Chamber and committees

I cannot speak for the health boards that did not respond, although I suspect that that might have happened because of some of the pressures that they are under at the moment. I would not take it as any of them suggesting that they do not take the issue seriously and I know that that is not what Ms Webber is suggesting.

If Ms Webber does not mind, I will ask one of my colleagues who are online to give the detail on the guidance on referral pathways. Dr O’Kelly might be the best placed to do that.

Once we have the final details of the scheme—obviously, that will depend on Parliament passing the bill—we will make those clear to staff. We are keen to get the balance right and to ensure that the scheme is as flexible as possible. It must be like that: we cannot have a rigid scheme for women who may have had surgery a number of years ago. We cannot expect them to have kept taxi or dinner receipts. That is not going to happen. It would be unreasonable to demand that women find bank statements from years ago.

We must be flexible in that respect. That is why we are looking at what public finance manuals suggest as an appropriate level of subsistence per person. We are trying to be as flexible as we can, while being mindful of our public finance obligations, which we cannot veer away from. There should be no pressure on staff who are deciding on the eligibility of applications or the level of costs to be recovered to work within a particular financial envelope.

Those are excellent questions. Nobody in the Government—certainly not me, as Cabinet Secretary for Health and Social Care—will have any issue with women who wish to be seen by a provider that is not the NHS. We went out to contract because it was recognised in Government that some of the women do not have trust in the NHS because of the process that they have been through. I am deeply sorry about that. I regret the fact that they do not have that trust and accept that that is not the fault of the women involved; they do not have that trust because of the failures that they have been presented with. That is why we have gone out to providers outside the NHS. If a woman wishes to be referred to an NHS England specialist centre, she can be. That option exists at the moment, even before we get into the contracts with Spire Healthcare in Bristol and, we hope, with Dr Veronikis.

I do not know whether I understood Ms Mackay correctly—she can tell me if I have not—but, once we have the clinical pathway up and running, the multidisciplinary team that will consider each woman’s case on a case-by-case basis will absolutely consider the pre and post-operative care, including mental health support, physical health support, physiotherapy and anything else that is needed. I cannot speak about the clinical space, but any pre and post-operative care will absolutely be considered.

In our dialogue with a number of the women in a recent consultation that was arranged by the alliance, a number of them said that, even if they had surgery elsewhere, they would expect their post-operative care to be in Scotland and we would have to make arrangements for those who did not want that and wanted their post-operative care to be somewhere else. The multidisciplinary team would absolutely consider that. That would be a clinical decision for it to make.

If Ms Mackay’s question was about reimbursement of costs, such costs would, to me, fall into the bracket of reasonable costs if they were to do with the woman’s procedure. If the woman did not have the procedure and there were costs that resulted as an effect of her transvaginal mesh implant, those costs would not be considered at this stage, because the costs that are being reimbursed are those that are related to the surgery for removal. However, I am happy to take that issue away. It has not been raised directly with me, and I do not know whether it has been raised with my officials, who may wish to come in on it. If the question was about that, I am happy to take that away.

In short, yes. If women needed to go through multiple surgeries to remove mesh, that would be covered.

That is an excellent question. I can assure you that some of that is happening right now, as you would rightly expect to be the case. All of us should say, however, that those women should not have had to take the time and make the effort to bravely come forward, campaign and fight hard while they were still suffering the complications with their transvaginal mesh implant to get a solution in place—I hope—to help with that suffering. I appreciate, however, that many of those women will continue to suffer until the contracts are signed, they go through the pathway and they get the corrective surgery. Some of that learning is taking place now.

The process is evolving. I have referred to the complex mesh removal service in Glasgow, which has had to evolve and develop as we have continued to receive feedback from the women involved. To me, that is the crux of the issue, and that is the promise that I will certainly make, as cabinet secretary. I know that my officials also understand that. We will continue to listen to the women. It is not a case of introducing the bill, which I hope will pass, and putting a pathway in place, then once the contracts are signed, that will be the end of the engagement with the women. Far from it. We will continue to engage, listen and hear what the women have to say, and we will continue to evolve our processes and practices, where possible.

That does not mean that we will be able to do 100 per cent of what is being asked of us. I will always try to ensure that we do as much as we possibly can, understanding the suffering that the women have gone through. However, some matters involve clinical decisions, as I referred to in a previous answer. Generally speaking, however, we should be open to listening to the feedback that we get from the women involved.

Yes. We have taken what we think are the reasonable costs into account. Those include the reasonable costs for corrective surgery overseas or in the UK and for reasonable costs such as taxis, hotels, food and subsistence.

Our detailed engagement over a number of years has given us an idea of how many women we think have been affected by mesh surgery and would be eligible for reimbursement. That is how we got to the figure in the financial memorandum. There may be women who have not yet come forward, although I told Dr Gulhane and the convener that we are regularly contacted by women who have been affected. If there are women who have not previously contacted us but who do so after the bill has been passed, we will look to make more resources available.

Yes. We think that the number of women who will be eligible for a reimbursement scheme—if not the overall number of women who have been affected by mesh—will be relatively small, so we do not think that the application scheme will require huge resources. To go back to Marie McNair’s point, it is important to get the right balance between having a quick application process for women who may have been waiting years for reimbursement and giving those women enough time to gather the required evidence of their costs.

I go back to my opening remarks to the convener. We recognise the suffering of the women involved, and we should try to apply as much flexibility as we possibly can. We must balance our public finance and funding obligations, but we should be flexible.

If the bill passes the appropriate parliamentary process and gets royal assent, we hope to be able to open the scheme as soon as possible, which should be in the summer of 2022, and initially keep it open for a year. However, I give the assurance that that does not mean that people will have to wait for a year. There will be a rolling process for reviewing applications, but the scheme will be open for a year because it might take people a bit of time to get the appropriate invoices from the independent providers or to contact the airline that they used a year or two years ago to get the required proof.

If it was necessary to extend the deadline, we would look at that favourably. We want to take a flexible approach, because we realise that people do not keep airline stubs from five years ago. We will try to be as flexible as we can while being mindful of our public finance obligations.

That is a really good question. I do not think that we have considered what the appeal process will look like, but there should be one. It is necessary for any such application scheme to have a process for individuals to question why certain costs have not been reimbursed. However, I hope that we would not get to such a position and that, if a cost was questionable, we would go back to the woman to understand more about that before an absolute decision was made.

My direction to those who operate the scheme will be to be as flexible as possible, within the public finance rules. It is understood that none of us would keep certain receipts for years and years, so it is important for us to take a fairly liberal view of what a reasonable cost is, although I am mindful—I can almost feel Ms Forbes’s eyes on the back of my neck—of our public finance obligations, which are important when we spend even a single penny of the public’s money.

My officials and I are not getting pressure from finance colleagues or from anyone else in Government. No one is sitting on a pot of money and saying that we cannot spend a penny more than that. We want to keep spending within the scope of the financial memorandum, but if we have underestimated certain reasonable costs that people can demonstrate, no one will be constrained in that respect. You are right that we must have an application system that is user friendly and not onerous for the women involved, but which is also mindful of and aligned with our public finance obligations.