Chamber and committees

That question is along the same lines as that asked by your colleague Dr Gulhane. I have offered to send the committee the complex mesh surgical service pathway. I am aware of the evidence that you received on 2 May. I felt that Dr Mathers clarified in that meeting that an electronic referral from the health board to the service is required. As I said, we will send the complex mesh surgical service pathway to the committee so that you have sight of it.

Dr Gulhane, that is what I said yesterday. I did the same thing. We have taken that away and will find out why that is happening.

I was pleased to meet Professor Anna Glasier very early after she was appointed. Her skills and personality embed exactly what women would like to see in their health champion. As you indicated, we have prioritised the menopause and endometriosis. I will have further discussions with the women’s health team about how we can expand on those. It is important to say that, although Anna Glasier is the champion, we also have a group of officers who are working further on the plan. Greig Chalmers leads the group specifically on this.

We have a lot to do. In a meeting last week, I said that, until we can say “health” without having to put the word “women’s” before it, we have a long way to go. However, I am confident that, with Professor Glasier’s leadership and the wealth of groups of women who want to get involved in women’s health and to raise it to the headlines, that can only be welcomed.

I am afraid that I have no information on the incontinence plan. I apologise.

I have read some of the reports from women who really struggled to explain to, and be listened to by, their GPs in the years leading up to 2015—when the issue was given front-page billing in media reports—and I can only imagine how frustrating that must have been for the women.

The work that has been done in Scotland and the cross-party work that Parliament has done has really improved everyone’s knowledge of the impact of vaginal mesh on women. As I indicated earlier, the fact that we have set up that specialist service and that specialist services are being set up in NHS England, too, with options to go abroad, is really helpful.

In an earlier answer to a supplementary question from Stephanie Callaghan, I indicated the training that NHS England has created for GPs and the importance of the work that Dr O’Kelly is doing to ensure that Scottish GPs can access that training, which is absolutely key to getting it right. I also refer back to the individuals in each of the health boards who are there to provide support.

Can you cover the point about medical records, Greig?

From the reading that I have done and the way that I have seen the service change over the past couple of years, I think that it has absolutely moved to being that holistic service. Early on in this evidence session, I mentioned that the service must be based on the person—the patient—so I strongly believe that the way that we can provide the best support for the women in this situation is by understanding their needs.

In about a third of referrals, I think, patients end up not choosing to go for surgery but looking for holistic support such as physiotherapy or support for pain or wellbeing. The service has to be aware of the possibility that that number could increase. I hope that the service will evolve to support women in the way that they feel is most appropriate to their circumstances.

I see that Greig Chalmers is nodding—he may want to add something.

We have to strike a balance. On 2 May, the committee was given clear evidence about the importance of having one route that everybody understands and that would avoid any confusion or cluttering of the landscape.

What I take away from your questions is that we need to ensure that GPs are absolutely clear about the pathway, perhaps by writing directly to the health boards and their officers who have responsibility for the matter. However, adding another pathway might cause confusion, and it might not be the best way of supporting women who are in desperate need of this support.

As we have said, Dr O’Kelly is not here today, and I would have asked him to answer that question, as it is on a specifically clinician-led area. That said, I think that setting a high standard is a positive way forward, and that is what credentialling will allow us to have across the four nations.

I am not sure that I would categorise the service as being under strain. As you have heard in our evidence and in the evidence that you received two weeks ago, it is clear that the service is improving and is listening to women. As I said in answer to Carol Mochan’s questions, waiting times have reduced, and the NSS survey responses show that women perceive an improvement in the service. However, it is appropriate to raise the point about availability of people to work in that specific area and other specialist areas. That is why we have to continue to ensure that the NHS in Scotland can get the right access to good people and employ the best people that we can. I hope that the importance of NHS surgery and support for women is recognised and that we can employ the appropriate consultants.

To look at it from the other perspective, putting care in one specific centre gives us a centre of excellence. In his evidence, Dr O’Kelly said that the service is well thought of and well perceived in the wider United Kingdom. It is important to have that centre where all the skills are in the one place, as opposed to perhaps having them more spread out across Scotland. I think that I am right in saying that we have one centre in Scotland and there are nine in England, which reflects population need. Given that the service is seen as being of such a high standard, I hope that we will continue to attract the right people to work there, so that women get the health support that they need.

Thank you for raising that point. That is a really important piece of legislation that is going through Parliament just now—you certainly highlighted that in your contribution to the chamber debate on the bill last week. As was mentioned in that debate, if the bill is passed and becomes an act and the patient safety commissioner is in place, it will be up to the commissioner to decide what areas they will work on. From my perspective, there is a huge amount of learning that we have to get on record and understand from the transvaginal mesh situation. I do not want to put something into that person’s in-tray straight away, but I think that it should be there.

Stephanie Callaghan brings an important idea to the table. For any women approaching any healthcare, a one-stop shop helps because we have incredibly full lives, so it is helpful if we can get all the information in one place.

We have great learning from other areas in the women’s health plan, and, very importantly, we have fantastic information from the women who have been through the centre to make decisions on whether to go for surgery to reverse the procedure or to go for more conservative and less surgical ways forward. We have a responsibility to enable women to make the best-informed choices with regard to that and to make the process clear, open and helpful so that they can make the best decisions.

As I said, we need to look at that in relation to the women’s health plan. Greig Chalmers and I have had conversations about how we integrate that.