Continued Petitions

Item 2 is consideration of continued petitions. The first petition, PE1517, which was lodged by Elaine Holmes and Olive McIlroy on behalf of the Scottish Mesh Survivors hear our voice campaign, is on polypropylene mesh medical devices. The petition calls on the Scottish Government to

“1. Suspend use of polypropylene Transvaginal Mesh (TVM) procedures;

2. Initiate a Public Inquiry and/or comprehensive independent research to evaluate the safety of mesh devices using all evidence available, including that from across the world;

3. Introduce mandatory reporting of all adverse incidents by health professionals;

4. Set up a Scottish Transvaginal Mesh implant register with view to linking this up with national and international registers;

5. Introduce fully Informed Consent with uniformity throughout Scotland’s Health Boards; and

6. Write to the MHRA and ask that they reclassify TVM devices to heightened alert status to reflect ongoing concerns worldwide.”

At the committee’s previous consideration of the petition in February 2021, it agreed to write to the Cabinet Secretary for Health and Sport in respect of several outstanding issues, including what action the Scottish Government is taking to rebuild the trust and confidence of the petitioners and other mesh survivors who have been disappointed by the way in which it has pursued some of the actions that are called for in the petition, and whether the Scottish Government will agree to the call for a substantial inquiry to examine what happened to the women, in order to understand how their experience fell so short of what it should have been and to ensure that it does not happen again.

The committee has received two submissions from the cabinet secretary, and the petitioners have provided a submission.

In her submissions, the cabinet secretary highlights the Scottish Government’s on-going engagement with patients. She explains that the new specialist pelvic mesh removal service will provide a holistic service to patients, and that the service will be shaped by the views of and feedback from the women using it. Although the cabinet secretary hopes that women will have confidence in the new service, she recognises that that may not be the case.

To that end, women will be able to have care from surgeons in NHS England. In recognition that some women may wish to be treated by a surgeon outwith the national health service, she confirms that

“NHS National Services Scotland intends, at the earliest opportunity, to issue an invitation to tender for specified mesh removal services”,

which will

“provide an additional option for patients that will include the possibility of referral outside the NHS, which includes the possibility of referral outside the UK.”

I welcome John Scott, Jackson Carlaw and Neil Findlay to the committee for consideration of the petition. Before I ask committee members for their comments, I will go to our visitors, starting with Jackson Carlaw.

The work of the Public Petitions Committee has been hugely important and influential during the past eight years and I plead with the committee not to close this petition for a number of reasons. Also, I say to Jackson Carlaw that, if there are three in this marriage in Parliament, on this final day of the session I am filing for divorce—I am sorry to break it to him publicly.

One way in which the committee can justify continuing the petition is that the ban, which was requested in the petition, is not a legislative ban. Jackson Carlaw referred to the cabinet secretary’s letter, but if we have a new cabinet secretary who takes a different view, that ban could end. We know that many in the medical profession would overturn that ban in a heartbeat. They want to restart implanting mesh because they believe that there is nothing wrong with it, despite all the evidence.

Secondly, there has never been a public inquiry into what is one of the biggest ever medical scandals in Scotland’s NHS. Therefore, that point of the petition remains as well.

A new service is being set up in Glasgow and we will have to see how that develops. There is not a lot of confidence in it from mesh-injured women. However, the other three elements of the petition—mandatory reporting, a register of implants and informed consent—go to the very heart of what that new service might look like. Therefore, the committee should keep the petition open and oversee whether the new service actually has mandatory reporting and a register, and engages in services with fully informed consent.

John Scott raised the issue of compensating women who have gone of their own volition to the US or wherever for surgery and paid for that through crowdfunding, savings or borrowing. I raised that with the First Minister last week. She said:

“We are making progress on all key asks of the charter; on the asks on which we are not yet making progress, the health secretary has already given instructions—for example, on our finding a way of reimbursing the cost of mesh removal surgery, probably through an extension of the remit of the fund that has been set up.”—Official Report, 18 March 2020; c 16.

However, eight days previously, the cabinet secretary’s letter to which Jackson Carlaw referred, to himself, Alex Neil and me, said:

“With regard to reimbursing women who have sought treatment from Dr Veronikis at their own expense, Scottish Government officials have investigated in detail whether there exists appropriate statutory authority to use public funds to refund patients who have arranged and received treatment privately, and not through a referral from an NHS Board. Further to this consideration, it is clear that there are not legal powers to reimburse persons in these circumstances.”

It went on to say that

“the advice is clear with respect to using public funds in this regard.”

Those are two contradictory positions. The First Minister says that the Government is looking at how it can do that, but the cabinet secretary has already discounted it. The Government may fall back on saying that it has to be done through a referral from an NHS board. However, the simple fact is that a number of women have taken their request to be referred to an NHS board and had it refused. Therefore, is that route completely blocked?

A number of contradictory things are going on and it would be appropriate for the committee to keep the petition open to look into those issues as well. There are other related issues, such as the appointment of the patient safety commissioner following the Cumberlege review—I am not sure who is overseeing or keeping an eye on that process—and there are also issues around the new mesh centre and how it develops.

