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

The next item of business is a debate on motion S6M-02895, in the name of Humza Yousaf, on the Transvaginal Mesh Removal (Cost Reimbursement) (Scotland) Bill. I invite any members wishing to participate to press their request-to-speak buttons as soon as possible or place an R in the chat function.

16:05  

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

I hope that the Parliament will agree that, throughout the bill’s progress—and up to what we hope will be its eventual passage through the Parliament—we have seen constructive engagement from all parties. Members have represented affected constituents and all of our deliberations have been informed most powerfully by the Scottish Mesh Survivors. Each one of us will have had engagement with women, whether constituents or non-constituents, who have been affected by the implanting of transvaginal mesh.

For all of our political disagreements—no doubt, there are many—we are united in helping the women at the heart of this terrible tragedy. As the relatively young history of devolution has shown, this Parliament is at its very best when we are united in our determination to right the wrongs that are faced by those we serve.

I thank everyone who has taken time to engage with and express their views on the bill. We have listened to those views and, as far as possible, we have taken that feedback on board in our development of both the bill and, importantly, the reimbursement scheme.

I also thank Gillian Martin and all the members of the Health, Social Care and Sport Committee for their careful and thoughtful scrutiny of the bill at stages 1 and 2. As a result of recommendations that were made by the committee in its stage 1 report, amendments made at stage 2 have helped to shape and improve the bill that is before us. I will highlight two issues that were raised in the report and that, thanks to the positive and constructive engagement of all involved, led to the two changes to the bill at stage 2.

The committee proposed that women who had mesh implanted in Scotland, but who arranged to have it removed after they had moved out of Scotland, should be eligible for reimbursement. The Government agreed that the eligibility criteria as originally drafted were too narrow and undertook to amend the bill. The amendments that were lodged and unanimously agreed at stage 2 extended the eligibility criteria to include those who were not ordinarily resident in Scotland at the time of arranging their mesh removal surgery but were ordinarily resident in Scotland when the mesh was inserted. That brings the eligibility criteria for the reimbursement scheme in line with that of the wider mesh fund.

The committee report also highlighted concerns that were expressed by campaigners and during evidence and debate at stage 1 about the proposed cut-off date by which surgery had to have been arranged in order to be eligible for reimbursement. The Government’s intention had been that that date would be set as 12 July 2021, the date on which the completion of the first stage of procuring a national health service referral route to private removal surgery was announced. However, having taken note of the committee’s views and, most importantly, having listened to the views and experiences of the affected women, I accepted that the delay since the announcement has caused anxiety among those women, who are already dealing with so much. The Government was, therefore, pleased to support an amendment in the name of Jackie Baillie to change the cut-off date to a date no earlier than the date of royal assent. That ensures that any women who have made arrangements since July, or who are currently finalising arrangements, will not be penalised for doing so.

Some members have asked me to clarify whether women would still be reimbursed if the arrangements were made prior to royal assent but the surgery did not take place until after royal assent, and I confirm that, as long as the arrangements are made before royal assent, those women will be eligible for reimbursement, even if the surgery takes place after that date.

Good progress is being made in the discussions with the two private providers. I can confirm today that commissioning negotiations with Spire Healthcare have now been completed. We expect that contracts for a framework agreement will be exchanged either this week or next, and the Spire hospital in Bristol is expected to become available for referrals during February. Discussions between NHS National Services Scotland and Dr Veronikis are also progressing positively, thanks to the commitment of all parties. So, if the bill passes today, I expect that the Government will specify in the scheme a date that will be either the date of royal assent or one shortly afterwards.

Through our collective efforts to address the issues that have been raised throughout the bill’s parliamentary passage, I believe that, together, we have produced a bill that has strong support and will have a positive impact on women who made their own arrangements for transvaginal mesh removal surgery and who incurred costs as a result.

If the bill passes today, as I hope it will, we will turn our attention to finalising the reimbursement scheme. I take the opportunity to once again express my thanks to the Health and Social Care Alliance Scotland for facilitating focus groups, and particularly to the women who attended the groups and shared their views, which have been valuable in helping to draft the scheme.

As members will know, during the stage 1 debate, I committed to providing a draft of the reimbursement scheme to the committee for its consideration. That was done ahead of stage 2.

We are now working on finalising the reimbursement scheme, and it is intended that the scheme will open for applications as soon as is practically possible after royal assent. No woman affected, or parliamentarian, should be in any doubt that we will work at pace and with urgency to open the scheme as close to the date of royal assent as possible. The scheme will be administered by NSS, which currently administers the mesh fund.

I reassure members that we recognise that no two cases will be the same. Our intention is for the scheme to allow administrators as much flexibility as possible, within the guidance, when processing applications, and each application will be considered on its merits.

It is wrong that women felt that using their own funds to arrange surgery for mesh removal was their only option. I can only imagine the distress that led women to that point. In some cases, they had to pay tens of thousands of pounds, take out loans and borrow money from family members and friends. For many women, the financial impact alone of private mesh removal surgery will have been severe, let alone the physical and mental health impacts of such a process.

