Meeting of the Parliament

Meeting date: Tuesday, January 25, 2022

Official Report 905KB pdf

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Transvaginal Mesh Removal (Cost Reimbursement) (Scotland) Bill: Stage 3

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

The next item of business is stage 3 proceedings on the Transvaginal Mesh Removal (Cost Reimbursement) (Scotland) Bill. In dealing with the amendments, members should have the bill as amended at stage 2, which is Scottish Parliament bill 3A, the marshalled list and the grouping of amendments.

The division bell will sound and proceedings will be suspended for five minutes for the first division of the afternoon. The period of voting for each division will be up to one minute.

Members who wish to speak in the debate on the amendments should press their request-to-speak button or enter an R in the chat function as soon as possible after I call the group.

Members should now refer to the marshalled list of amendments.

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

The group is on costs incurred in connection with qualifying mesh removal surgery. Amendment 1, in the name of Sue Webber, is grouped with amendment 2.

The reimbursement bill covers the cost of primary removal of transvaginal mesh and of any unexpected procedures that are required either at the time of mesh removal surgery or soon afterwards.

I have been contacted by women who still have questions. Amendment 1 seeks to clarify which procedures are included in the scheme to avoid any doubt. My amendment seeks to clarify that complications or further surgery that is required because of mesh removal surgery are covered by the reimbursement and that corrective surgeries pertaining to the mesh removal surgery—not issues caused by the original implant surgery—are included.

I seek that clarification because there are ladies who had their corrective surgery carried out at the same time as mesh removal. Those surgeries include fascial slings, Burch colposuspensions and other procedures to repair prolapses or incontinence, which were the very reasons for which they had mesh implanted in first place.

There are women who have had mesh removal who have been advised, for various reasons, to allow time for healing before they consider further surgery. That is often down to “surgeon preference”. From a surgical perspective, that phrase can be a catch-all, but it leaves women out on a limb. Amendment 1 seeks to provide clarification.

Although there is no reason to believe that those consequential surgeries could not be done on the national health service, that depends on trust. Given the entrenched involvement of the NHS with the transvaginal mesh scandal, many of the women involved, including some of those who have contacted me, do not trust the NHS to perform consequential surgery. Those women trust only private providers such as Dr Dionysios Veronikis to right the wrongs of the NHS. I am keen to get some commitment from the cabinet secretary that the Government will look sympathetically on the costs of any consequential treatment and that those costs will be reimbursed, although I make it clear that that will not be the outcome of the amendments that I have lodged today.

I move amendment 1.

I rise in support of Sue Webber’s amendments, having been contacted—as, I am sure, many other members have been—by constituents who are in exactly the position that she describes. They want clarity and to understand that the full consequences of those devastating injuries will be made whole. Such injuries include not only those caused by transvaginal mesh implants but those caused by mesh implants in other parts of the body. I have met survivors of hernia and rectal mesh damage.

There are many people who are still asking questions and to whom the bill will give some comfort and closure. Sue Webber’s amendments offer an elegant solution to a loose end in the legislation.

It is clear that amendment 2 seeks to further remove any ambiguity and serves to reinforce a timeline so that appointments and procedures booked prior to the deadline but taking place after that deadline are still covered. The amendment states that that is to be done

“For the avoidance of doubt”.

We will get into the detail of the bill in the debate. I thank members for the constructive role that they have all played in taking the bill forward.

I am grateful to Sue Webber for lodging her amendments, which are about the inclusion of reimbursement for additional surgeries and procedures arising from mesh removal surgery, whether those are performed at the same time as the mesh removal surgery or afterwards.

I know that these matters were the subject of useful evidence from my officials at a recent meeting of the Health, Social Care and Sport Committee, and I am happy to restate, and expand on, the Government’s position on Sue Webber’s amendments. I hope that that will be useful.

In considering the amendments, it is important to emphasise that the bill has a specific purpose, which is to reimburse past costs incurred by women who have paid to have qualifying mesh removal surgery conducted privately. Qualifying mesh removal surgery is defined in the bill as surgery whose purpose is

“to wholly or partially remove from a person’s body synthetic mesh which was originally implanted transvaginally”.