Therefore, for a number of reasons, I urge the committee to continue the petition. You have done fantastic work on it. I know that, as a convener and a committee, I would be trying to wind up loose ends at the end of the term, but this is not a loose end—this must continue.

09:45

I thank all three of you, who will I am sure be living in happy coexistence post-election.

For my part, I think that the petition is a huge issue. There are organisational and accountability issues for the committee. The fact of the matter is that we really ought not to go beyond what the petition itself asks for. It is a more general consideration for the Public Petitions Committee to avoid creep from the core business of a petition to what might be considered something that comes out of it.

If this was not the end of the session, I would be arguing for the petition to be referred to the Health and Sport Committee, because there should be parliamentary scrutiny and oversight of all the issues that have emerged here, including compensation. Clearly, there has been some progress; for example, the National Institute for Health and Care Excellence is looking at the advice that is given to people.

There is still a conflict, as some people with conditions say that you cannot not have mesh in certain circumstances. There is clearly going to be quite an argument going on there. The question is whether that is a matter for the Public Petitions Committee.

My view is that some things remain outstanding. The question of compensation should probably be raised in a new petition, because it is a very specific ask that can be brought to bear and it is not in the original petition at all. I will be interested to hear what other committee members feel.

In an ideal world, I would have referred the petition over to the Health and Sport Committee for it to keep an eye on and to ensure that the scandal around this is properly considered in terms, which is part of the original petition. However, we do not have that option. Given that the petitioners have always had the sense that, if we do not shine a light on this, nothing will happen, and that, if we do not keep the focus of the light on things, nothing will happen and there will be drift, there is an argument for holding on into the new session, when referring the petition over to the next health committee and taking a new petition might be options. That is my view, but I am interested to hear members’ views.

Does any of our visiting colleagues wish to add anything?

I thank everyone for their helpful comments. It is of course up to this committee to request that the next health committee takes on the petition and carries out an inquiry, and I would support that. However, it would be worth keeping the petition open to await the response from the new health committee, which would mean that everything would not simply die away if it said no, because the petitions committee would have the matter open. If the next health committee takes on the call and opens up an inquiry, it might then be opportune for the petitions committee to close the petition.

We are getting a wee bit ahead of ourselves. All petitions come back to the Public Petitions Committee ahead of the end of a session. We get reports back from all the committees to which we have referred petitions. We are still responsible for them whether other committees have done work on them or closed them—we have information on whether they were closed.

We cannot refer the petition to the Health and Sport Committee, because it is too late, and I do not think that we can define what we want the next health committee to do with it. If we refer the petition to it, it becomes that committee’s responsibility and it responds as it chooses.

The main thing is that petitioners could come in with a new petition on questions around compensation and other issues that were not highlighted in the original petition. The petitioners can bring a new petition with a new focus if there is no progress on a petition and things look as if they have stalled. I think, however, that there is general recognition that work has been done on this petition.

The downside of referring the petition to the next health committee is that we have no control over what it does with it. The upside is that that committee then has a specific focus on the work that has been done and on whether there is a need for an inquiry. We have to recognise that there are limits to that process, but that is balanced by the fact that the petitioners can lodge a new petition if they feel that there is a delay, a drag or other issues that they want to highlight, and that gives me comfort. At this stage, we cannot technically refer the petition to any committee, because nothing will be done; we can only make recommendations to the next petitions committee.

Unless I am misreading the committee, we want to hold on to the petition, although we recognise, as Jackson Carlaw says, that eventually a petitions committee will have to let it go. However, there are outstanding issues that need to be addressed, and new issues have emerged that could be part of a new petition. We believe that the new health committee could focus on those outstanding issues, but obviously that is a matter for the new petitions committee to decide.

10:00

My feeling is that we should continue the petition, but make a recommendation in our legacy paper to the new petitions committee that the petition does not just sit but is referred to the new health committee. We also recognise that new issues might emerge in a new petition, and the context for that will be all the work that has already been done. I hope that members are content with that approach, if it is clear to them what I have suggested.

All the things that have been said about the petition remain true: that this is a scandal, that there are huge issues, and that there are women who are living with pain daily and who have lost confidence in the system. That is the other reason why the petition should be held on to—because they do not have confidence to let it go. Whether it was the review or other issues, the system so far has let them down. We need to give them confidence that there will still be parliamentary scrutiny, while recognising that that does not necessarily have to be done through a petitions committee. The specific emerging issues that Neil Findlay and others have highlighted, including compensation and so on, might be part of a further petition at a later date.

I think that we are agreed that we will continue the petition, and that we will put in our legacy paper commentary on where the petition might usefully go. We will also say to the petitioners, in relation to the specifics of issues that have emerged from the petition, that they might want to bring a further petition. Do members agree to that approach?

Members indicated agreement.

I again thank our visiting MSPs. It has been an absolute privilege for me as a committee convener to welcome you to so many meetings. The work of the Public Petitions Committee is immeasurably enhanced by MSPs coming along to speak up on behalf of petitioners alongside the petitioners themselves. It is a powerful combination, and I hope that that will be sustained in the next session of Parliament. Thank you for your attendance.