The bill, which I hope will be passed today, will seek to ensure that those past costs are met and that the women affected are no longer at a financial disadvantage because they paid for their treatment out of their own pocket. If we pass the bill today, we will take a step closer to providing justice for women who so thoroughly deserve it after the trauma that they have suffered. I hope that the whole Parliament will be able to support the bill.

I move,

That the Parliament agrees that the Transvaginal Mesh Removal (Cost Reimbursement) (Scotland) Bill be passed.

16:12  

I refer members to my entry in the register of members’ interests. I am a practising NHS doctor.

Today, we seek to repay a debt. Over the past two decades, 20,000 women underwent transvaginal mesh implant surgery in our NHS in Scotland. They did so to treat conditions such as incontinence and prolapse, which many women can suffer after trauma at childbirth.

The implant procedure was halted in 2018 because it was clear that many women who had implant surgery were suffering from painful and life-changing side effects. There were complications from surgery because of erosion of the mesh inside the body, which resulted in nerve damage, chronic pain and vaginal scarring. There have also been cases of organ perforation, with synthetic polypropylene mesh becoming exposed inside the vagina. Some women have even died.

In the Health, Social Care and Sport Committee, we heard from women who had harrowing experiences of mesh surgery. Many of them faced scepticism. They were simply not believed when they were crying out for help. Issues included pain, infections, reduced mobility, auto-immune issues, difficulties with intimacy and psychological strain. The women were simply not believed. That added to their distress and extended the time before any remedial intervention could take place.

It is no surprise that so many women sadly lost trust in our Scottish NHS and turned to private healthcare providers in the United Kingdom or abroad. Anne is one such sufferer. Back in 2010, she was fit and healthy. She went to a doctor with anterior prolapse and mild incontinence, but an operation to fit transvaginal mesh left her in agony. In a BBC interview this morning, Anne recounted how she was offered a simple “gold standard” transvaginal mesh procedure. However, after the operation, she began to suffer from a wide range of problems and was left in chronic pain. After years of frustration, with nowhere to turn for help in Scotland, the retiree spent £19,000 travelling to Missouri in the United States to get her implant removed by the world-renowned expert Dr Veronikis. Sadly, her story is not unique.

The debate focuses on women who have already paid for private surgery being able to recoup their costs. As my colleague Jackson Carlaw said, that is a debt of honour, because those women were injured on the NHS. We should recognise that the Scottish Government announced in July 2021 that future surgery and travel costs to Spire Healthcare in Bristol and the Mercy hospital in Missouri in the United States would also be covered. It has been estimated that the cost of each procedure is between £16,000 and £23,000. However, that is obviously not a cut-off in the bill—there is no cut-off.

We are pleased to support the Transvaginal Mesh Removal (Cost Reimbursement) (Scotland) Bill. We have been supporters since the issue was first raised in the Scottish Parliament by a public petition. We are also pleased that there are now specialist services in Scotland for women who are experiencing complications from mesh implant surgery and that clinicians have undergone specialist training and credentialling. The Scottish Government will also work with providers outwith the NHS, so that women who have lost trust in the NHS can have mesh removed. However, I would happily support the surgeons in Scotland, some of whom I have worked with here in Glasgow, to provide world-class care equivalent to anything that can be given abroad.

Although we support the bill, we believe that improvements could still be made. My colleague Sue Webber’s second amendment was to clarify a point. I thank the cabinet secretary for his clarification on the cut-off date for women to be compensated if they have booked surgery but not yet had it. That was the point of the amendment and we are reassured.

As a result of our discussions in the committee and our debate in the chamber, I believe that we will all be comfortable with where we are today. We hope that we can continue to stand united to fully support Scotland’s brave women who have suffered greatly for years following complications from transvaginal mesh surgery.

The Scottish Conservatives will support the bill.

16:17  

I welcome the opportunity to open the debate for Scottish Labour.

The bill empowers the Scottish Government to reimburse women for private healthcare costs relating to transvaginal mesh removal surgery by putting in place a scheme for making reimbursement payments. The bill will include, for example, travel and hotel accommodation costs in relation to the surgery—and quite rightly so.

I want to use much of the time that I have to herald the great work done by the women who experienced life-altering mesh surgery and campaigned strongly to get us to where we are today. I think that all of us in the chamber—this has been mentioned—have heard from someone who has been affected. The women should be thanked for ensuring that we in the Parliament listened to serious concerns from our constituents. Every member of the Scottish Parliament should take time to recognise the efforts of those women and reflect on the steps that were taken to get us here, not least so that we do not make the same mistakes again.

We can never celebrate enough serious democratic engagement by those at the sharp end in our society. I encourage other groups that feel that they may have been treated unjustly to come forward to their Parliament. It is their Parliament, and it is our duty to help them.

Scottish Labour supports the bill at stage 3, as we have done, critically, throughout the process. It speaks to the cross-party spirit of the bill as presented today that we have reached a proposal that meets the needs and expectations of most of the women who put the issue under the spotlight so boldly many years ago. They are my priority, and I trust that they are satisfied today.

