Chamber and committees

In March I asked that an Accountable Officer short life working group be set up to examine the present course of care for women who experience mesh complications. As set out in response to a previous parliamentary question (S5W-22523 on 1 May 2019), the group has agreed a remit to consider what additional steps could be taken to offer choice to women who want – and are clinically suitable for – removal of mesh. The group will also review and identify areas of best practice in the United Kingdom and beyond, and if these are not already available, consider how these can be provided in Scotland. In doing this, the group will:

• consider the physical and psychological needs of women who experience complications following vaginal mesh surgery;
• consider sharing experience, techniques and learning with colleagues in Europe, the USA and elsewhere. For this to be successful it is important that surgeons and clinical teams engage with counterparts of proven merit and who are regarded by the professionals as leaders and innovators in their field
• review the course and organisation of care for patients suffering complications in Scotland with a broader UK perspective;
• examine the complex education and training requirements we must have to ensure a sustainable and resilient high quality service; and
• identify the resource requirements to provide the service our patients need.

To date the working group has met twice, and has begun to consider the matters set out above. Members have begun an exercise to benchmark the care pathways in each of their Health Boards against NICE guidelines published earlier this year, and have also started to consider the sharing of learning and experience with clinicians elsewhere. In respect of the latter, it has been agreed that a group of clinicians based in Scotland, including surgeons, a specialist nurse and physiotherapist, should undertake a series of visits to overseas clinicians in order to review, compare and contrast their practices with those currently in place in Scotland. The group will continue to progress arrangements for this. Furthermore, a protocol is being developed to ensure patients’ views are fed in to the group and are given its careful consideration.

The group aims to conclude its work in the autumn, at which point it will report to Health Board Chief Executives.

If a woman is concerned that she is experiencing complications after transvaginal mesh surgery, we would advise that:

• She should not hesitate to discuss her concerns with her GP or other clinicians involved in her care
• She can ask for a second opinion before making a decision about her care and treatment. Where possible, this request will be met, and her GP will be able to arrange this.

Advanced specialist services are currently provided in Scotland by two Mesh Complication Centres, one in NHS Lothian and in NHS Greater Glasgow and Clyde. These centres offer a range of treatments, including partial and full mesh removal, as well as non-surgical interventions. Patients should not hesitate to discuss with their GP their suitability for referral to these centres, regardless of their location, as regional and national referrals are accepted.

In a similar manner to above, if a patient is dissatisfied by the advice or with the care provided by the complication centre in either NHS Lothian or NHS Greater Glasgow and Clyde, then she can request to be reviewed by clinicians in the other centre.

Finally, a patient can make an individual request for treatment outside of Scotland. Clinicians will initially discuss any such request with the patient and, if agreed, will then refer it to the Health Board for consideration. The Health Board will review the application, in doing so considering whether the treatment requested can reasonably be provided in Scotland, and in due course will inform the clinician and patient whether the request is accepted.

All answers to written parliamentary questions are available on the Parliament’s website, the search facility for which can be found at http://www.parliament.scot/parliamentarybusiness/28877.aspx .