Chamber and committees

The Scottish Government is mindful of the use of mesh in non-transvaginal settings. In February 2018, the then-Chief Medical Officer wrote to NHS Scotland Medical Directors about public interest in the use of mesh implants, including in hernia repair. Medical Directors were asked to ensure that clinicians offer patients all appropriate options for surgery, as well as the option of no surgery. In addition, the importance of shared decision making, informed consent and listening and acting upon patients’ concerns was noted.

Furthermore, the Scottish Government has commissioned the Scottish Health Technologies Group (SHTG) to produce two reports on the use of mesh in hernia repair; the first published in January 2020 and the second in December 2021 . These reports, based on current published evidence, support the continued use of mesh in a variety of abdominal wall and groin hernia subject to all the tenets of Realistic Medicine – ensuring shared decision making and informed consent with knowledge of the benefits, risks alternative measures and the possibility of doing nothing. The findings of the reports have been discussed with professional bodies, including the Royal Colleges and the British Hernia Society.

The Chief Medical Officer (CMO) wrote to the Board Chief Executives and Medical Directors in December 2021 to draw their attention to the SHTG report. In the letter, the CMO asked Health Boards to consider the availability of non-mesh surgery, how best to address skill gaps, if they exist, and the development of broader clinical networks for management of complex cases. The actions resulting from this will be discussed at a meeting of the Scottish Association of Medical Directors in August.

There is also work ongoing with regard to establishing a Medical Device Information System (MDIS) which will provide important surveillance and outcome information.