It is welcome that Jackie Baillie’s amendment was accepted at stage 2. It ensured that, although the mesh removal surgery must have been arranged by a specific date in the scheme, it does not have to have taken place by that date. The minister clarified that in his speech, and we thank him for doing so.

Although my amendments fell at stage 2, I met the cabinet secretary afterwards, and I am assured that the scope of bill, as passed, will ensure that all the women who suffered and paid for corrective treatments or part treatment can be reimbursed, and that the Government is actively seeking to ensure that that happens.

I will caveat my comments by saying that there is still a long way to go in rectifying the injustice of mesh and setting Scotland out as an example of how we can shift the balance.

We should continue to be open and receptive to the concerns of the women and those like them who have similar experiences. We must always offer our attention and respect to those with first-hand experience of the issue and we must accept that, for a long time, the received wisdom and official response to how the women were treated were wrong.

As I am sure other members know, the reforms have come about as part of a lengthy and well-considered response to reasonable worries that were expressed by those who were so unfairly given this treatment. Securing adequate reimbursement is not only practical, fair and just but a way of expressing our regret as a nation that anyone could be left in the pain and distress that so many women were left in. We must learn from this and ensure that it is never allowed to happen again.

Scottish Labour supported Sue Webber’s amendments because we thought that the bill’s scope should be as wide as possible. We must ensure that any perceived lack of clarity is stricken from the bill and that all those who are affected are given clear communication about what they are rightfully entitled to. Everyone who is entitled to reimbursement must receive it without delay.

I thank my colleagues on the Health, Social Care and Sport Committee, many of whom are in the chamber, for their work on the bill in recent months. We worked well together and we moved things forward in a timely manner. I trust that we will soon arrive at a resolution that addresses the problem that the bill was introduced to deal with. As a committee member, I have been impressed by the detailed work on and care that has been taken over the issue. I think that we can all agree that the bill’s general principles are moral and just.

I trust that we can now get the bill over the line and deliver on the promise of justice that I and Scottish Labour are absolutely committed to. The committee worked hard to get to this point, and I thank its members.

16:21  

At this final stage of the bill, I am pleased to speak in support of it again for the Liberal Democrats. I am gratified to note the universal support and heartfelt concern for the victims of what is undoubtedly one of the most awful public health disasters in Scottish history. I thank Jackson Carlaw, Neil Findlay and Alex Neil in particular for their work in getting us to this space and for all that they have done to highlight the plight of thousands of women living in Scotland who have been affected by the procedure.

The number of women is in the thousands. As Dr Gulhane told us, more than 20,000 women in this country underwent mesh surgery before it came to an end in 2014. Thousands suffered as a result. Those women have suffered chronic pain that has affected their daily lives and has in many cases forced them to retire from jobs that they loved. That is not to mention the significant impact on their mental health and the financial cost that many survivors have had to bear in order to pay for their mesh to be removed through private healthcare in this country or abroad—we have heard that many went abroad. We have gathered today to address that cost.

In the stage 1 debate, I shared the story of Cathy, one of my constituents, whose account echoed those of many women whose general practitioners and physiotherapists referred them to receive what they were told would be a marvellous new procedure. Like many other women, Cathy received little information, other than being told that the procedure would cure her of the mild issues that she had with incontinence.

As a result of the mesh implant that she received and its follow-on effects, Cathy’s mobility, mental health and intimacy with her partner have all been adversely affected, and her quality of life has been devastated. Following her discharge from hospital, and amid crippling pain, Cathy made numerous attempts to call the doctors and nurses who treated her. She never received a call back. If her concerns had been taken seriously at the time, she might have been spared five years of coping with crippling pain.

I have met many survivors of the procedure—sometimes in the Parliament building—and all have had similar stories to tell. Cathy and hundreds of women who are in her position were badly let down. The ordeal has seriously damaged the trust that many of those women had in their healthcare system. Understandably, many of them sought private healthcare providers to remove the implants, and the costs of surgery ranged anywhere from £16,000 to £23,000. The women should never have had to bear that cost, and it has saddled many women with substantial and significant debt, so I am pleased that the plans for reimbursement will now compensate entirely for the cost of surgery and associated costs, including those of travel and accommodation.

I was pleased to support the amendments in Sue Webber’s name and I am sorry that they were not agreed to. The amendments would have extended the compensation scheme to victims of the procedure no matter where the implant was in their body, which my party called for at stage 1.

Benjamin Franklin once wrote:

“Justice will not be served until those who are unaffected are as outraged as those who are.”

I am proud to count myself among the MSPs who have followed the facts of this scandal with outrage for far too long.

I say this directly to the survivors of the surgery, some of whom will be watching us. What you have had to endure has been an outrage and an injustice. It should never have happened, and you have had to bear it for far too long alone. Although those of us who are unaffected will never be able fully to understand the suffering that you have had to bear, and the bill can never take away the physical or mental trauma that you have endured or the time that you have lost, I hope that, after today, you feel that there is a prospect of compensation and care long overdue, that your voice has been heard and that justice has, in some way, been served. That is the very least that you deserve.

