Meeting of the Parliament 24 October 2023
This debate on what is a tragic and complicated issue is one of many in which I have taken part, as has Alex Cole-Hamilton, since I was elected in 2016.
I welcome the fact that we can have further debate in the chamber today on the recent report of the independent transvaginal mesh case record review, because I believe that the misery and devastation that was caused to so many women, not just here in Scotland but globally, will go down in history as one of the greatest medical injustices ever suffered by women.
The severe and painful complications that were experienced by so many women who were implanted with mesh were exacerbated because the women were let down by those whom they should have been able to trust. By that, I mean the health boards, the medical establishment, a disgracefully flawed review and, frankly, politicians.
Cross-party consensus has existed since the horrendous problems with mesh implants came to light, which resulted in the ill-fated moratorium on implants in 2014. I commend Jackson Carlaw for his unwavering commitment.
It is not constructive to revisit in the debate the distressing history of problems, but thanks must go to Professor Alison Britton, who chaired the review, and the 18 women who agreed to take part in what was to become a two-year process. The report reveals that only two of the 18 women who took part had undergone either full or partial mesh revision surgery, with a further four receiving it over the next two years. That meant that the majority of those who participated in the case record review had not undergone any revision surgery, and the review group had to rethink its framework regarding how it would tackle the broader range of issues around the treatment and experiences of healthcare of the majority of women who had experienced implants.
Practically, that entailed the review group requesting more than 40,000 pages of records. From the initial meeting with each participant to the subsequent request for case records, to the completion of each report, the group spent some 45 to 50 hours on each participant’s case, and it wrote 18 bespoke participant reports. It is not rocket science to see how labour and resource intensive that undertaking was, but the group concluded that it was worth it to get an in-depth study of the experiences of the volunteers.
So, where are we now? Crucially, the implantation of transvaginal mesh has been halted since 2018, and there are no plans to lift that halt. The review group supports the Scottish Government’s continuing commitment to offering women a choice of surgeon, if mesh removal is considered appropriate, and to reimbursing women who had previously arranged to have mesh removed privately. Scotland is the first UK country to reimburse people for private treatment that has been sought.
The Scottish Government is determined to ensure that those with mesh complications get the treatment that they want and need, but I acknowledge the points made by Tess White and Jackie Baillie, and I will not defend anything that exacerbates the suffering of these women. I would like all the problems that have been raised today to be addressed urgently.
The Government has introduced new training on mesh for general practitioners and has improved information for patients about the specialist service in Glasgow. As we have heard, patients can also have the surgery at an English NHS centre or at one of the independent providers in Bristol or the United States. Women who previously used their own money can apply to have that reimbursed by the end of March next year.
The mesh service in Glasgow offers specialist assessment and care in the treatment of complications. It is hosted by NHS Greater Glasgow and Clyde and forms part of the UK network of 10 specialist mesh centres, and it is recognised for its clinical expertise in the field.
The report makes recommendations, only some of which I have time to list. We have heard some of them. It recommends that bespoke data-sharing agreements should be put in place prior to the commencement of a large case review. It advocates for Scotland having a mesh register that records surgery in Scotland as well as surgery that has occurred in other parts of the UK. Women should have access to information, and additional support mechanisms should be put in place for GPs and practice teams to aid understanding of the concerns that women raise with them.
There should be clear and transparent communication with patients regarding the type of surgery that they will undergo, and a detailed set of medical notes and dialogue. The counselling advice that is given and communication on the risks and potential complications all have to be clear and transparent. There should be the creation of a national specific consent form for use across the country to improve the consistency of information that is given during the counselling process. The report also recommends that information on referral and treatment is clarified and published on a website.
Training and credentialing of surgeons in Scotland is a critical element. The process has to be clearly articulated, not only for clinicians but for women who use the service. Patients must be informed that when they turn up for appointments they have the option of having a trusted person with them and that they can record discussions that take place during the appointment. All that will restore some trust.
It is crucial that there is an agreed system of NHS follow-up and on-going support in place for patients who are returning from mesh revision surgery taking place outside Scotland, and that that data is captured and collated.
All those recommendations are sensible and necessary, and I hope that those that have not been implemented will be as soon as possible.
Many people, including me, regularly call the mesh survivors group brave and courageous for taking on the fight, and they are. However, I am sure that most days they do not feel brave or courageous, as they struggle to cope with the basic things that most of us take for granted. The damage has been done to them, but they simply do not want a sister, a friend, an aunt or any other woman to go through what they had to endure. That, in my view, is dignified, unselfish and inspirational.
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