Chamber and committees

That is a good question. I will keep emphasising the point about trying to be as flexible as we can. We chose 12 July as the cut-off date for eligibility for the scheme because that is when we made the announcement about the independent providers. In all the communications that have followed from 12 July, we have been keen to say to the women that we are working as hard as we possibly can with those independent providers to finalise the contracts and to put the appropriate pathways in place and, if they can hold off from arranging any surgery with independent providers until the scheme is in place, that would be favourable.

Some women had arranged their surgery prior to 12 July, but it would not have taken place until after 12 July. In those cases, they will be reimbursed when the scheme is open.

To go into the granular detail, what we mean by “making an arrangement” is something for us to consider. If the patient, the surgeon and the clinical team that was to perform the surgery understood that it would take place on a certain date, that would be an arrangement. If an initial preliminary inquiry had been made but nothing had been booked, that would not count as “making an arrangement”. Again, however, we will look at each circumstance and each individual on a case-by-case basis.

It is important to separate what we are doing in relation to the complex pelvic mesh removal service and the pathways for the independent providers, and what the bill seeks to do. The issues are clearly interlinked but, to answer your question, I will separate them out.

There has to be a cut-off date in the bill. If I was really being pushed hard on it, we could absolutely consider where the flexibility lies.

I hope that contracts will be finalised relatively imminently, but there are no contracts of that nature, particularly given that we are dealing with providers overseas so, naturally, working through where those services are different from the NHS services will take a bit of time. Once they are finalised, there will be a pathway for women that will include, for example, a multidisciplinary team that will include Dr Veronikis and Professor Hashim from Spire Healthcare in Bristol. They will be part of the MDT process that will decide what the best pathway for those women is.

I would not see a reason, when that pathway is up and running, to have to reimburse because, if the MDT decides that the procedure provided by Dr Veronikis is the best route, that is provided free of charge anyway. I do not think that it would make sense to have eligibility criteria at the end, when the bill receives royal assent.

I can see that Ms Baillie wants to come back in.

The reason why I referenced when the bill will be passed and receives royal assent was that you asked about waiting until the bill has been passed and receives royal assent. I do not think that we should, so it seems that we are on the same page in that respect.

On the gap between when I made the announcement and the contracts being finalised, I do not think that it is an unreasonable point. I am happy to take that away and look at whether there is flexibility. As you said, probably a small number of women are involved. That said, if we made that change, we could get a rush of women who all decided that they wanted to be seen by Dr Veronikis, for example. I understand that, of course, because he is such an expert in his field. That could complicate matters, given that we are in the midst of our contract negotiations. What would happen with those women, and where would they be on the list? There is an MDT process that we want women to go through, because that will help with pre-operative care, post-operative care and so on. That is where the nervousness comes in.

Jackie Baillie has asked me to look at that in good faith. Some of the women involved whom I have spoken to have asked me to look at that in good faith. I will consider the issue of the gap between 12 July and contracts being finalised but, as I said, there is some nervousness about the unintended consequences that that might have and about what it might do in terms of the current contract negotiations.

Yes. Let us say that the cost of surgery overseas was £20,000, and £10,000 was covered by a crowdfunder and £10,000 was covered by the woman. In that case, the £10,000 that the woman had paid would be eligible—in fact, it would be the woman’s right to seek reimbursement for that money, as long as it was for reasonable costs attached to the surgery. Those costs could be for flights, accommodation, travel to the surgery and any reasonable costs for food and drink and so on. I am sure that we will get into the detail of that later. The portion that was non-crowdfunded would be eligible for reimbursement.

I understand the point well, but it would be really challenging for us to reimburse a woman for a loan from a family member and to square that against our obligations under public finance rules, which we have to follow rigorously. Ultimately, we are using public money. However, I will take that point away and I will speak to colleagues in economy and finance to consider whether there is any flexibility on that.

Again, that takes us into difficult territory. If a woman gets a loan from a family member, I am sure that all of us around the table would have some sympathy with the person wanting to reimburse that family member. However, what if it is a loan from a friend, a work colleague or even—if the person was in desperation—a classic loan shark, as they were called back in the day? Such borrowed money takes us into really difficult territory. Therefore, at the moment, the eligibility criteria are for reimbursing women who have had to pay out of their own pockets, and they cover all reasonable costs that have been incurred.

That said, I ask the committee to let me take the issue away. I can see why the situation in which someone has been generously gifted money by family and friends would be of interest to members.

