Continued Petitions

Good morning. I welcome everyone to the third meeting of the Public Petitions Committee in 2021. This meeting is being held virtually. I will be participating via audio only, but the rest of the members will be visible.

The only item on our agenda today is consideration of continued petitions. The first petition is PE1517, which was lodged by Elaine Holmes and Olive McIlroy on behalf of the Scottish mesh survivors hear our voice campaign.

I welcome Jackson Carlaw and Neil Findlay. I understand that John Scott, who has had an interest in the petition in the past, may be joining us, but he has not joined us so far.

The petition calls on the Scottish Government to suspend the use of polypropylene transvaginal mesh procedures; to initiate a public inquiry and/or comprehensive independent research to evaluate the safety of mesh devices using all evidence available, including evidence from around the world; to introduce mandatory reporting of all adverse incidents by health professionals; to set up a Scottish transvaginal mesh implant register, with a view to linking it up with national and international registers; to introduce fully informed consent uniformly throughout Scotland’s health boards; and to write to the Medicines and Healthcare products Regulatory Agency, asking it to reclassify TVM devices with heightened alert status to reflect on-going concerns worldwide.

The petition was last considered in October 2020, when we took evidence from Dr Dionysios Veronikis. Since that evidence session, we have received submissions from the Cabinet Secretary for Health and Sport, the chief medical officer, the Royal College of Obstetricians and Gynaecologists, and the petitioners. In their submissions, the cabinet secretary and the chief medical officer highlight actions that the Scottish Government is taking to work with mesh-injured women to improve the national specialist service; establish close working relationships with the equivalent services that are being developed by NHS England; consider what further steps can be taken to provide additional options for patients, including referral outside the national health service; and take a proposal to the United Kingdom medical education reference group, which is the first step in the current process for submitting proposals for a General Medical Council-regulated credential with respect to mesh removal surgery.

In their submission, the petitioners reiterate that they do not believe that there is a safe and proven treatment route in Scotland. As such, they are calling on the Scottish Government to fund women so that they can travel to the United States to be treated by a surgeon they trust and choose, if that is their wish. The petitioners also call for the Scottish Government to refund the small number of women who have already paid life savings to attend surgeons in the United States.

Since the publication of our papers, we have received a submission from Dr Wael Agur, which notes that he has helped to develop the West of Scotland pelvic mesh complications pathway. He describes that care pathway as the most comprehensive for mesh-injured women in Scotland and states that it is being considered by Government officials for national use. He also states that, for most deeply embedded mesh devices, other than vertical retropubic mesh devices, he does not expect members of the mesh multidisciplinary team to be confident that the surgical skills are adequate for total device removal, in a safe and effective manner, in Scotland. He believes that, until the service builds expertise and trust in this area, a funded out-of-country referral pathway to the US or to England should be put in place for women who wish to use it.

We have looked at the petition previously in some detail. I will invite our visitor MSPs to make their contributions before I ask committee members to reflect on what we should do with the petition.

Thank you very much. I welcome John Scott, who has now joined us, but I will call on Neil Findlay first.

Frankly, the petition came forward out of the exasperation of the Scottish mesh campaigners. Working with them over the years, we tried every parliamentary and campaigning trick in the book to advance the cause and bring about a ban on mesh, and when that was exhausted, my office advised the group to lodge the petition. I thank Tommy Kane, who worked with me at that time, for the work that he put into the petition, along with the Scottish mesh survivors group. I think that that was the right move, because it was only as a result of taking the petition forward that we had the very moving—I would say electrifying—moment at the committee meeting, which the convener at the time, David Stewart described as one of the most emotional meetings that he had been at, when in a room packed with women and their families, we saw the suspension being announced. That suspension was only a temporary measure and is only there because the health secretary at the time, Alex Neil, announced it and Jeane Freeman continued it.

There is no legislation in place to enforce the suspension and that is one of the key criteria of the petition, so I think that we should continue with the petition. We need a permanent ban. We know that the medical establishment has a strong desire to start implanting mesh again. Many of the people who recommended mesh implants for women in the first place, which have caused so much harm, believe that nothing wrong was done. They believe in this product. They think that it was the right move and they would do it again tomorrow, the day after, and the day after that.

