I am pleased to have the opportunity to close today’s debate. First, it is important to recognise and acknowledge the efforts of all the women who have campaigned for better services for those who have complications from mesh surgery. Their dedication and fortitude have been admirable.
I hope that all the improvements that the cabinet secretary described earlier will mean that women will now have access to more of the help that they need. I also hope that the bill’s intention is, therefore, clear. We want to ensure fairness for the women for whom those options were not available in the past, and who paid for their treatment out of their own pocket.
As I turn to some of the detail that we have discussed today, I thank all members who have contributed to the debate. It is clear that, although some members have quite rightly raised important points and asked probing questions, we all want the same thing: we want to ensure that we do right by the women who have suffered.
As the cabinet secretary did, I extend my thanks to the Health, Social Care and Sport Committee for its consideration of the bill and for its support for the bill’s general principles.
I fully appreciate that women will be frustrated by the length of time between the Government’s announcement of the successful bidders on 12 July and the final contracts being agreed. I assure them that NHS National Services Scotland is working hard to finalise the arrangements as quickly as possible. However, I am sure that all members will understand that there is a balance to be struck between concluding the agreements quickly and ensuring that all aspects of wraparound and emergency care are provided following those agreements.
As the cabinet secretary said, the Government will consider the matter further and intends to confirm its position on the cut-off date at stage 2, should Parliament agree to the bill at stage 1.
In his response to the stage 1 report, the cabinet secretary has committed to considering further the issue of residency and to lodging an appropriate amendment at stage 2. He has also agreed to provide the committee with a draft of the reimbursement scheme that will provide details on the meaning of the term “arranged”, while still allowing scheme administrators the flexibility to take into account individual circumstances. The Government considers that approach to be preferable to a delay through making of regulations. It is intended that NHS NSS, which already administers the mesh fund, will administer the scheme. The Government will work closely with NHS NSS in the coming months, as we make more detailed plans for its administration. NSS will be given sufficient resources to manage the scheme effectively.
The intention of the bill is to reimburse the full costs of surgery, along with reasonable travel and accommodation costs, for the person who undergoes surgery and a person who travels with them as support. However, it is not anticipated that reimbursement will be given for luxury accommodation or first-class travel, for example, which is why the caveat about reasonable costs exists.
For other expenses such as food, the intention is to give women a choice of whether they want to evidence their costs—if they are able to do so—or to receive a capped rate per person per day. That approach is to ensure the flexibility that we all agree is important, and is a direct response to feedback from women who told us that they want a straightforward process.
A number of people raised issues around crowdfunding and donations from family. The purpose of the scheme is not to reimburse people who donated money to help a woman with the cost of surgery. The Government also does not intend to reimburse moneys that were received through online funding platforms, such as crowdfunding platforms, for which it would be difficult or impossible to identify donors—who would not, in any case, have expected repayment. It is the intention that applicants will be asked to declare any such moneys on their application form, and that their reimbursement payment will be reduced accordingly.
Further consideration has been given to the matter of money that was received informally from friends and family members. On reflection, the Government feels that it would be unreasonable to request details of private arrangements. Accordingly, applicants will not be asked to declare those donations when applying for the scheme. It will, of course, then be up to individuals to repay any moneys that they received, as they see fit.
The Government will make every effort to ensure that those who are eligible to apply for reimbursement are made aware of the scheme. The issue of qualifying surgery came up during the debate. Qualifying surgery has to have had the principal purpose of wholly or partially removing mesh, regardless of the outcome. We expect to undertake a range of methods to publicise the scheme, including through press releases, social media, the Health and Social Care Alliance and NHS Inform. The bill requires that the scheme be laid before Parliament and published.
On the Glasgow centre, we fully recognise that general practitioners and other local clinical staff need to be aware of the existence of the service in NHS Greater Glasgow and Clyde and of its offers, so that they are able to explain them to women who present with mesh complications. Health boards’ accountable officers for mesh have been involved in development of the centre and have a continuing role to play in ensuring that health boards are aware of the service and what it can offer.
The national specialist mesh removal centre has been, and will continue to be, developed with patients’ and the public’s input. The pathway of care, which must take into account the patient experience, will continue to be a key focus for the Government. Nursing specialists and physiotherapists from the specialist centres are linked with their counterparts in local health boards to ensure continuity from pre-operative to post-operative care.
The Government has asked the Health and Social Care Alliance to take forward work on development of a patient-focused map of the care pathway, which will be created from patients’ perspective, thus helping future patients to understand the referral process and what it means for them.
We all know that Covid-19 has had a significant impact on our health services across Scotland. It has meant that health boards have not always been able to run out-patient clinics or to provide other services in the timescales that we would want and expect. We acknowledge that that means that some women have, regrettably, had to wait for far longer than we would ever wish in order to be assessed in the services in Glasgow.
To answer Martin Whitfield’s question, I note that 17 women are waiting for surgery in Glasgow. I believe that Glasgow clinicians were due to confirm that figure to the committee, but the correspondence is not yet noted on the committee’s website. I give our assurances that we are fully committed to working with NHS NSS and the national specialist mesh removal centre to look at ways of improving the speed of referral and processing.
Hernia mesh removal was raised by a number of members, including Mr Cole-Hamilton. He is correct to say that it is outwith the scope of the bill. Jackson Carlaw referred to my appearance at the Citizen Participation and Public Petitions Committee, where I made it clear that although there is some common ground, the same situation has not arisen from use of mesh in other areas. Evidence was presented at the Citizen Participation and Public Petitions Committee, but the Government does not consider that there is evidence that might justify a pause in use of the relevant devices.
To summarise, in January 2020, the Scottish Health Technologies Group published its report on use of mesh and on primary inguinal hernia repair in men, which concluded that, compared to non-mesh procedures, using mesh resulted in lower rates of recurrence, fewer serious adverse events and similar or lower risk of chronic pain. The SHTG is undertaking more work on hernia repair in men; its report is expected imminently. Once we have a copy of that report, we will consider the recommendations and share them with relevant officials and health boards, specialist associations and the Citizen Participation and Public Petitions Committee. During my appearance there, I committed to attending the committee again if that would be helpful.
On other gynaecological uses of mesh, at the same time as use of transvaginal mesh was halted, the then chief medical officer introduced a high-vigilance protocol for use of mesh in other sites. That resulted in the appointment of accountable officers who are responsible for oversight of the protocol and have continued to meet regularly to improve services for people who are affected by mesh.
It is important to note that we are talking about complex and long-established procedures for which there are few, if any, viable alternatives. However, it is absolutely crucial that the most stringent safety measures are adopted for patients, who should be fully aware of the risks and benefits of such procedures before they decide on their treatment.
I think that it was Neil Findlay who first suggested a General Medical Council-approved credential for mesh removal surgery. The Scottish Government wrote to the Royal College of Obstetricians and Gynaecologists and the GMC to express our support for the introduction of a GMC-approved credential in mesh removal surgery. As specialist centres are established across the UK, credentialling will define the skills that are required to perform mesh removal surgery, and will set out how those skills can be acquired and assessed. By formally recognising the skills of our surgeons, credentialling will provide assurance for patients and the service, reduce the risk of harm, and help to improve public confidence.
I agree with members who made the point about women not being listened to about mesh, and I agree that that was indicative of the wider problem of health inequalities that women experience. That is one of the reasons why we have produced the women’s health plan. It is ambitious and we are making tangible progress, but we have much to do. It is a starting point, not an end.
Do I have time to make a final point, Presiding Officer?