As far as I am concerned, you would be more able to evidence that sort of thing as a reasonable cost. It is slightly different from getting a loan from a family member; I know that all families are different, but you are unlikely to be charged interest by someone in your family. I realise that I am thinking of my own family, though, so I suppose that I should not take that for granted.

However, you are absolutely right to say that interest would be applied to any bank loan. If a person can evidence that loan and the associated interest, I do not think that it would be unreasonable for them to ask for that cost to be reimbursed.

Thank you for the invitation to give evidence.

You are right that the bill is narrow in scope, but the interest in it from members of the Scottish Parliament and the women who have been affected and their families is huge. I have met a number of those women, some of whom are my constituents, and I am dealing with an active constituent case. Therefore, we know that the interest is huge.

From the outset, we want to acknowledge the real pain and suffering of the women involved and their fight for not only justice, but—this is important—relief from the pain that they feel. That is at the top of our mind. Given the pain and suffering of those women, convener, I am pleased that you have been able to deal with scrutiny of the bill as quickly as possible. I just wanted to acknowledge that before I go into the detail of your question.

Throughout this session, I hope that we make it clear that we want to be as flexible and open as we can be. Before we get to stage 2, we will look closely at the evidence that you have taken and the report that you have produced as a result.

The issue has enjoyed good cross-party working—indeed, I would argue that, maybe more than many other issues that I can think of, it has shown the Parliament working at its best. A number of MSPs have been involved in the work to highlight the plight of the women, but it is worth while again putting on record the efforts of Jackson Carlaw as well as those of the former MSPs Neil Findlay and Alex Neil.

To come to the detail of your question, convener, you are right: under the current eligibility criteria, the women who are eligible are those women who paid for mesh removal surgery to be carried out by an independent provider and who were ordinarily resident in Scotland at the time that that treatment was arranged. That goes back to our view that the state has a responsibility for such individuals who are ordinarily resident in Scotland, regardless of whether they had the mesh implanted by the NHS in England or any other part of the United Kingdom, or, indeed, overseas. When such individuals are ordinarily resident in Scotland, the state has a responsibility towards them. We recognise that, if a woman was ordinarily resident in Scotland when she had her mesh removal procedure—regardless of whether she is a Polish Scot, an English Scot, a Pakistani Scot or a Scot whose family has been in this country for 10 generations—it is the state’s responsibility to reimburse her for the cost of that procedure.

If we opened up the eligibility criteria to anybody who had transvaginal mesh implantation carried out by NHS Scotland, we might get into difficult territory, because we would exclude women who might have had a mesh implant carried out elsewhere but who were ordinarily resident in Scotland and who felt that they had to pay for private mesh removal.

Our approach to the entire scheme is to try to be as open and as fair as we can be.

I do not know whether my officials, who are participating virtually, wish to add to what I have said.

Yes is the short answer. As Ms Mochan might be aware, we have arranged some consultations with the women through the Health and Social Care Alliance Scotland, which is an excellent organisation and is well respected by the committee.

We have tried to be as clear as we possibly can about arrangements. It is difficult, but I am happy to look at whether we can be clearer in our communication. Generally, if it is understood by the patient and the consultant or clinical team that a surgery will be taking place on a specific date, that is, to me, an arrangement. Again, a preliminary call inquiring about the services that a particular provider provides is, to me, not an arrangement. If there are specific cases in which someone is in doubt about that—I say this very openly, because I know that many of the women involved will be watching this session—please contact the Scottish Government. We would be happy to be as explicit and clear to you on what we mean by an arrangement, and we will also be entirely flexible, as best we can.

At this stage, the message remains: “Please do not make your own arrangements. We are very close to finalising those contracts with Professor Hashim and Dr Veronikis, and we hope to have that pathway up and running very soon.” I know that that can be a bit of cold comfort, given everything that the women have gone through in the past and the fact that there have been some false starts for them, too. However, we are making progress.

I take Ms Mochan’s point about doing all that we can to be clear in the language around arrangements.

There should be a process for women to challenge decisions.

I agree with Ms Baillie’s last sentence in particular. I received the same letter that she received; I was cc’d into the letter from some of the women involved. I read those quotes last night and was taken aback, so I will ask my officials to make contact with those women. Obviously, we would respond anyway because we received the letter, but I am keen to make contact with them.

I will not rehearse and reiterate too much of what Ms Baillie said. Because of the direct and indirect impacts of the pandemic, there is a challenge, but being told that you will have to wait two years for a referral is not acceptable. I will respond to the women who wrote the letter as quickly as I can. If they are able to provide the particular circumstances, we will look at how some of the issues that they raised can be resolved.