The petition asked for a ban, but we have a temporary suspension. The petition asked for a public inquiry, but there has not been one. The petition asked for mandatory reporting, but there are questions over whether that has been adhered to. The petition asked for a mesh register—has that been introduced and is it working? The petition asked for informed consent and reclassification and, subsequently, campaigners have asked for things

such as the opportunity to travel abroad for treatment from someone whose skills they have confidence in and trust.

At the moment, a so-called specialist mesh centre is being established in Glasgow that will be staffed by the very people who recommended the implementation of the mesh in the first place and who told patients that it was a 20-minute procedure that was the gold standard in treatment and would be life changing. Yes, it was life changing—devastatingly life changing—but that is what they were told by surgeons and consultants, some of whom will be running this new mesh centre. Would you go to that centre if the people running it were the ones who recommended the implantation in the first place? There are genuine concerns about whether the centre will be a waste of money and whether anyone will have confidence in it and go there for treatment.

At the moment, we have a very significant issue. Women have been told by surgeons in Scotland that they have had a full mesh removal, only to find out later that that is not so and that they still have mesh in their bodies. That has been proved by some of the women travelling to the US, having crowdfunded, used their life savings, sold possessions or whatever to fund their trips, and finding out that they still had mesh in them, despite being told that it had all been removed.

The Canadian Government has paid for more than 100 of its citizens to travel to the US for treatment by Dr Veronikis, and I think that we should have the same thing here now.

Finally, many of the women have gone through every hoop possible to get the treatment that they want and have got nowhere with it. They have applied for treatment outwith the UK and the Government has said that it would look at that, but they have not had any positive reply to say that that would happen.

My plea is to keep the petition open. So many question marks remain. I hope that the committee will take the petition forward in the next session, because some of us are departing the stage.

I call John Scott.

Thank you very much. There is no doubt about the extent to which the survivors’ accounts have had an impact on anyone who has heard what has happened, including current and past members of the Public Petitions Committee and campaigners. I will always remember the evidence sessions when women came and responded and reacted to what they were hearing. I found it very powerful that, in the middle of their own suffering, they were able to make their case and show what had happened. I was also very concerned about what seems to have happened with Dr Veronikis, who was offering to be supportive and helpful and to come here but was treated as if he were applying for a job and had to prove himself. I found that to be disrespectful.

There is much around this issue that has to continue. There are some very focused issues around the question of supporting women to go to America. The question that the committee is wrestling with today is whether this petition, in its current form, allows us the space to drive matters forward, or whether a new petition to be brought in immediately after the new session starts could better allow that focus. I hear the strength of feeling about the importance of the issue continuing to be at the forefront of the Parliament’s and the Government’s minds. The question is how best to make that happen.

The experience of the women, including throughout the period when the petition has been before the Public Petitions Committee, is that things have been said but not followed through. People feel let down; they do not know the whole story around the review. That lack of confidence and trust is what we are wrestling with. We want to make sure that it continues to have a real focus. The gap between what was said about Dr Veronikis and what was done is one of the issues that I found difficult.

I invite committee members to comment and we will try to come to a conclusion. I will not preclude anybody from coming back in, because I am conscious that this is a very important matter.

Thank you very much. Neil Findlay wants to come back in.

I want to advise that there has been zero contact with Dr Veronikis since the cabinet secretary previously commented. I think that the matter could have been resolved—could have been redeemed—but no effort seems to have been made, and that is very disappointing.

The committee can do what it wants, but it could write to the Government, calling for a public inquiry and for a funding scheme to be put in place to allow women to get the surgery. It could also call for a refund scheme. I do not think that any of that would require another petition.

My caution against another petition would be that it takes a lot of energy to go through this process. Many of the women are in physical pain, and many of them do not work because of their condition. Therefore, starting this all again, although I am sure they would do it, would require a lot to get it to the stage we are at today. Also, as the committee knows better than anybody, the process takes a lot of time, and I think we would be going back to square 1.

Continuing the petition and making demands of the Government, or writing to the Government to ask what it is doing about a number of issues, would be a better way to go.

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What we are wrestling with here is not whether we think these women have been treated badly or that there is a great deal more to do. On balance, the committee can see that the argument for holding on to the petition is a strong one. We should recognise the progress that the women have made, that commitments have been made and that there has been some change, but there is clearly a long way still to go.