The Liberal Democrats will take pride in supporting the bill tonight.

16:25  

Accounts of the complications of transvaginal mesh and the lifelong effects have been relayed in the Parliament many times. Recounting their experiences through the Public Petitions Committee, campaigning inside and outside the Parliament building and championed and assisted by MSPs such as Jackson Carlaw, Neil Findlay, Alex Neil and many others, brave women have fought to be heard, and they have kept going to find resolutions to the many problems that they have faced as a result of mesh being used in their surgery.

The mesh survivors, as they have become known as a shorthand, have told us of the heartbreaking physical damage and attendant psychological trauma that they have endured. They campaigned for a moratorium on the use of transvaginal mesh, which is now in place, and they are now to be reimbursed for the financial sacrifice that they felt they had to make in order to access private healthcare to remove the mesh from their bodies.

As I said in the stage 1 debate,

“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.”—[Official Report, 24 November 2021; c 27.]

The bill is a simple and narrow one, designed by Government and amended by my committee and the Parliament to ensure that financial hardship is not added to the women’s trauma, or that it is at least undone.

In an unusual but very welcome step ahead of stage 3 today, the Scottish Government made the draft details of the reimbursement scheme available to the Health, Social Care and Sport Committee, as the cabinet secretary mentioned. That is very welcome. It allows us to question the designers of the scheme on some outstanding issues and, as a result, I feel confident that the scheme will achieve what the bill intends it to achieve. The flexibility in applications that we wanted is there; the assistance for those applying is there; and the understanding that many women might still be suffering from the physical and psychological effects is to be taken into account by those administrating the scheme.

We have always said that the process for applying for reimbursement should not cause additional stress and anxiety for those applying to or managing the scheme, and we have been given that assurance. We have also heard that the Scottish Government is taking steps to ensure that, in the future, women will have choice and control over their care, including options to have transvaginal mesh removal surgery undertaken by independent providers if that is what they wish.

I thank all those who assisted the committee with our scrutiny and who responded to our call for views, and those who gave evidence in person or online. In particular, I join my committee colleagues who have already thanked the women who spoke with us, facilitated by the Health and Social Care Alliance. They told us—probably for the umpteenth time—of their experiences of transvaginal mesh complications. It takes a tremendous amount of bravery to do that, especially when we keep on asking them to do it.

I hope that the women who spoke to us and who might be watching the debate feel that our committee listened to them with understanding and compassion, and that our recommendations at stage 1 and amendments at stage 2 shaped the bill in the way that they advised us it should be shaped. We widened the eligibility for reimbursement, which I think was the right thing to do to ensure that no women fell through any gaps.

However, the bill is not the end of the mesh story. I want to give mesh campaigners and the women who suffered as a result of its use the assurance that our committee will be keeping a very close eye on the development of improved specialist mesh removal services. We know from their discussion with us that there is still a long way to go to rebuild trust, and we will be playing our part in ensuring that those services reach the standards that we, and they, expect.

16:29  

I am very pleased to be able to speak in the debate, which marks yet another milestone in the journey of the victims of transvaginal mesh. I welcome the action that the Government is taking and believe that the legislation will start to provide some justice to the women who have survived the mesh scandal.

In the stage 1 debate on the bill, Jackson Carlaw spoke of how a fundamental disconnection resulted in the concerns of many women being dismissed by the medical profession as “women’s problems”. It is nothing short of a disgrace that that went on for more than 20 years. That failure exposed women to avoidable harms for far too long and added to their stress.

I put on record my admiration for the women who have fought this fight. They have fought it with dignity and determination in the face of a failure by many in the medical profession. Today, we prove that their fight has not been in vain. It has led to increased restrictions on the use of transvaginal mesh around the world; it has also brought the bill to Parliament today.

I also pay tribute to the actions of MSPs past and present, including the so-called three meshketeers: Neil Findlay, Jackson Carlaw and Alex Neil. They supported the women and their efforts should not go unrecognised.

However, let us not lose sight of the fact that women who suffered the adverse effects of mesh implants have paid a very heavy price. It has taken a terrible toll on their physical, mental and emotional health and wellbeing, and, as the minister said, on their financial health. Many victims have spoken of the chronic pain, suicidal thoughts and family break-ups that they have faced. All that is life changing; all that was preventable.

The bill that we seek to pass today does far more than just reimburse women who have suffered—it rights a fundamental wrong. The bill rightly grants the Scottish Government the powers to reimburse costs associated with private surgery to remove transvaginal mesh implants. It also sets out more about the administration, eligibility, time limits and application to the scheme and relevant reviews.

At stage 1, the Health, Social Care and Sport Committee asked for further clarity regarding fairness and parity of treatment for all individuals concerned. I therefore very much welcomed the stage 2 amendments that extended the eligibility criteria on residency. I also welcomed the flexibility on the cut-off date for reimbursement.

