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Mesh reimbursement Bill - Correspondence following the committee meeting on 26 October 2021

Letter from Greig Chalmers following the Committee meeting on 26 October, 27 October 2021

Dear Ms Martin,

TRANSVAGINAL MESH REMOVAL (COST REIMBURSMENT) (SCOTLAND) BILL

Thank you for your letter of 27 October. I and my colleagues were pleased to be able to offer our evidence on 26 October and hope that it was of assistance to the Committee.

In your letter you seek clarification on two points, which I offer below. In this I describe the the Government’s present policy intention.

Residency

As we discussed at the evidence session on 26 October, section 1(3)(b) of the Bill provides that mesh removal surgery is qualifying surgery if it was arranged in relation to a person who was, at the time the surgery was arranged, ordinarily resident in Scotland.

The policy intention in this provision is to encompass within the scheme arising from the Bill persons who would have had an expectation that mesh removal surgery would have been arranged for them by a Health Board in Scotland, but who did not wish it so arranged because of a loss of trust in relation to which the Committee has heard evidence.

Persons ordinarily resident in Scotland at the time when private mesh removal surgery was arranged were then “in the care of” an NHS Scotland Health Board. The Government plans that persons in the same circumstances now should have access to the range of treatment options described in officials’ evidence on 26 October, which it is intended will include surgery provided by surgeons in non-NHS facilities. The policy intention is therefore to reimburse persons who have in the past arranged and paid for surgery which would have been available to them free of charge if Ministers’ present policy had applied.

Persons not ordinarily resident in Scotland at the time when any private mesh removal surgery was arranged could not, of course, have had an expectation at the time that surgery would be arranged and any cost met by a Health Board in Scotland, because they would have been within the responsibilities of a non-Scottish NHS entity if resident elsewhere in the UK, or of a foreign government if living overseas.

We do of course take note of the particular circumstance described in your letter, in relation to persons returning to be resident in Scotland, and will give consideration to it. It would be useful in this regard if the Committee Clerks might let us know of any instances of this situation that have been raised with the Committee, appreciating of course that persons might have made the Committee aware of their circumstances without wanting any of their personal details to be disclosed.

Ancillary provisions

The second point raised in your letter is concerned with the use that might be made of powers to make regulations under section 3(1). In particular, whether regulations under this section might permit the Government to draw up a scheme in future for circumstances other than those currently covered by the Bill?

The answer to this question is no: regulations made under section 3 are restricted to incidental, supplementary etc. provision considered appropriate for the purposes of, in connection with, or for giving full effect to the Act (or any provision made under the Act). The purposes of the Act are restricted to reimbursement of qualifying mesh removal surgery and schemes for other types of surgery do not fall within those purposes. Paragraph 26 of the Explanatory Notes offers an example of the type of regulations that could be made under section 3.

I hope that this reply is helpful.

I am copying this letter to the Cabinet Secretary for Health and Social Care.

Yours sincerely,
GREIG CHALMERS
Head of Chief Medical Officer’s Policy Division