The Government has been clear that additional surgery or on-going treatments that are required after mesh removal will be provided by NHS Scotland as part of a person’s on-going care. Indeed, that is currently the case. That position will be the same for all women, whether they are covered by the bill or if their mesh is removed under the contracts with private providers that the Government is currently agreeing or if their mesh is removed by the national specialist centre in Glasgow.

The Government accepts, of course, that women who have had their mesh removed may well have on-going physical and mental health needs, and it is the Government’s intention that aftercare and on-going treatment will be provided by a patient’s local health board, working in partnership with the national centre where appropriate.

The Government thought that it would be useful to Parliament’s consideration of the bill to make available a draft of the reimbursement scheme in order to explain how the scheme will operate in practice. The draft reimbursement scheme makes it clear that the Government will meet the costs of additional surgery or treatment arising as a direct result of complications from the mesh removal so that, for example, in the unlikely event that something goes wrong during surgery or a patient develops an infection at the site of surgery, costs arising can be met. That is explained in paragraphs 11(1) and 11(2) of the draft scheme.

However, I think that it is reasonable for the bill and the scheme to draw a distinction between direct complications of the surgery and longer-term health needs or requirements for new surgery that may be a consequence of mesh removal, such as the possible return of incontinence that the mesh was originally to treat. I take on board what Sue Webber said in relation to that point.

Amendments 1 and 2 would, for example, open the way to reimbursement for substantial new reconstructive surgery. I think it is fair to say that the Parliament has agreed that that is not the purpose of the bill or the scheme.

I also observe that the amendments would allow for reimbursement for surgery or treatments that were arranged for the future, and not just those received in the past. Procedures that would potentially be covered by the amendments could take place months or even years after the mesh removal surgery. If the amendments were agreed to, the reimbursement scheme would need to remain open indefinitely for receipt of such claims in order to ensure that legitimate expectations of reimbursement for such treatments, as raised by the amendments, were met.

During the opening debate at stage 1 and elsewhere in consideration of the bill, there has been agreement that reimbursement should be in place for surgery that took place in the past and in the time before the Government-procured private surgery options were in place. To that end, the Government supported Jackie Baillie’s stage 2 amendment to set the cut-off date as a date not before the date of royal assent. The committee agreed to that amendment unanimously at stage 2. The Government does not believe that the reimbursement scheme should be open ended, which would be the practical and pragmatic effect of Sue Webber’s amendments, even if that is not her intention.

With that explanation, I hope that members are reassured that the bill and the scheme provide for the reimbursement of costs from complications arising from mesh removal surgery. I hope that Parliament will agree that long-term health needs should be met through the NHS and that, in that regard, all women should be treated equally.

For those reasons, I am afraid that the Government cannot support amendments 1 and 2. I hope that, on the basis of what I have said, Sue Webber will be content to withdraw amendment 1 and not to move amendment 2.

I call Sue Webber to wind up and to press or withdraw amendment 1.

I made it quite clear that it is not my intention that the amendments would address some of the points that the cabinet secretary has raised; it is very much to make it clear to the women that reimbursement is available for

“clinically relevant surgery ... arising from the mesh removal surgery”.

If such removal surgery necessitates a reconstructive procedure taking place for a woman, I hope that we will seek to cover that if it is a consequence of the mesh removal.

That would be covered by the NHS—that is the point. If we left it open ended for women to get surgery years later, the scheme would be open ended. I hope that we can all agree, notwithstanding the important points that Sue Webber makes about trust, that we would expect our NHS to make sure that women receive the treatment and aftercare that they deserve and require.

Those women may well have to wait for years if they have to wait for the NHS, and I struggle with that. I will press amendment 1, because the women want to have that clarification and the confirmation that they should also be reimbursed for any procedure that is needed as a result of their mesh removal surgery if it is managed through the private schemes and relationships that they have with the Spire Healthcare group in the United Kingdom or with Dr Veronikis in the USA.