Although we support the bill, the Scottish Conservatives believed it not to be perfect and I welcomed Sue Webber’s amendments today. As the residents of Edinburgh know, if Sue Webber comes forward with a solution, it will always be an elegant one, as Alex Cole-Hamilton suggested. We welcome the minister’s clarification that many of those aspects are covered by the bill.

For mesh sufferers, the legislation cannot come a moment too soon. The women were badly let down and have faced devastating and life-changing consequences as a result. We have a responsibility now to ensure that they receive the best and most appropriate treatment available, and I welcome the minister’s assurances in that regard.

We have a duty to help the women rebuild their lives. We owe them that, and that is why my party will be supporting the bill this evening.

16:33  

As a member of the Parliament’s Health, Social Care and Sport Committee, I welcome the opportunity to speak in the stage 3 proceedings of this vitally important bill.

I put on record my support for, and recognition of, all women who have had their lives changed as a result of mesh implants. I thank all the women who have taken part in focus groups on the bill and who have contributed to the committee’s scrutiny of it. It is because of the courage of the women affected that we are at this point. I also welcome the cross-party way that the bill has been taken forward, both in the chamber and in committee.

The bill is narrow and has a limited function: to refund women who have paid for private surgery to remove transvaginal mesh and reasonable connected expenses, such as additional medical intervention, pre or post-op, which could require more time in hospital, which is an issue that I raised during scrutiny of the bill.

The bill will be directly relevant to a comparatively small number of women across Scotland, but the impact on them is hugely significant, as other members have mentioned.

The bill rightly brings the Parliament’s attention to the traumatic experiences of those women who have suffered pain and distress after having mesh implanted. Some have experienced extreme pain and health issues, which have affected and completely changed their lives. In committee, we heard directly from women about the physical symptoms and psychological distress that they experienced, the latter of which was often made worse because they felt that their experiences were not taken seriously enough when they sought help.

During those sessions, we heard how, regrettably, many of the women who have been impacted have lost trust in the ability of the NHS to address the issues relating to mesh implants. Having listened to those women, I completely understand why they have lost trust and why it is important that those concerns are addressed. I therefore welcome the steps that are being taken by the Scottish Government—which will be enhanced through the bill—to improve the care offered to affected women and ensure that their voices are heard and that their treatment wishes are granted in a person-centred way.

In particular, I welcome the national specialist mesh removal service in Glasgow, which has been offering full mesh removal since July 2020. So far, 33 women have had mesh removal surgery at the centre. New surgeons have been recruited and there are now four urogynaecologists. That allows women more choice over who they are treated by and gives them the option to be treated by a surgeon who has not been previously involved in their care. The service benefits from a multidisciplinary team approach, with contributions from specialist nurses, physiotherapists, pharmacy staff and a clinical psychologist. All of that is extremely important.

Alongside the national specialist service, the bill allows the Scottish Government to make it possible for women to choose—because of a lack of trust or past experiences in our NHS—to be referred for surgery in NHS England or the independent sector. That alternative pathway approach uses a specialist centre in NHS England, Spire Healthcare in Bristol or the Mercy hospital in Missouri.

In evidence to the committee, we heard how some women had already paid to have private treatment for corrective and mesh removal surgery before arrangements were in place for women to be referred for that surgery. I therefore welcome the provisions in sections 1 and 2 of the bill that allow for women in that circumstance to be reimbursed. I ask the cabinet secretary for an assurance that the payments will be made in a timely manner following any claims that are made.

I note again that the bill is narrow but essential. It will ensure that all women who have been impacted by transvaginal mesh—many of whom have been seriously impacted physically and psychologically—receive the care that is suited to them and that they choose. I agree with Gillian Martin that the bill is only part of the care process and I look forward to continuing to monitor progress.

16:37  

I am pleased to make a contribution as we reach stage 3 of this important bill. It has been a long process. As an MSP who was elected last year, I have been part of the process for only a short time.

Tribute is due to all the brave women who have told their story time and again, campaigned ferociously and called on us to do the right thing despite all their personal pain, both physical and mental. Tribute is also due, as we have heard already, to Jackson Carlaw, Alex Neil, Neil Findlay and other colleagues in Parliament who have worked to keep the issue firmly on the agenda and the Government on track to deliver the legislation.

I am sure that, for many people, today feels like another milestone on what has become a journey for justice. I have only had a short insight into that from a parliamentary point of view, through the Health, Social Care and Sport Committee. It has been humbling to be a part of the process of scrutinising the bill. As other speakers have said, listening to the evidence of so many women and thinking about how to act accordingly has been key to that process.

Scottish Labour is supportive of the overall aims and principles of the bill. Far too many women have gone through a traumatic experience since having their mesh fitted, and it is right that the Scottish Government covers any related costs that have been incurred in removing the device. As we have said at each stage, it is imperative that any agreed legislation ensures that all patients who have taken steps to have their mesh removed are reimbursed. No one should be left behind.

The cabinet secretary is right when he speaks of the consensual approach that has been taken to the bill and the consensus that we found at the committee stage. It is welcome that my colleague Jackie Baillie’s amendment was accepted at stage 2. It will ensure that, although mesh removal surgery must have been arranged by the date specified in the scheme, the actual surgery does not need to have taken place by then. That will be a great comfort to many people.

