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Research will be on-going all the time. The Scottish Government has asked for a review of the evidence. The Scottish Health Technologies Group has already published a report of a review of evidence on primary inguinal hernia repair in men. Following that, we asked the group to examine hernia more broadly, to include men and women and to review the outcome of mesh versus non-mesh surgery in a variety of abdominal wall hernias. We have asked the group to look at the published evidence on that and to come back to us, and we are waiting for publication of that report. We expected it at the end of summer this year. That is quite a broad term, but we are hopeful that it will be published very soon and that it will give good-quality evidence. Without high-quality and well-reviewed evidence, it is not possible for patients to make an informed decision.

You are absolutely right—the pandemic has placed immense pressure on the NHS. We talk about that in almost every parliamentary committee and regularly in the chamber. Undoubtedly, after 18 months of impact on NHS capacity and how we work, there is pent-up demand for surgery in a number of clinical areas such as orthopaedics. Cancer surgery has been prioritised throughout the pandemic.

An NHS recovery plan is in place. Work is being done to ensure that we can tackle the pandemic and keep the number of hospitalisations at a level at which the NHS can function. There are plans in place for the NHS to recover from the pandemic. National treatment centres are being developed where surgery can take place. The process will not be instant or overnight, but there is a recovery plan in place that will benefit everyone who is waiting for treatment, not just the people whom you mentioned.

In such situations, it is really important that we work with the evidence that is available. I know that, sometimes, the evidence is limited and the full picture is not clear, but the available evidence points to the benefits outweighing the risks in most cases, as we have said.

As well as working with the evidence, we have to work with the principle of realistic medicine. You will know that that has been an important principle in Scotland for a number of years. It was considered to be almost revolutionary when Catherine Calderwood wrote the first report on realistic medicine, and we have come some way since then. I say that we have come some way but I am confident that we are not at the point at which we can be absolutely 100 per cent sure that every patient in every case and at every time engages in a shared decision-making process. There is on-going work to ensure that surgeons are confident about raising issues and that they raise them in a manner that enables people to ask questions. There is a power imbalance in medicine that makes it difficult for patients to ask questions of surgeons, so we need to make sure that patients are empowered and that shared decision making takes place.

You mention women being more able than men to get together to create strength through numbers. That is an interesting observation. One of the reasons for the women’s health plan is that there is evidence that women face inequalities in access to healthcare, and one of the reasons for those inequalities is the general power imbalance for women and the fact that they are easy to ignore, as are many other groups of people who suffer health inequalities.

We are working on the issues in many different ways. With regard to gynaecological procedures that have not been halted, there is a high-vigilance protocol in place that will systematically gather evidence over time on the issues. It is unfortunate that Terry O’Kelly is not here but, to provide a bit more information, a system of unique device identification is being worked up, which will mean that a barcode is entered on patients’ electronic records to give information about the device that was used, the surgeon who did the operation and other details about the surgery. That will enable NHS Scotland to follow cases through for a number of years, and we will have good quality data available to us.

On the general thrust towards informed decision making—

I cannot make a decision on funding until I see the full proposal, but the committee should rest assured that the Government is willing to look very closely at any information that comes forward. We are well aware of the need for a good, solid evidence base in this area.

To be fair, I cannot recall where I left things, convener. However, I will say that, with regard to the second report that is coming, I am more than happy to offer to come back to the committee to discuss that, if required. We will certainly inform the committee when that report is published and available.

No. That was perfect.

As I understand it, it is the Medicines and Healthcare products Regulatory Agency that grants licences for those products on a United Kingdom-wide basis. David Bishop might want to come in on this but, as I understand it, the transvaginal mesh situation prompted a review of all those processes. I think that on-going work is still being done on that.

Our feeling in the Scottish Government is that the MHRA’s procedures should be absolutely robust and that there were lessons to be learned from that situation. We are keen to ensure that those lessons are learned.

I invite David Bishop to give some more information on that front.

That would be a challenging undertaking retrospectively. However, on the use of mesh in other sites for gynaecological procedures that was not subject to the halt, the high-vigilance protocol has a number of procedures in place that ensure that that is perfectly possible. There is documentation of all the procedures and complications and on the reporting of complications on an agreed database. Crucially, documentation is given to every single patient who is treated with mesh that details their procedure and the mesh product used, along with the name of the patient. Therefore, in future, the precise situation that you have outlined will be less likely to arise in gynaecological procedures in which mesh is used.

I am not sure how that would happen, given the scale of the procedures, with 5,000 to 6,000 per year being carried out since the 1980s. However, as Mr O’Kelly outlined, patients should first present at their GP.

People must be listened to, because the key point that has come out through all the testimonies is that people do not feel listened to. We must learn from the transvaginal mesh incident—people’s concerns have to be taken seriously and acted on appropriately. In many areas, there will be a multidisciplinary team in place, as Mr O’Kelly outlined. There is a complexity in dealing with mesh complications, and the multidisciplinary team and clinical networks will together look at each individual case. However, it must be straightforward for patients to access that level of expertise when they find themselves in the situation that Mr Kidd describes.

Thank you. I am grateful to the committee for having me here today. At the outset, I want to acknowledge the efforts of those who have brought forward the petition; I commend them for doing so.

As members know, we have taken decisive action on transvaginal mesh. That action is well documented elsewhere, so it is important today to focus on the use of mesh in other situations.

We are acutely aware that there is concern about the use of mesh in other sites, not least from those who are experiencing complications. I am very sorry to read of the impact that those have had on individuals and their families. I was sorry to read in a submission on this petition that people felt that their symptoms were “dismissed” when they presented for help. Some people did not feel that they were informed of the risks of the procedure that they underwent, and it is only natural to feel let down in those circumstances.

If I may, I will for a moment focus on the use of mesh in hernia repair, which is a very common procedure in NHS Scotland. The Scottish Government asked the Scottish health technologies group to review available evidence on the use of mesh in hernia repair, first in adult inguinal hernia and secondly in abdominal wall hernia more generally. The group published a report on adult inguinal hernia in January 2020 that concluded that, compared with non-mesh procedures, using mesh resulted in lower rates of recurrence, fewer serious adverse events and similar or lower risk of chronic pain. We await the publication of the second piece of work, which considered the more general use of mesh in hernia repair and is expected imminently.

There are, of course, other gynaecology procedures for which the use of mesh has not been halted. In those circumstances, a high-vigilance protocol is in place across the whole of NHS Scotland. It is important to remember that some of those procedures are complex and long established, with few—if any—viable alternatives. To suspend their use would leave a cohort of people with limited or no treatment options.

I know that this is a very difficult and emotive subject. I welcome being questioned on it and I want to reassure the committee and anyone watching that the Government is absolutely committed to ensuring that everyone with mesh complications gets the care and treatment that they deserve.