The question is, that amendment 1 be agreed to. Are we agreed?

Members: No.

There will be a division. As it is the first division of the afternoon, there will be a five-minute suspension.

15:45 Meeting suspended.  

15:56 On resuming—  

We move to the vote on amendment 1. Members should cast their votes now.

Voting has closed.

On a point of order, Presiding Officer. My app blocked up. I would have voted no.

Thank you. We will ensure that that is recorded.

On a point of order, Presiding Officer. I—[Inaudible.] I would have voted yes.

Thank you. We will ensure that that is recorded.

For

Baker, Claire (Mid Scotland and Fife) (Lab)
Balfour, Jeremy (Lothian) (Con)
Bibby, Neil (West Scotland) (Lab)
Boyack, Sarah (Lothian) (Lab)
Briggs, Miles (Lothian) (Con)
Burnett, Alexander (Aberdeenshire West) (Con)
Cameron, Donald (Highlands and Islands) (Con)
Carlaw, Jackson (Eastwood) (Con)
Carson, Finlay (Galloway and West Dumfries) (Con)
Clark, Katy (West Scotland) (Lab)
Cole-Hamilton, Alex (Edinburgh Western) (LD)
Dowey, Sharon (South Scotland) (Con)
Duncan-Glancy, Pam (Glasgow) (Lab)
Findlay, Russell (West Scotland) (Con)
Fraser, Murdo (Mid Scotland and Fife) (Con)
Gallacher, Meghan (Central Scotland) (Con)
Golden, Maurice (North East Scotland) (Con)
Gosal, Pam (West Scotland) (Con)
Grant, Rhoda (Highlands and Islands) (Lab)
Greene, Jamie (West Scotland) (Con)
Griffin, Mark (Central Scotland) (Lab)
Gulhane, Sandesh (Glasgow) (Con)
Hamilton, Rachael (Ettrick, Roxburgh and Berwickshire) (Con)
Hoy, Craig (South Scotland) (Con)
Johnson, Daniel (Edinburgh Southern) (Lab)
Halcro Johnston, Jamie (Highlands and Islands) (Con)
Kerr, Stephen (Central Scotland) (Con)
Lennon, Monica (Central Scotland) (Lab)
Leonard, Richard (Central Scotland) (Lab)
Lockhart, Dean (Mid Scotland and Fife) (Con)
Lumsden, Douglas (North East Scotland) (Con)
McArthur, Liam (Orkney Islands) (LD)
Mochan, Carol (South Scotland) (Lab)
O’Kane, Paul (West Scotland) (Lab)
Rennie, Willie (North East Fife) (LD)
Ross, Douglas (Highlands and Islands) (Con)
Sarwar, Anas (Glasgow) (Lab)
Simpson, Graham (Central Scotland) (Con)
Smith, Liz (Mid Scotland and Fife) (Con)
Smyth, Colin (South Scotland) (Lab)
Stewart, Alexander (Mid Scotland and Fife) (Con)
Sweeney, Paul (Glasgow) (Lab)
Villalba, Mercedes (North East Scotland) (Lab)
Webber, Sue (Lothian) (Con)
Wells, Annie (Glasgow) (Con)
White, Tess (North East Scotland) (Con)
Whitfield, Martin (South Scotland) (Lab)
Whittle, Brian (South Scotland) (Con)
Wishart, Beatrice (Shetland Islands) (LD)