We were supportive of Sue Webber’s amendments, which were helpful and sought to reflect much of what we heard in committee. They will ensure that women will have access to specialist services for on-going issues and, as specified in her first amendment, that the timeframe for mesh removal surgery will not apply to that.

I note the cabinet secretary’s willingness to engage on the issue and to ensure that it will be for the NHS to respond and make sure that any further surgery can take place. Given the on-going pressures on the NHS, the cabinet secretary should expect scrutiny on that as we progress, which I am sure that he will be open to.

I highlight the contribution that my colleague Carol Mochan has made in her stage 2 amendments to extend eligibility to those who are

“not ordinarily a resident in Scotland”

and to ensure provision for people who incurred costs on behalf of someone else. She made her case strongly and, again, I know that the cabinet secretary engaged on the issues with her to ensure that the scope of the bill was as wide as possible and that nobody would fall through the gaps.

We have the opportunity today to offer financial redress to people who have endured so much, who have travelled across oceans and who often have spent all that they had to relieve pain and live life a little more fully. We cannot take away all their pain, either physical or psychological, but we can use the powers of this Parliament to do the right thing. There will, of course, be more to do, and this is not the end of the journey. However, we can back the bill at decision time, ensuring that we do right by mesh survivors and leave no one behind.

16:41  

Like many other members, I sincerely thank the women who have campaigned for the bill and for justice to be delivered. During committee evidence sessions, we heard first hand the impact that mesh implantation has had on their lives and the terrible pain and debilitating symptoms that many women have suffered. Their determination in the face of that is inspiring, and this victory is very much theirs.

I have been heartened by the spirit with which members have engaged with the bill. I note that concerns were expressed by members during stage 1 about its scope being too narrow, with the risk that mesh survivors would fall through the cracks of the reimbursement scheme, and I shared many of those concerns. However, I am pleased that the cabinet secretary has engaged with the committee and other members and has listened and responded to those concerns. The constructive engagement across the parties is reflected by the fact that we have reached stage 3 with only two amendments, highlighting how the Parliament works at its best.

I know that the aim of all members in the chamber and on the Health, Social Care and Sport Committee has been for the bill to deliver justice to the mesh survivors. However, our job is not done. We must ensure that the reimbursement scheme is flexible and achieves its intended aims. In the committee, we heard concerns about the in-betweeners, who are women who have already arranged private surgery but who have not yet received it, and I am grateful for the cabinet secretary’s reassurances in that regard this afternoon. I thank him for sharing the draft scheme and, like other members, I await the final detail of the scheme with keen interest.

The bill addresses the financial costs that many women have incurred when obtaining mesh removal surgery, but it does not address the emotional and physical costs. In the committee, I asked about on-going mental health support for mesh survivors, and it is worth revisiting that point. Many women may have experienced trauma as a result of mesh implantation, and it is vital not only that we provide them with the mental health support and treatment that they need but that we seek to rebuild the trust that may have broken down between them and NHS services.

The committee heard that follow-up care, including mental health support, physical health support and physiotherapy, for women who received removal surgery outwith the NHS was not always easily accessible in Scotland for individuals. We must ensure that those women are receiving comprehensive, wraparound care and that the people who are treating them are aware of their history.

We must not neglect the women who did not seek private removal surgery but who might have experienced trauma and a breakdown in trust. They, too, must receive the support and treatment that they need, and just as much emphasis must be placed on rebuilding their relationships with clinicians.

Scottish mesh survivors have on-going concerns about the treatment of people with mesh complications. It is important that we seek to address those. Concerns about waiting times for the national mesh complication centre were raised with the committee. Our NHS is under unprecedented pressure. The committee heard evidence that patients are facing long waits for appointments. Some women have experienced waits of at least nine months for assessment, with longer waits for appointments and surgery. I would appreciate any comment by the cabinet secretary about how we can work to reduce those waiting times.

As the committee noted in its stage 1 report, it is vitally important that any individual who has experienced complications caused by transvaginal mesh can have their case reviewed and can receive appropriate treatment as quickly as is practically possible via the complex mesh national surgical service. The committee has stated its intention to continue taking an active interest in that service and to take further evidence on that subject this year. I look forward to taking part in that important scrutiny work.

Scottish Greens will be delighted to vote for the bill at decision time.

16:46  

On behalf of Scottish Labour, I thank everyone who has contributed to this necessary debate.

As others have noted, the reforms in the bill have come about as part of a lengthy and considered response to reasonable worries expressed by those who were so unfairly treated. Scottish Labour warmly welcomes the agreement by all parties that securing adequate reimbursement is fair and just and expresses our regret that anyone could be left in such pain and distress for so long.

Gillian Martin rightly indicated that the Health, Social Care and Sport Committee will be keeping an eye on the progress that the bill provides for women. As Emma Harper reiterated, this is not the end of the committee’s work. We have much more to do in reassuring women that we can have a world-class service in future.

