Chamber and committees

The National Complex Mesh Surgical Service assesses patient needs and, where appropriate and subject to shared decision making and informed consent, performs mesh removal surgery. To date, 135 mesh removal procedures have been undertaken by the Service. Many women make the choice following assessment and discussion with the specialist team to follow a conservative pathway of care and do not undergo surgery.

The needs of patients and their goals may differ and therefore their definition of success will vary too. The removal of mesh is often only part of the treatment journey, with further reconstructive surgery depending on clinical need taking place at a later date. Patients may also have other needs which require to be addressed by other members of the clinical team.

The service is required to comply with normal clinical governance mechanisms in place within NHSGGC to provide an assurance that the service being delivered is safe and of an appropriate quality.

I have asked Gerard Hart, Chief Executive of Disclosure Scotland to respond. His response is as follows:

Disclosure Scotland’s current forms of guidance are primarily available online as either informative webpages or downloadable documents. Where possible, we draft our guidance for a reading age of 9-11. Before these are published, we review both their form and content to ensure they are suitable for users of differing needs, this includes:

• compatibility with screen reading software,
• use of accessible colour schemes and text fonts for ease of reading,
• use of clear demonstrative graphics to illustrate key points and making using of Alt Text function to ensure these images can be understood by screen reading software.

We have also begun publishing short infographic guidance videos which summarise key points on safeguarding and the disclosure process for all stakeholders, ensuring that they follow the same accessibility principles laid out previously. These guidance videos include narrations and full captions.

We are reviewing the guidance and support we provide as part of the implementation work for the Disclosure (Scotland) Act 2020. Last year we collaborated with 102 organisations, including organisations who work with and advocate for children and young people, to review proposed new guidance, collect feedback on what improvements we can make and on what new forms of guidance would be effective in communicating any changes to safeguarding processes. This feedback from our stakeholders is informing the design of guidance and support that will be published for the implementation of the Disclosure (Scotland) Act 2020 for both organisations and individuals.

When making changes to our digital service delivery, we consider all aspects of the Digital Scotland Service Standard to ensure our digital system is built around different users and their needs and that they are accessible and inclusive for everyone. We are subject to independent assurance from the Digital Assurance Office with our public facing services to ensure we align to these standards. Although ‘digital first’ is our strategy for service delivery, not everyone can use digital Government services. We will deliver improvements to our assisted digital journey as part of the Disclosure Act implementation.

The Scottish Government aims to engage with children and young people wherever appropriate during the development and review of child protection policies and services.

Throughout the recently updated , national-guidance-child-protection-scotland-2021-updated-2023.pdf (www.gov.scot) it is continuously emphasised that at a local level, staff working in child protection should engage positively with children and families during delivery of services. A resource is also currently being developed by Scottish Government in collaboration with the Centre for Excellence for Children’s Care and Protection (CELCIS) which will provide an accessible source of information on the guidance specifically for children, young people and families. This resource is being co-designed with children and young people.

The Bairns’ Hoose Bairns' Hoose - Children and Young People Participation and Engagement Plan (www.gov.scot) describes how children and young people will be involved in the development and implementation of the Bairns’ Hoose in Scotland.

More broadly, the Children and Young People’s Participation Framework offers an approach that ensures a range of children and young people are involved in the wider work of the Scottish Government. This includes a particular focus on those identified as being seldom heard, furthest from their rights, or vulnerable because of factors related to their personal development, features of their family life, or because of wider influences that impact on them within their community. Any engagement with children and young people around child protection policies and services will follow the principles of the CYP Participation Framework.

I have asked Gerard Hart, Chief Executive of Disclosure Scotland to respond. His response is as follows:

The following table details average number of days to process disclosure applications, by application type, from 2016 to 2023:

I have asked Gerard Hart, Chief Executive of Disclosure Scotland to respond. His response is as follows:

Disclosure Scotland is focused on providing reliable safeguarding outcomes for the public. It plans and regularly reviews service delivery performance to meet the Service Level Agreement. The process includes a range of system and human validation checks to ensure the accuracy of the information disclosed along with a comprehensive programme of training and performance management.

