Hansard

Over the years, we have all heard countless accounts of the complications of transvaginal mesh surgery and its lifelong effects, even after the mesh has been fully or partially removed, as well as countless accounts of physical damage and countless accounts of psychological trauma. Many women have had countless years of suffering, and, for many, that suffering will be experienced for years to come.

As the convener of the Health, Social Care and Sport Committee, I am pleased to speak today on our report on the Transvaginal Mesh Removal (Cost Reimbursement) (Scotland) Bill.

I want to say up front that the bill could not, and does not, undo the physical or psychological trauma that the women have faced and continue to face as a result of mesh complications. The bill has been introduced for a specific purpose, as the cabinet secretary has just outlined. We, as a committee, support that purpose, which is to reimburse individuals who have paid to have transvaginal mesh removed from their body in private healthcare settings.

It is apparent to anyone who has listened to those who have been affected that, as a result of their experiences, the women have lost trust in a system that is meant to care for them. Those women have not experienced the compassion, choice and control that they should be entitled to expect from the system. In the past, they have not felt empowered to discuss the complications or treatment options, or to be actively involved in decisions about their care. As a result of that, many have gone down the road of seeking private treatment.

We have heard that the Scottish Government is taking steps to ensure that, in the future, women will have that choice in and control over their care, including the option of having transvaginal mesh removal surgery undertaken by independent providers. We welcome that.

The key principle of the bill is fairness for all individuals in relation to transvaginal mesh removal services in Scotland, and the committee considers that it is unfair and unreasonable to expect women who have already had surgery to meet the financial cost of that surgery themselves, given that that option will be available to women free of charge in the future. The bill seeks to rectify that unfairness. The committee supports that intent and, more broadly, we support the general principles that underlie the bill.

Our report concentrates on areas in which we think that the bill, as drafted, might need to be clarified to make sure that it achieves that fairness for the women who are affected. In some areas, we have made suggestions to strengthen that intent.

Before going into detail about the committee’s recommendations, I will take a moment to thank all those who assisted us in our scrutiny—those who responded to our calls for views and those who gave evidence in person or online. I would particularly like to thank the women who spoke to us about their experiences of transvaginal mesh complications in a private session that was facilitated by the Health and Social Care Alliance Scotland. We are very grateful to them, and we are in absolutely no doubt about how difficult it must be to have to recount those experiences time and again.

Evidence from that meeting and following our call for views suggests that there are still areas of uncertainty around the bill that continue to be a source of anxiety. In particular, our report recommends that greater clarity is needed around the residency criteria that are set out in the bill. As it stands, women who were not resident in Scotland at the time of their original mesh surgery but who lived here when their mesh removal surgery was arranged would be eligible for reimbursement. In contrast, women who were resident in Scotland at the time of their original surgery, when the mesh was put into their bodies, but who lived elsewhere when they arranged mesh removal surgery would not be eligible.

The Scottish Government has told us that it has not received any correspondence from women in that situation, but it acknowledges that the number of women who may ultimately apply for reimbursement under the bill is unknown. It is reasonable to assume that the Scottish Government might not have heard from everyone who might be covered by the bill. It is also reasonable to assume that some women who are affected do not yet know about the bill. The committee believes that, if it means that even just one more woman can be helped, the bill should be amended to include all those women who are seeking reimbursement for mesh removal surgery who originally had their mesh implanted by the NHS in Scotland irrespective of where they were living when that mesh removal surgery was arranged.

The committee also heard from a number of women who described themselves as the in-betweeners—women who are in the process of arranging treatment privately or who?are currently waiting?for their private surgery to take place. The introduction of the bill has caused some confusion and concern among those women. In short, they are unsure whether they will be eligible for reimbursement. Additional costs from travel restrictions and delays imposed by the Covid-19 pandemic have added to that anxiety. They want reassurance that their?costs will be reimbursed if the bill is passed.

According to the bill, a cut-off date for qualification for reimbursement will be specified in the details of the scheme. We are told that that date is likely to be 12 July 2021. The Scottish Government has suggested that that is a date on which individuals could reasonably be expected to have been aware of the availability of the new specialist mesh service as the preferred route for mesh removal surgery. However, there is a gap between 12 July, when the outcome of the procurement exercise for that service was announced, and the conclusion of contracts with independent providers, which remain under negotiation.

There is a risk that a relatively small number of women will fall through that gap and therefore be judged ineligible for reimbursement. The committee does not think that it is fair that those individuals should be obliged to cover the cost of their surgery themselves. We thank the cabinet secretary for indicating today, and when he appeared before the committee, that he is willing to look at that. We understand that there cannot be an open-ended period and that there must be an end date, but we would like the proposed end date to be reviewed, given what I have just said.