We thank all the women who shared their stories again and again. Craig Hoy made that point well.

I thank Paul O’Kane for reminding us of the work that was done before this session of Parliament. I can only imagine the work that happened beforehand. We thank Jackson Carlaw, Neil Findlay and Alex Neil in particular, as well as all the committees that worked to bring the bill to this stage. It has been long awaited and we thank all those who worked on it over those years.

Scottish Labour fully supports the overall aims and principles of the bill and wants to see it in place as soon as possible. As many members have said, far too many women have gone through traumatic experiences since having mesh fitted. It is right that the Scottish Government should cover any related costs and it is imperative that the bill moves forward quickly after we—as I hope we will—agree to it at decision time.

The bill includes travel and hotel accommodation costs. We are assured from the bill and the guidance that it will cover all the cut-off dates and the evidence to review if someone is refused payment. The cabinet secretary indicated that someone has been appointed to administer the scheme. That is all very welcome.

We need the legislation now. I am glad that we are getting on with the job. I reiterate my party’s position: we support the bill. We will, of course, continue to scrutinise the Government to ensure that the bill is fit for purpose and to see how the Government will raise awareness so that women know that they are entitled to reimbursement. If we cannot adequately inform people of what they are entitled to, we cannot be surprised when they fail to take up that offer.

Scottish Labour hopes that the debate will give the affected women reassurance that we will move forward. I thank everyone who has contributed today.

16:49  

I congratulate Mr Yousaf and the Government on driving the bill forward to its conclusion today.

I do not think that people realise how unprecedented and brave the bill is. It may have a narrow focus, but it is unprecedented for a country and a national health service to reimburse the costs incurred by women for health treatment falling outside the scope of that national health service and, in some cases, taking place internationally. I hope that that sits as an example to other countries that are seeking to decide how to bring justice to the women in their countries who have suffered, and it may yet serve as a model for some unforeseen future problem.

I do not want to walk away from the fact that issues remain. We will wait to see what Professor Alison Britton’s casework review reveals when her report is published, and we look to the implementation of the recommendations that were made by Baroness Cumberlege, which is on-going. We also note the cabinet secretary’s assurance in relation to the women who have had mesh removed but have consequential health issues that still require to be resolved. We want to ensure that a focus continues to be brought to bear on them.

I thanked a number of people in my speech at stage 1. I do not wish to go through the list again, but I would like to thank some other women this time: formidable journalists who have been fundamental to the success of the campaign. I thank Lucy Adams at the BBC and, in particular, her predecessor Eleanor Bradford, who was one of the first journalists in mainstream broadcasting media who was prepared to confront the issue and ensure that it got a public airing. Mandy Rhodes at Holyrood magazine has been an assiduous supporter of the women throughout, and a continual support to those of us who have sought to maintain a focus on the issue.

However, I hope that they will forgive me if I single out the indefatigable and indomitable efforts of the investigative journalist Marion Scott, first of the Sunday Mail and now of the Sunday Post. Maz, as she is known to the women, has absolutely been beside them at every turn, and she has left no stone unturned in ensuring that every aspect of the story and its development around the world was given a proper airing and brought to bear on the debate that we have had. I know that she has been the most extraordinary friend to the women, and they owe her—and believe that they owe her—a great deal for ensuring that the campaign that they have been fighting has led to the success that it has today.

I thank once again my constituent Elaine Holmes, who brought the petition to the Parliament together with Olive McIlroy almost eight years ago, in April 2014.

I will conclude with a personal reflection. I have been in the Parliament for 15 years, and many of the big issues that I confronted in my youth in politics were resolved before I got here—many in my favour, and others not. However, I realise that the issues that I have been involved in in the Parliament form a thread. I supported Trish Godman’s campaign on wheelchairs in the first session, which has had such a life-changing effect on many people who previously had no bespoke wheelchairs and had to make do with things that were unsuitable. There was the campaign that my colleague and friend Ruth Davidson asked me to lead on behalf of my party on same-sex marriage. There was the campaign that I fought with others for access to orphan-condition pharmaceutical medicines, which had previously so often been overlooked. I have stood up for my Jewish constituents in Eastwood and Jewish people more widely across Scotland. I have campaigned with Margo MacDonald and am now campaigning with you, Presiding Officer, to bring enlightenment on the issue of assisted dying.

The common thread that runs throughout all those things and the campaign on mesh is that they have all depended entirely on powerful cross-party working in the Parliament. They are models of what we can achieve when we work together as parliamentarians, and how powerful the message and the changes can be for people across Scotland, in every different way of life, when they know that they have the support of the whole Parliament.

Some members have been kind enough to mention that Alex Neil, Neil Findlay and I have been referred to from time to time as the three meshketeers. Today, this is a united Parliament of meshketeers, and that is something of which we can all be proud.

16:53  

I do not know whether I have ever said this before in my 10 years in Parliament, but it is a genuine pleasure to follow Jackson Carlaw’s excellent and very powerful speech. It was another speech that, unsurprisingly, put the women who have been affected—the survivors of mesh—at the front and centre of the discussion. It was a very fine and powerful contribution from Jackson Carlaw, and it is a genuine pleasure to follow his speech and sum up the debate.

