cases.

On behalf of the cabinet secretary and myself, I once again thank all the people who have contributed to bringing the bill to this point. I look forward to detailed scrutiny at stage 2, during which the points that members have raised today can be considered. We will also reflect on today’s debate when we finalise our approach to stage 2.

We know that work needs to be done to rebuild women’s trust in the services that are available here in Scotland. We hope that the work that the Government and NHS Scotland are doing to improve the care that is offered will help to restore women’s confidence in those services, but for women who wish to be treated elsewhere, we are working to ensure that there is a clear referral pathway to a specialist centre in NHS England or an independent provider.

In order to ensure that anyone who has previously paid for private mesh removal surgery will not be financially disadvantaged, the Government considers it fair and reasonable to have in place a scheme that will allow such women to apply for reimbursement of past costs.

I commend the general principles of the bill to Parliament.