What guidelines are in place to ensure that patients with post-mesh removal conditions receive equitable aftercare across all NHS boards.

The Scottish Government is committed to ensuring that women who have undergone mesh removal have equitable access to appropriate, high-quality ongoing care, regardless of where they live in Scotland.We recognise that mesh removal may not be the end of a woman's treatment. Some women may subsequently require further assessment and treatment for persistent or recurrent conditions, including stress urinary incontinence (SUI) or pelvic organ prolapse (POP), and some may require further reconstructive surgery or other post-surgery care. Care should be determined according to individual clinical need and through shared decision-making between the patient and their clinical team, with referral to another NHS Board or specialist service where the necessary expertise is not available locally.The assessment and management of urinary incontinence and pelvic organ prolapse is supported by national clinical guidance, including NICE guideline NG123. All NICE guidelines should be considered relevant to be considered by professionals in NHSScotland unless there is a competing Scottish Intercollegiate Guidelines Network (SIGN) guideline. This guidance covers assessment, non-surgical and surgical treatment options, and the management of complications associated with mesh procedures. It emphasises the importance of taking account of each woman's individual needs, preferences and circumstances when considering treatment options.NHS Boards are responsible for delivering care in line with relevant clinical guidance and NHSScotland policies, and for arranging referrals where specialist expertise is required. Patients requiring outpatient assessment or elective treatment are managed in accordance with NHSScotland waiting times arrangements and are prioritised according to their individual circumstances and clinical need. This helps ensure that women requiring treatment following mesh removal can access appropriate care through established clinical pathways and consistent clinical standards across Scotland.The Scottish Pelvic Floor Registry and Audit Programme (SPFRAP), led by Public Health Scotland, has been commissioned to support quality improvement in pelvic floor services in Scotland. The programme aims to collect and analyse clinical audit data against recognised standards of care to identify variation, support shared learning and promote best practice across NHS Boards. This will help strengthen consistency and continuous improvement in pelvic floor services, including care provided to women following mesh removal.