Chamber and committees

I do not have much to add, although every single person around this virtual committee table will be in the same space when it comes to all of us valuing the role that social care workers have played throughout the pandemic. Dare I say that it should not have taken a pandemic for people to realise just what a significant and important role our social care workers play. Saying that is one thing; rewarding them appropriately is another. In Government, we have a good track record. In the past 12 months, we have increased their pay, effectively from £9.50 to £10.50 per hour, and we are putting up the appropriate finance and funding for that.

I fully appreciate that there are members across political parties who will say that they want us to go further. If that is the case, we will obviously engage with those budget discussions with the Cabinet Secretary for Finance and the Economy, but you must be able to tell us where you take that money from—perhaps from other parts of the health service or social care. Emma Harper is of course right that that could have a knock-on impact on other parts of the workforce, which we have to factor in.

I am always up for having this conversation on what more we can do to reward our social care staff. Let us do that based on figures and based on what is available in the budget. Let us have a realistic conversation about where the money would have to be taken from if other parties want us to go even further.

Forgive me—I am not sure what is happening with my headphones. If there are problems, I will log out and log back in again, perhaps without the headset. I will not touch the set-up that I have now, so I hope that you will be able to hear me fine. Thank you, convener. I hope that you and all the other members are doing well this morning.

Section 1(3) of the bill currently defines “qualifying” mesh removal surgery as surgery for a person who,

“at the time the surgery was arranged”,

was

“ordinarily resident in Scotland”.

During the evidence sessions at stage 1, concerns were raised that the criterion was too narrow in scope. It was felt that the eligibility criterion should be widened to allow those who were not ordinarily resident in Scotland at the time that they arranged mesh removal surgery but were ordinarily resident at the time of the insertion of the mesh. During my appearance before the committee on 2 November, I gave an undertaking to consider that point further. In response to the stage 1 report, the Government agreed that the residence eligibility criterion is too narrow, and it undertook to lodge amendments on that.

Amendments 1 and 2 will therefore extend the eligibility criterion to include people who were not ordinarily resident in Scotland at the time of arranging their mesh removal surgery but who were ordinarily resident in Scotland when the mesh was inserted. I hope that the committee will welcome those amendments.

In respect of amendment 5, in the name of Carol Mochan, the bill is intended to allow reimbursement of those who have arranged and paid for mesh removal surgery. Where mesh removal surgery is arranged by a health board, it is, of course, provided free of charge, and a health board would not normally arrange surgery for a patient who was not ordinarily resident in Scotland. For those reasons, the Government cannot support amendment 5 but, as always, I am keen to continue to liaise and engage with Ms Mochan on her explanation of the amendment. We can, of course, revisit the issue if that is required at stage 3.

I move amendment 1.

I am happy to waive that right, other than to say that I am happy to speak to Ms Mochan later if her amendment is not agreed to, to see whether we can give any further reassurance in relation to stage 3.

Amendment 1 agreed to.

Amendment 2 moved—[Humza Yousaf]—and agreed to.

Amendment 5 moved—[Carol Mochan].

Can you hear me now?

What I could do—[Inaudible.]

I thank Jackie Baillie for lodging her amendments—and for being the only member whose backdrop shows that she is clearly in the festive spirit.

I am genuinely grateful to Jackie Baillie for lodging the amendments. Along with others, Jackie Baillie pressed the Government to consider whether it was right to have a cut-off date of 12 July, which is the date that we had in mind when I announced publicly the completion of the first stage of procuring an NHS referral route to private removal surgery. I thought that the arguments of committee members and, most importantly, the affected women from whom the committee took evidence were persuasive. I have always said that, ultimately, if the primary purpose of the bill is to bring justice to those women, their voices must be central to any of our deliberations.

I absolutely appreciate that there has been a delay since the announcement in July and that it has taken some time for contracts to be completed. That is not because of any lack of good will on the part of the parties involved—far from it; they have been engaging well and helpfully in negotiations. However, the fact is that the contract negotiations are complex. Having met a number of the women involved, I accept that the delay in completing those contracts has undoubtedly caused anxiety for women who have suffered for far too long, and the Government does not want those women to be penalised. The contract negotiations continue to make progress, but it is taking time to work through the intricacies around them.

