Chamber and committees

We have written to general practices through NHS NSS, not just about the importance of any referral pathways but about the fund that was open previously to support women who had gone through transvaginal mesh complications. We would expect anybody who had those complications to present to their GP for help in the first instance, with the referral pathways made clear. I am happy to take up that point with NHS NSS and colleagues at health board level, in case there are any gaps. In the communication and correspondence that we have received, that has not presented itself as a significant issue, but I am happy to take it away.

You have reiterated and re-emphasised an issue that the convener asked about, and I commit to going away and looking at it. As other countries will have their own schemes to help women who have had transvaginal mesh implants, women in those circumstances might be able to access that support rather than the support that is available here.

I take your point, though, about women who had mesh implanted in Scotland but who now live in other parts of the UK or, indeed, overseas. Given that, in some respects, the pain that they are suffering is a direct result of an implant that they received from NHS Scotland, is there a fairness argument to be made with regard to whether we reimburse them for any corrective procedure that they might have had? I am not shutting the door on that and will go away and look at it, but we do not think that it is necessarily a significant issue, given that we have not had any correspondence on it. As you will imagine, we regularly get correspondence on the general issue of mesh.

However, you make a fair point. If reimbursement in such circumstances can help even just one woman, that is one woman whose life will have been utterly transformed. As I have said, I am not closing the door on that, and I will take another look at eligibility in that regard.

At the moment, women who had their mesh surgery through NHS Scotland but who are not ordinarily resident in Scotland and live elsewhere are not eligible. If we looked at changing the eligibility criteria, we would also look at the appropriate communication that would accompany such a change. In short, those women are not eligible at the moment, but if we change the criteria, we will, of course, look at the appropriate way of communicating with and reaching out to them.

Yes. Again, it is an exceptional situation, as everybody around the table will recognise. All of us have probably met some of the women who are involved and, in our limited experience, we understand as best we can how much they have suffered as a result of what has happened. We need the bill and the pathways in question because of the unique nature of the issue. I do not think that the bill will irreversibly damage trust in the NHS. Again, I hope that the figures that I read out in response to Ms McNair’s question give the sense that, although some women have been affected by the implantation of transvaginal mesh, many are seeking surgery and treatment through the NHS in Scotland.

That is a very fair question. That is why, in my previous answer, I was keen to stress that the plight of women who have been harmed by transvaginal mesh is exceptional. We are not setting a precedent; we are recognising the unique nature of what happened to those women, for which there has to be a unique solution. The very obvious point is that the way to avoid setting a precedent is to make sure that we do right by people at the beginning of their treatment, so that there is no need for such a situation to unfold in relation to any other procedure. As Sue Webber is aware, if people believe that there has been NHS negligence or a misdiagnosis, there is a process for them to seek a claim in that respect. The figures are published at least annually about the number of claims that are made and the value of those claims.

People have the ability to seek redress, but I hope that the good faith that we are showing by introducing the bill restores some of the faith in Scotland’s healthcare system that the women concerned have understandably lost.

That issue was raised in previous committee sessions. In my view, the answer is no. If a portion of the money was crowdfunded, that portion would not have had a cost for the women involved. We are looking to reimburse women for the costs that they would have had to pay out of their own pockets. If we were to open it up to donors and crowdfunders, we would get into very difficult territory when it comes to public finance and the surety of that money going to the places where it is meant to go to. I do not mean that there would be any malicious intent on the part of the women in that regard at all, but as some people donate to crowdfunders anonymously, how would we know who the money should go to, for example?

At this stage, I would not open up the scheme to cover situations in which money has been given through crowdfunding or by donation, because those costs are not incurred by the women involved. However, we are hoping that the scheme will cover all reasonable costs for the women involved and anyone who went with them to support them in having the surgery.

Yes—that may involve me or my officials. I have referred a couple of times to the alliance, which has expertise in the area and has been exceptionally helpful in assisting us to engage with the women involved.

I detect from the women a bit of frustration about the next steps and about the fact that we are in November—they ask what has been said and done since we made the announcement on 12 July. That is difficult, because we are in a challenging space of contract negotiation. In general, that is always complex, but it is particularly so when we are dealing with independent providers that are not NHS Scotland providers. We must get everything tied up. It is no fault at all of Professor Hashim or Dr Veronikis, who we thank for engaging well in the process. We hope to tie that up soon but, understandably, the women involved are desperate to hear what the pathways will be for them to get the corrective surgery that they require.

We are working hard to re-establish trust. However, we are not making any judgments about those who wish to use the services of a provider outwith NHS Scotland, because they have the right to do that, particularly given all that they have been through. We are trying our best, though, and one way in which we are doing that is by adapting our own service, which is the complex pelvic mesh removal service in NHS Greater Glasgow and Clyde. We have made changes to the service since its inception by, for example, changing the site of the service. We did that because of feedback from women, who wanted a more private location. We have also made other changes around the service’s arrangements.

How do I know whether trust is being regained by at least some of the women affected? I hope that that is shown by the fact that the mesh removal service has been used by a number of women. Between April and September of this year, 19 mesh removal surgeries were carried out in Glasgow and, in September, more than 64 patients were reviewed by the MDT. That was an increase of 26 from the previous month, so I hope that that suggests that there is trust in the service. A number of patients are on the waiting list and, since the service was designated, 32 mesh removal surgeries have been carried out. Those numbers suggest that there are women who trust the service that we have in Glasgow, but I absolutely accept that, for a number of women, trust has broken down and might be damaged beyond repair, and we will keep reaching out and doing our best to rebuild and regain that trust.

No; from the feedback that we get from women, I think that the reimbursement scheme is essential. We absolutely need the scheme, and the costs are reasonable.

On the related issue of pathways, although Ms Webber is right that there is already the ability to refer to providers outside of NHS Scotland—for example, to NHS England—we heard back clearly from women that they wanted independent providers to be available. There is a lot of faith and trust in Professor Hashim and Dr Veronikis—rightly so, because they are leaders in their field.

To be absolutely clear, such a hierarchy does not exist. I know that Ms Baillie understands this, but it is always worth reiterating it for the record: the decision will be one that neither she nor I will make; ultimately, it will be one for an MDT to make. My expectation, which I will communicate clearly in whatever form is necessary or appropriate, is that a woman’s choice will be a primary consideration.

Although I cannot give Ms Baillie a 100 per cent cast-iron guarantee that if a woman wants to go to a particular independent provider, she will be able to do so, because the clinical team might decide that there is a good clinical reason for going for one provider over another, I can absolutely assure Ms Baillie that Professor Hashim and Dr Veronikis will be part of that MDT discussion. They will not be sitting in a different room when the people who are involved in the complex mesh service make decisions on where a woman should go for surgery. Dr Veronikis and Professor Hashim would be involved in that MDT discussion.

It is absolutely the case that a woman’s choice must be one of the primary considerations.