I hope that people, particularly the women who are watching our consideration of the bill, will feel able to agree that our work on it has seen this Parliament at its very best, as others have said, with members working across parties to try to make life better for our constituents—the people who send us here to represent them, to right wrongs that have been done and to help those who have been harmed through absolutely no fault of their own. That is what we have tried to do together in relation to this very important bill today.

Again, I thank the members of the Health, Social Care and Sport Committee for their thoughtful consideration. My thanks also go to those members, both past and present, who have campaigned on the mesh issue for many years. In some respects, as the current Cabinet Secretary for Health and Social Care, I am doing the easy bit in bringing the bill forward, as there was already good will among members of all parties. I pay tribute to my predecessor, Jeane Freeman, for committing to taking action at the end of the previous session, and to her predecessor, Shona Robison, who first engaged with the women who were affected and promised them that their plight would not be ignored.

I also praise—as other members have rightly done—the cross-party campaign that was spearheaded by Jackson Carlaw, Neil Findlay and Alex Neil, who played an incredibly important role in ensuring that the voices of mesh survivors were heard loudly. They were determined in their efforts and they made sure that those voices were heard not just by the Government but by the Parliament. Something tells me that the three aforementioned MSPs probably do not catch up regularly over a pint—albeit that Jackson Carlaw seemed to refer to their doing it more often than we think—but they can all take real pride in their collective efforts.

I also thank both the Finance and Public Administration Committee and the Delegated Powers and Law Reform Committee for their consideration of the bill.

Of course, all of us have rightly ensured that the most important thanks and gratitude have been given to those women who have taken the time to engage with the bill and to express their views on it as it has progressed, both in the focus groups and in the committee evidence, as well as in speaking to parliamentarians and ministers. Many of them have spoken to me directly and personally. It is fair to say that, without their courage, we would not be where we are today, and I thank them for that.

Gillian Martin made the important point that the women who are affected have probably told their stories time and again, which, unfortunately, has involved retraumatisation. I hope that, following our passing the bill, as it looks as though we are about to do, they will no longer have to share those stories.

The Government and NHS Scotland are working hard to improve the care that has been offered to those women. Many colleagues have referenced the national specialist mesh removal service in Glasgow. We will continue to see how we can improve that service—there has already been feedback on how it can be improved. Given Dr Gulhane’s clinical experience, I was heartened to hear him speak positively about the expertise and skills of the individuals at the national centre. However, I say again that, if there are improvements to be made, we will seek to hear that feedback from the women involved.

A number of members asked about the reimbursement scheme, seeking a reassurance that its administration will be as flexible as possible. I say again clearly, in my role as the cabinet secretary for health, that it is my expectation that each application should be considered on its own merits. My instruction is also clear that, when there is doubt about any aspect of an application, those who are administering the scheme will work alongside applicants and will apply common sense and good judgment. I do not expect that women who had mesh removal surgery done privately in America five years ago will have kept the receipt for their taxi from the hotel to the hospital. Therefore, I expect the scheme to be operated on a basis whereby those who make the claims are given the benefit of the doubt, appropriate judgment is applied and everything is done in a way that is consistent with our obligations on public finance.

On some of the other issues that colleagues raised, they are absolutely right. Undoubtedly, there are concerns about waiting times for referral to the national centre, as Paul O’Kane and other members mentioned. That is a fair comment. However, that service has been impacted like the rest of the NHS. I take Paul O’Kane’s challenge—that he and others will continue to scrutinise that referral—in the spirit in which it was intended. They are right to do so.

Carol Mochan made an important point about communication. I give her an absolute assurance that it is foremost in our thoughts that, prior to the scheme being ready to open, we will have in place clear communication about eligibility criteria, what is expected, how an application is made, how long a person will have to wait, and so on. All that work is being done at the moment.

Colleagues made other important points about the fact that there are on-going issues. It is not—as, I think, Carol Mochan said—the end of the road. Although the bill is an important step, which we all recognise, there are women who have not had mesh removal surgery, and we need to guide them as appropriately and as sensitively as we can through the other avenues for recourse that absolutely exist for them. This is not the end of the road, but it is an important chapter.

It is probably right that I give the last word to the women who fought so long to get us to this point today. We would not be here without them or without the campaigning of MSPs over a number of years. I will quote from a letter that was submitted by some of those women to members of the Public Petitions Committee. It said:

“These women have already suffered the loss of the lives they once enjoyed, their jobs, mobility, and marital lives. They have been left on benefits and dependent on others because they trusted they were receiving ‘gold standard treatment’. We do not believe they should have to suffer the loss of their life savings too.”

I whole-heartedly agree, and I feel confident that everyone in the Parliament believes that reimbursement of those personal costs is the very least that mesh survivors deserve. We are all here today with that unified purpose—to make sure that we do right by women who have suffered through no fault of their own.

I am delighted to close the debate. I hope that members will unanimously support this incredibly important bill.