I confirm now that the Government wishes to add its support for Jackie Baillie’s amendment 3. We hope, too, that there is a consensus in the committee and more widely that the scheme should not be open-ended. After the cut-off date passes, all the options put in place by the NHS, including referral to private providers, should offer women the support and choices that they need. We therefore need a date so that the scheme is not open-ended—I think that the committee would probably agree with that. The Government considers that it is reasonable for there to be an extension to the cut-off date so that the scheme can include time since July to around the time of royal assent.

I took notice of amendment 4, which Jackie Baillie summed up well. However, I think that amendment 3 is better, because it retains some element of flexibility. Given the uncertain times that we are in, it would be sensible to keep open the option of adjusting the cut-off date in case there is some unanticipated development.

As I said, good progress has been made on contracts with the two private providers, and we are confident that surgery in the independent sector will be available from early next year.

I thank Jackie Baillie for lodging amendment 3. I confirm again that the Government will support it and I hope that that support allows Ms Baillie to withdraw amendment 4.

Hi, convener.

I echo what Ms Mochan said about the collaborative and constructive approach to the passage of the bill. I will resist Carol Mochan’s amendments, and if they are not agreed to, I am more than happy to work with her between stages 2 and 3 to see whether we can resolve some of her concerns.

I am grateful for Carol Mochan’s explanation of the intention behind her amendments 6 and 7 and I assure her that the bill, as drafted, caters for the circumstances that she has in mind.

Section 1(4)(a) states that qualifying costs are

“as charged to or in respect of the person who underwent the surgery”.

The words “in respect of” already allow for expenditure by someone other than the patient to be taken account of and reimbursed. If a person who is not the patient has directly paid part of the cost of surgery, evidence of that expenditure can be submitted and considered for reimbursement as part of the patient’s claim.

As I noted in Parliament on 24 November, we expect that applicants might want to claim reimbursement of costs and then pay back any money that was made available to them or spent on their behalf by family members or friends. The draft scheme, which has been provided to the committee, includes some important details on that point.

Paragraph 17 of the draft scheme clarifies that money received from “public fund raising campaigns” must be declared in the application and might be deducted, but costs that have been met directly by another person may be included in an application. It will be for the recipient of any reimbursement to distribute the money that they receive. For example, if a sibling paid for the patient’s surgery, that expenditure could be included in the patient’s application, and of course, once the patient received the reimbursement, she could then repay her sibling.

I am also worried that amendment 7 could lead to people who have only a slight connection with the patient applying for reimbursement in relation to the patient’s surgery. I appreciate that that will not have been intended, but in general I think that it would make sense for applications to be made for or on behalf of the patient and their supporter and then to allow any private moneys to be repaid.

I hope that that clarification has been helpful to Ms Mochan and that, as a result, she will be content to seek to withdraw amendment 6 and not move amendment 7.

On amendments 8 and 9, I am, again, grateful for the explanation. I appreciate that the plans of patients hoping to arrange mesh surgery might well have been disrupted, particularly given the times that we live in, and my officials are aware of a number of such cases, as no doubt committee members, too, will be. However, the Government is not aware of any circumstances in which travel has been actively curtailed in the way envisaged in the amendments.

That said, we consider that—[Inaudible.]—in the draft scheme more than sufficient flexibility to deal with individual circumstance—[Inaudible.]

—made impossible as a result of the decisions of foreign Governments, and it is expected that carriers will have either refunded the costs or offered—[Inaudible.]

Without going into detail, I am dealing with a case to which that question is relevant. The NHS is well versed in dealing with people whose first language is not English. Once the eligibility criteria have been decided, which the Parliament will do in passing the bill, that will allow us to engage in the process around eligibility. When that process is well defined, it will be important for us to ensure that we communicate through all possible channels and reach out to communities whose first language is not English. Because of the pandemic, we have good experience of how to do that. We have made good progress on that engagement, with the help of many organisations, such as Black and Ethnic Minority Infrastructure in Scotland, or BEMIS. We will continue to use those networks.

A good question is what we can do now, because the issue is not just about the eligibility criteria for the scheme, although that is why we are discussing the bill today. There are also the pathways, which can be complex to explain and understand. We can maybe do a bit more work with our networks on explaining the pathways when the contracts are finalised, which I hope will be soon. We will explain the pathways for women to the complex pelvic mesh removal service in Glasgow and the pathways thereafter in terms of the multidisciplinary teams and women who want a referral to independent providers. Emma Harper has raised a good point. After this committee session, I will double check on what networks we are reaching out to.