Against

Adam, George (Paisley) (SNP)
Adam, Karen (Banffshire and Buchan Coast) (SNP)
Adamson, Clare (Motherwell and Wishaw) (SNP)
Allan, Dr Alasdair (Na h-Eileanan an Iar) (SNP)
Arthur, Tom (Renfrewshire South) (SNP)
Beattie, Colin (Midlothian North and Musselburgh) (SNP)
Brown, Keith (Clackmannanshire and Dunblane) (SNP)
Brown, Siobhian (Ayr) (SNP)
Burgess, Ariane (Highlands and Islands) (Green)
Callaghan, Stephanie (Uddingston and Bellshill) (SNP)
Chapman, Maggie (North East Scotland) (Green)
Coffey, Willie (Kilmarnock and Irvine Valley) (SNP)
Constance, Angela (Almond Valley) (SNP)
Don, Natalie (Renfrewshire North and West) (SNP)
Doris, Bob (Glasgow Maryhill and Springburn) (SNP)
Dornan, James (Glasgow Cathcart) (SNP)
Dunbar, Jackie (Aberdeen Donside) (SNP)
Ewing, Annabelle (Cowdenbeath) (SNP)
Ewing, Fergus (Inverness and Nairn) (SNP)
Fairlie, Jim (Perthshire South and Kinross-shire) (SNP)
FitzPatrick, Joe (Dundee City West) (SNP)
Forbes, Kate (Skye, Lochaber and Badenoch) (SNP)
Gibson, Kenneth (Cunninghame North) (SNP)
Gilruth, Jenny (Mid Fife and Glenrothes) (SNP)
Gougeon, Mairi (Angus North and Mearns) (SNP)
Grahame, Christine (Midlothian South, Tweeddale and Lauderdale) (SNP)
Gray, Neil (Airdrie and Shotts) (SNP)
Greer, Ross (West Scotland) (Green)
Harper, Emma (South Scotland) (SNP)
Harvie, Patrick (Glasgow) (Green)
Haughey, Clare (Rutherglen) (SNP)
Hepburn, Jamie (Cumbernauld and Kilsyth) (SNP)
Hyslop, Fiona (Linlithgow) (SNP)
Kidd, Bill (Glasgow Anniesland) (SNP)
Lochhead, Richard (Moray) (SNP)
MacDonald, Gordon (Edinburgh Pentlands) (SNP)
MacGregor, Fulton (Coatbridge and Chryston) (SNP)
Mackay, Gillian (Central Scotland) (Green)
Mackay, Rona (Strathkelvin and Bearsden) (SNP)
Macpherson, Ben (Edinburgh Northern and Leith) (SNP)
Maguire, Ruth (Cunninghame South) (SNP)
Martin, Gillian (Aberdeenshire East) (SNP)
Mason, John (Glasgow Shettleston) (SNP)
Matheson, Michael (Falkirk West) (SNP)
McAllan, Màiri (Clydesdale) (SNP)
McKee, Ivan (Glasgow Provan) (SNP)
McLennan, Paul (East Lothian) (SNP)
McMillan, Stuart (Greenock and Inverclyde) (SNP)
McNair, Marie (Clydebank and Milngavie) (SNP)
Minto, Jenni (Argyll and Bute) (SNP)
Nicoll, Audrey (Aberdeen South and North Kincardine) (SNP)
Regan, Ash (Edinburgh Eastern) (SNP)
Robertson, Angus (Edinburgh Central) (SNP)
Robison, Shona (Dundee City East) (SNP)
Ruskell, Mark (Mid Scotland and Fife) (Green)
Slater, Lorna (Lothian) (Green)
Somerville, Shirley-Anne (Dunfermline) (SNP)
Stevenson, Collette (East Kilbride) (SNP)
Stewart, Kaukab (Glasgow Kelvin) (SNP)
Stewart, Kevin (Aberdeen Central) (SNP)
Swinney, John (Perthshire North) (SNP)
Thomson, Michelle (Falkirk East) (SNP)
Todd, Maree (Caithness, Sutherland and Ross) (SNP)
Torrance, David (Kirkcaldy) (SNP)
Tweed, Evelyn (Stirling) (SNP)
Whitham, Elena (Carrick, Cumnock and Doon Valley) (SNP)
Yousaf, Humza (Glasgow Pollok) (SNP)

The result of the division on amendment 1, in the name of Sue Webber, is: For 49, Against 67, Abstentions 0.

Amendment 1 disagreed to.

Amendment 2 moved—[Sue Webber].

The question is, that amendment 2 be agreed to. Are we agreed?

Members: No.

There will be a division. Members should cast their votes now.