I think it is possible to hold on to the petition. The clerks have done a lot of work over a period of time to facilitate and support the petitioners in making progress. We should not think that the only place these issues should be discussed is in the Public Petitions Committee, but the concern is that the rest of the parliamentary process makes it much more difficult to pull people back in to challenge them on what they have said before. We did bring a minister and the chief medical officer in at the time. We and the petitioners had control of that agenda, whereas, if it goes out into the more general parliamentary process—where it will still always be discussed—there will be less control.

I am thinking out loud. My feeling is that we need a new petition in order to pursue with the Government why it is not prepared to have a compensation scheme or to fund people to go to America. That could be done immediately. Although, in the normal run of things, a petitioner would have to wait a year, because of the election it could be done immediately. It might be that we should hold on to the current petition as a bridge into that new petition, so that we are still asking whether the issues about holding a public inquiry and the building of trust are being addressed but have a subsequent petition to focus directly on the serious matter of the lack of confidence that means that, even if the Government does sort it out and gets a centre, women will choose not to use it.

My sense is that there is limited scope for this petition now, that there are new areas that we need to focus on, and that what we are wrestling with is how to hold on to the general momentum while focusing on some specific issues.

A number of members have indicated that they want to come in.

It is important to remember that clerks do work with petitioners to make sure that their petitions meet all the criteria, and they would be supportive. However, it would still have to be for the petitioners to do the work, otherwise there would be a blurring of roles. I understand what you mean, and there is plenty of evidence to show how supportive the clerking team has been of petitioners over the years in making sure that they have been able to engage with the process.

My sense is that the significance of the petition and the progress that it has made so far is such that we do not want to let it go. We would not want anybody to think that Parliament believes that the matter is concluded. The issue is not just about funding, although that is important, but about how, over a long period, the gap has grown between what is supposed to have happened and what has happened. That is my sense of where the committee has got to. We are clear that there is a lot more to be done.

On balance, my view is that the petition should remain with the committee because our agenda is entirely decided by petitioners. We often refer matters to other committees, but when we do that, it becomes for them to decide what priority a petition should be given, which causes anxiety for us. However, I think that we should write to the Health and Sport Committee, as John Scott suggests, to say that the issue remains unresolved and that it is something on which it might want to reflect in its legacy report. It is certainly something that we can reflect on.

We should write to the Cabinet Secretary for Health and Sport to flag up that there are on-going issues about rebuilding confidence and the extent to which the issue is now one of confidence and trust. The Government cannot just recycle its previous response. Saying, “Yes, we could look at out-of-country referrals,” is not quite the same thing as making a commitment to working with Dr Veronikis—there is quite a big gap there. A letter to the cabinet secretary would be useful, and perhaps it could reflect the views that are being presented to us about the need for a substantial inquiry. We know that work has been done elsewhere and it would be useful to know the extent to which the Scottish Government’s work relates to that.

I am happy to hear from anybody who feels that we are not doing the right thing, but I think that we agree that we should keep the petition open, with a desire to see progress. It would be for the new Public Petitions Committee to make a decision about how that progress is to be made. Keeping the petition open should not simply become a symbolic thing. There should be a focus on particular areas, and the clerks will make it clear to the petitioners what areas cannot be pursued unless there is another petition. Do we agree that is what we want to do?

People always have to balance the arguments when they look to have a public inquiry. Does an inquiry take resources that could be used in another way? There is always a judgment to be made.

The committee wants people to understand what happened and, as a consequence, make decisions about what should happen in the future. Neil Findlay makes the point that currently there is no ban, but rather a temporary suspension, and I certainly think that that should be the focus of any inquiry. However, that is not necessarily where we want to go now.

There is work being done on the issue. One thing that has been mentioned is the development of a national specialist service. Is there any possibility of that? We should ask the Scottish Government to reiterate its commitment to working with the petitioners and the women who are survivors, in the understanding that doing so will mean that there are questions that need to be answered.

Nobody else wants to come in. We agree to continue the petition and write to the Health and Sport Committee and the cabinet secretary, to flag up the impact of decisions not having been pursued in the way that we would want, and to highlight Neil Findlay’s point that women are still suffering and that there are still serious questions about how that suffering was allowed to happen and to what extent Government understands the situation. That is the really serious matter here.

We agree to continue the petition and to write to the cabinet secretary and the Health and Sport Committee. I am mindful of Gail Ross’s point that we should be asking for a response from the cabinet secretary on the question of compensation and funding referrals to America. Is that agreed and acceptable?

In that case, I thank our visitor colleagues. We will continue the conversation as we go forward.