Hansard

I am pleased to open the debate on the Transvaginal Mesh Removal (Cost Reimbursement) (Scotland) Bill.

I would like first to thank the Health, Sport and Social Care Committee, which is so ably convened by Gillian Martin MSP, for its thoughtful consideration of the bill, its report and its support for the general principles of the bill. I am also grateful to the Finance and Public Administration Committee and the Delegated Powers and Law Reform Committee for their consideration of the bill. I want to take this opportunity to thank everyone who has taken time to express their views on the bill in evidence to the committees and to me directly.

In particular, I thank the number of affected women who have taken part in focus groups about the bill. I know that every member will agree with me when I say that it is because of the courage of the women affected that we are at this point. It should not have taken them having to retell their stories to get us here, but I am grateful to all those women who have, over the years, shared their experiences and helped to shape the bill.

It would be churlish of me not to mention the excellent cross-party efforts that have highlighted the plight of those women, in particular those of Jackson Carlaw, Alex Neil and Neil Findlay, the latter two of whom are no longer in the Parliament.

The bill that the Government presents today is a narrow bill with a limited function which, in all likelihood, will be directly relevant to only a very few people. However, it would be equally fair to say that the impact on those very few people will be very significant indeed.

The bill brings the Parliament’s attention back to the traumatic experiences of the substantial number of women in Scotland who have suffered pain and distress after having mesh implanted. Many of us have heard directly from women about the physical symptoms and mental distress that they suffered, which was often made worse because they felt that their experiences were not taken seriously enough when they sought help.

The Government and the national health service are working to improve the care that we offer to those women. In particular, in Glasgow, there is now a national specialist mesh removal service, which has been offering full mesh removal since July 2020, and, so far, has provided 33 women with mesh removal surgery.

At the Glasgow centre, new surgeons have been recruited, and there are now four urogynaecologists, which allows women more choice over who they are treated by and the option to be treated by a surgeon who was not previously involved in their care. The service also benefits from contributions from dedicated nurses, physiotherapists, pharmacy staff and a clinical psychologist.

I say clearly and unequivocally that I completely understand that a number of women have lost trust in our NHS. I will work hard, as will the service, to rebuild that trust. However, from having talked to a number of mesh survivors, I know that they feel that it is broken beyond repair. I am sorry for that.

Alongside the national specialist service, the Government and the NHS are working to make it possible for women to be referred for surgery in NHS England and in the independent sector. Therefore, women who are seen at the national centre who do not want surgery in NHS Scotland will have the choice to be referred to a specialist centre in NHS England or to independent providers. In July, I announced that two providers—Spire Healthcare in Bristol and the Mercy hospital in Missouri—had been selected to provide those choices.

Since the summer, NHS National Services Scotland has been working to finalise contracts. In particular, NSS has been seeking to make sure that arrangements for surgery are supported by other services that will meet emergency and wider medical needs. I appreciate that the wait since July has undoubtedly been frustrating for women who have already had to wait for a considerable time. However, I hope that the Parliament agrees that it is essential to have all the right care in place, particularly when women might have to travel some distance.

I know that I have now spent a fair bit of time talking about matters that are outside the scope of the bill, but those issues are important to the women affected and to members across the chamber.

With arrangements for referral to the independent sector planned, it seemed to the Government right to reimburse women who had already arranged mesh removal privately and paid out of their own pocket. Therefore, the bill before Parliament gives ministers power to reimburse the costs borne by women who, in the past, entered into private arrangements for transvaginal mesh removal surgery. Section 1 of the bill establishes that power. It gives power to reimburse the costs of the person who underwent the surgery and those of a companion, where there was one.

Together, sections 1 and 2 give the Government power to develop a scheme by which payments will be made, and they provide that the scheme be laid before the Parliament and published.

I will now address some of the issues that are raised in the committee’s report, to which I responded on Monday. The committee proposed that women who had mesh implanted in Scotland but then arranged to have it removed having moved out of Scotland should be eligible for reimbursement. The Government agrees with that view in principle and will lodge appropriate amendments at stage 2.

The committee has also asked the Government to consider whether there might be some change to the cut-off date before which arrangements for private surgery have to have been made in order to be eligible for reimbursement. At present, the proposed date is 12 July of this year, because that is the date on which the Government confirmed which providers had been selected as preferred bidders to provide surgery in the independent sector. However, I promised to further reflect on the matter, and I will do so in good faith. In the Government’s response, I explained that I will consider whether it is reasonable now to adjust that date, and I will confirm the Government’s position at stage 2.

I have also considered the committee’s implicit recommendation that the reimbursement scheme be made in regulations. On that point, the Government is not convinced. Making the scheme in regulations would involve further delay for women who we all acknowledge have already had to wait—in some cases for years—for reimbursement. In this case, I am not convinced that the merits of greater parliamentary scrutiny outweigh the priority of offering assistance to the women involved as quickly as possible. However, I appreciate that members and the committee want to understand how the scheme will operate in practice and, therefore, if the Parliament agrees to the bill at stage 1 today, as I suspect we will, I will make available a draft of the scheme to the committee before stage 2.

I hope that the committee finds the Government’s response to its report helpful and constructive and that the suggestions and compromises that we have made show our good faith. I should add that the Government will also reflect on today’s debate before we finalise our position on our stage 2 amendments. I look forward to considering important points of detail with the committee at stage 2.

I can only imagine the distress that has caused women to use their own funds—the amount of money involved has often been quite considerable—to seek private surgery for mesh removal. I have met a number of the women, both in my capacity as the Cabinet Secretary for Health and Social Care and as a constituency MSP. I suspect that every member who speaks in the debate—and probably every member of this Parliament—has had, at the very least, correspondence from a constituent about the matter. I am sure that every single one of us has been moved by the plight of the women.

I think that all of us can agree that it is wrong that women felt that their only option was to dig deep into their pockets for treatment. Some of them had to take out loans, and some of them had to borrow from friends and family. The Government is determined to ensure that women never have to feel that way again.

The successful passage of the bill will put in place a scheme that will ensure that the costs are met and that the women involved are no longer at a financial disadvantage. I very much look forward to working with colleagues across all parties to make that a reality. I appreciate the co-operation of the committee and its members.

I move,

That the Parliament agrees to the general principles of the Transvaginal Mesh Removal (Cost Reimbursement) (Scotland) Bill.