Voting has closed.

On a point of order, Presiding Officer. My apologies—my connection went. I would have voted no.

Thank you. We will ensure that that is recorded.

On a point of order, Presiding Officer. On checking, my vote had not recorded. I would have voted yes.

Thank you. We will ensure that that is recorded.

For

Baker, Claire (Mid Scotland and Fife) (Lab)
Balfour, Jeremy (Lothian) (Con)
Bibby, Neil (West Scotland) (Lab)
Boyack, Sarah (Lothian) (Lab)
Briggs, Miles (Lothian) (Con)
Burnett, Alexander (Aberdeenshire West) (Con)
Cameron, Donald (Highlands and Islands) (Con)
Carlaw, Jackson (Eastwood) (Con)
Carson, Finlay (Galloway and West Dumfries) (Con)
Clark, Katy (West Scotland) (Lab)
Cole-Hamilton, Alex (Edinburgh Western) (LD)
Dowey, Sharon (South Scotland) (Con)
Duncan-Glancy, Pam (Glasgow) (Lab)
Findlay, Russell (West Scotland) (Con)
Fraser, Murdo (Mid Scotland and Fife) (Con)
Gallacher, Meghan (Central Scotland) (Con)
Golden, Maurice (North East Scotland) (Con)
Gosal, Pam (West Scotland) (Con)
Grant, Rhoda (Highlands and Islands) (Lab)
Greene, Jamie (West Scotland) (Con)
Griffin, Mark (Central Scotland) (Lab)
Gulhane, Sandesh (Glasgow) (Con)
Hamilton, Rachael (Ettrick, Roxburgh and Berwickshire) (Con)
Hoy, Craig (South Scotland) (Con)
Johnson, Daniel (Edinburgh Southern) (Lab)
Halcro Johnston, Jamie (Highlands and Islands) (Con)
Kerr, Stephen (Central Scotland) (Con)
Lennon, Monica (Central Scotland) (Lab)
Leonard, Richard (Central Scotland) (Lab)
Lockhart, Dean (Mid Scotland and Fife) (Con)
Lumsden, Douglas (North East Scotland) (Con)
McArthur, Liam (Orkney Islands) (LD)
Mochan, Carol (South Scotland) (Lab)
O’Kane, Paul (West Scotland) (Lab)
Rennie, Willie (North East Fife) (LD)
Ross, Douglas (Highlands and Islands) (Con)
Sarwar, Anas (Glasgow) (Lab)
Simpson, Graham (Central Scotland) (Con)
Smith, Liz (Mid Scotland and Fife) (Con)
Smyth, Colin (South Scotland) (Lab)
Stewart, Alexander (Mid Scotland and Fife) (Con)
Sweeney, Paul (Glasgow) (Lab)
Villalba, Mercedes (North East Scotland) (Lab)
Webber, Sue (Lothian) (Con)
Wells, Annie (Glasgow) (Con)
White, Tess (North East Scotland) (Con)
Whitfield, Martin (South Scotland) (Lab)
Whittle, Brian (South Scotland) (Con)
Wishart, Beatrice (Shetland Islands) (LD)