The report of the Transvaginal Mesh Case Record Review underlined what was already an important agenda for the Scottish Government: to improve care and services for women who are experiencing complications as a result of a transvaginal mesh; and, to ensure that the NHS continually reinforces good practice in confirming and recording patient consent and the treatment offered to patients. Progress continues in a range of connected activities relevant to Professor Brittons’ recommendations.

The recommendations made align with the practice that is embedded in the operation of the Complex Mesh Surgical Service, and through NHS Scotland more generally. We continue to work with NHS colleagues to ensure that women can access the care that they need, are fully supported by their GP and other clinicians, and have access to information they need to make informed decisions about their care.

The Chief Medical Officer wrote to Health Board Medical Directors on 10 October to draw their attention to the report of the Review and to the failings it identified, and to require them to seek assurance through local clinical governance committees that measures are in place locally to prevent a recurrence of the failings identified, and to assure the quality of processes connected to patient consent and record keeping. With regards to more recent patient records she reviewed, Professor Britton herself noted she was encouraged by the improvement in practice, with increasingly robust consent processes in place.

Work continues in other areas including enhancing information available to patients, credentialing of clinicians in mesh removal and improved data gathering.

The Scottish Government therefore considers that it is taking appropriate action to embed the report’s recommendations with regards to healthcare services in Scotland.

The Scottish Government recognises land is one of our most valuable assets. That is why the Scottish Land Rights and Responsibilities Statement articulates the Scottish Government’s vision for the ownership, use and management of land, setting out how we see the balance between the rights of landowners, managers, local communities and society at large.

Moving forwards the legislative requirements, such as those set out in the proposals for the upcoming Land Reform Bill and other voluntary based measure such as the Scottish Land Commission’s Good Practice programme, will all play an important role in meeting our objectives for land reform. Whilst the Regional Land Use Partnership (RLUPs) pilots were established to test and explore locally appropriate approaches to land use, the scope of the pilots was not to consider or challenge matters of land ownership or rights and responsibilities.

Regional Land Use Partnerships (RLUPs) pilots have been asked to adopt a natural capital approach to their work. This allows the pilot regions to explore how regional opportunities and priorities for land use can enhance, protect, mitigate and adapt to areas of national importance such as biodiversity and climate change.

The Scottish Government is currently working with the RLUP pilot regions as we seek to understand and evaluate the progress of the pilot programme as a whole.

I have asked Gerard Hart, Chief Executive of Disclosure Scotland to respond. His response is as follows:

Disclosure Scotland work closely with organisations regarding supporting children and young people with information on the disclosure processes. This is to ensure that children and young people have the information they need to understand the disclosure process and to inform those supporting them on their journey. This work includes publication of information on supporting learners who have offended and what education practitioners should know as part of a suite of resources available on the Education Scotland website. We also collaborate with Who Cares? Scotland on disclosure matters and have produced some short videos providing information on key areas that have caused concern to care-experienced young people such as application completion and what the consideration for listing (barring) process is. This information is available on the "disclosure scotland" - Who Cares? Scotland (whocaresscotland.org) .

During the formal consideration for listing (barring) process, if Disclosure Scotland identify a potential vulnerability, we will engage with relevant professionals such as social workers, to ensure we are communicating with the individual in the most appropriate and supportive way.

Good progress is being made in implementing the national-guidance-child-protection-scotland-2021-updated-2023.pdf (www.gov.scot) , which was published in 2021 and updated in 2023.

A National Child Protection Guidance Implementation Group was established in September 2021 for a period of 2 years to provide strategic oversight and offer support to local areas as they implemented the national guidance. A Monitoring and Evaluation subgroup of this implementation group was established to consider how to evaluate local and national implementation of the Guidance. The subgroup developed a self-evaluation tool for local Child Protection Committees (CPCs) to assess progress with implementation. The tool was completed by all CPCs in Autumn 2023 and the findings were analysed by the Centre for Excellence in Children’s Care and Protection (CELCIS) with the support of Scottish Government and the Care Inspectorate. This analysis identifies where progress has been made and where continuing changes and adaptations are required, and will be published on the CELCIS website in the near future.