Against

Adam, George (Paisley) (SNP)
Adam, Karen (Banffshire and Buchan Coast) (SNP)
Adamson, Clare (Motherwell and Wishaw) (SNP)
Allan, Dr Alasdair (Na h-Eileanan an Iar) (SNP)
Arthur, Tom (Renfrewshire South) (SNP)
Beattie, Colin (Midlothian North and Musselburgh) (SNP)
Brown, Keith (Clackmannanshire and Dunblane) (SNP)
Brown, Siobhian (Ayr) (SNP)
Burgess, Ariane (Highlands and Islands) (Green)
Callaghan, Stephanie (Uddingston and Bellshill) (SNP)
Chapman, Maggie (North East Scotland) (Green)
Coffey, Willie (Kilmarnock and Irvine Valley) (SNP)
Constance, Angela (Almond Valley) (SNP)
Don, Natalie (Renfrewshire North and West) (SNP)
Doris, Bob (Glasgow Maryhill and Springburn) (SNP)
Dornan, James (Glasgow Cathcart) (SNP)
Dunbar, Jackie (Aberdeen Donside) (SNP)
Ewing, Annabelle (Cowdenbeath) (SNP)
Ewing, Fergus (Inverness and Nairn) (SNP)
Fairlie, Jim (Perthshire South and Kinross-shire) (SNP)
FitzPatrick, Joe (Dundee City West) (SNP)
Forbes, Kate (Skye, Lochaber and Badenoch) (SNP)
Gibson, Kenneth (Cunninghame North) (SNP)
Gilruth, Jenny (Mid Fife and Glenrothes) (SNP)
Gougeon, Mairi (Angus North and Mearns) (SNP)
Grahame, Christine (Midlothian South, Tweeddale and Lauderdale) (SNP)
Gray, Neil (Airdrie and Shotts) (SNP)
Greer, Ross (West Scotland) (Green)
Harper, Emma (South Scotland) (SNP)
Harvie, Patrick (Glasgow) (Green)
Haughey, Clare (Rutherglen) (SNP)
Hepburn, Jamie (Cumbernauld and Kilsyth) (SNP)
Hyslop, Fiona (Linlithgow) (SNP)
Kidd, Bill (Glasgow Anniesland) (SNP)
Lochhead, Richard (Moray) (SNP)
MacDonald, Gordon (Edinburgh Pentlands) (SNP)
MacGregor, Fulton (Coatbridge and Chryston) (SNP)
Mackay, Gillian (Central Scotland) (Green)
Mackay, Rona (Strathkelvin and Bearsden) (SNP)
Macpherson, Ben (Edinburgh Northern and Leith) (SNP)
Maguire, Ruth (Cunninghame South) (SNP)
Martin, Gillian (Aberdeenshire East) (SNP)
Mason, John (Glasgow Shettleston) (SNP)
Matheson, Michael (Falkirk West) (SNP)
McAllan, Màiri (Clydesdale) (SNP)
McKee, Ivan (Glasgow Provan) (SNP)
McLennan, Paul (East Lothian) (SNP)
McMillan, Stuart (Greenock and Inverclyde) (SNP)
McNair, Marie (Clydebank and Milngavie) (SNP)
Minto, Jenni (Argyll and Bute) (SNP)
Nicoll, Audrey (Aberdeen South and North Kincardine) (SNP)
Regan, Ash (Edinburgh Eastern) (SNP)
Robertson, Angus (Edinburgh Central) (SNP)
Robison, Shona (Dundee City East) (SNP)
Ruskell, Mark (Mid Scotland and Fife) (Green)
Slater, Lorna (Lothian) (Green)
Somerville, Shirley-Anne (Dunfermline) (SNP)
Stevenson, Collette (East Kilbride) (SNP)
Stewart, Kaukab (Glasgow Kelvin) (SNP)
Stewart, Kevin (Aberdeen Central) (SNP)
Swinney, John (Perthshire North) (SNP)
Thomson, Michelle (Falkirk East) (SNP)
Todd, Maree (Caithness, Sutherland and Ross) (SNP)
Torrance, David (Kirkcaldy) (SNP)
Tweed, Evelyn (Stirling) (SNP)
Whitham, Elena (Carrick, Cumnock and Doon Valley) (SNP)
Yousaf, Humza (Glasgow Pollok) (SNP)

The result of the division on amendment 2, in the name of Sue Webber, is: For 49, Against 67, Abstentions 0.

Amendment 2 disagreed to.

That ends consideration of amendments.

As members will be aware, at this point in the proceedings, I am required under the standing orders to decide whether any provision of the bill relates to a protected subject matter—that is, whether it modifies the electoral system and franchise for Scottish parliamentary elections. In my view, no provision of the Transvaginal Mesh Removal (Cost Reimbursement) (Scotland) Bill relates to a protected subject matter. Therefore, the bill does not require a supermajority in order to be passed at stage 3.