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In response to Alexander Stewart’s earlier question, you very generously said that conversations could potentially take place in the event that there was interest in Scotland in trying to gain experience of all of this. If we raise that potential conversation in our evidence session with the Scottish Government minister who is responsible for this area of healthcare, what would be the appropriate way to explore that further? Would it be for the Scottish Government to make contact with Shouldice hospital to see whether a conversation could be initiated?

I thank you again for your good humour in dealing with us amateurs in this field of experience. We are very grateful.

That concludes our evidence session. For our next consideration of the petition, we will hear from the chief medical officer and the Minister for Public Health, Women’s Health and Sport, Maree Todd. Our next meeting will be on Wednesday 18 May.

Out of interest, is there any difference with regard to the application of the procedure, the success rate and the outcomes, depending on sex? Does it matter whether the patient is a man or a woman, or is the procedure equally effective?

I fully understand the difference, and that is why we are interested in pursuing information on hernias. It is quite different from transvaginal mesh, and the use of mesh in hernia repairs is far more widespread and has been done over a much longer period.

I am interested in your experience as someone from the leading hernia hospital in Canada. An issue that came across to us was that clinicians were opposed to the idea that there was an alternative treatment to vaginal mesh. You have obviously specialised in your process and can demonstrate that you have had excellent results. Is that widely accepted as a clinical practice by clinicians across Canada, or is there any resistance to the idea that there is an alternative to mesh as an appropriate route forward with hernia repair?

I know that you are not seeking to draw parallels, but, from our experience, I think that the use of mesh in the transvaginal example was underpinned by issues of cost and the fact that it was a much simpler procedure than the alternative.

You referred to the European Hernia Society. The British Hernia Society, in expressing its scepticism and its justification for mesh as the principal and preferred route, says that the sutures that are required for the alternative—the tension-based repair procedure that you pioneer—are not resilient enough. How do you respond to that? How do you deal with that?

Following on from that, I invite Paul Sweeney to reflect on what has been said so far and then to ask our next set of questions, as well as any question that might have occurred to him.

One of the issues that we faced in Scotland in relation to the removal of mesh in the transvaginal area was that that operational procedure required a huge amount of skill. The glib view, before all this was examined properly, was that it might be possible for some clinicians from Scotland to simply sit in on a few procedures to gain the necessary skills. However, that did not prove to be the case, which is what led to the legislation in Scotland that is facilitating the transfer of women to wherever the skills exist.

In due course, we will have a meeting with the Scottish Government minister with responsibility for this issue. For the moment, though, Alexander Stewart will explore the potential transferability to Scotland of the skills and experience of the staff of the Shouldice hospital, and of its preferred model.

You just referred to the situation in which the use of mesh might still be appropriate. It occurs to me that the reason that mesh has been relied on by some is that the nature of the hernia suggests that the tissue walls are not sufficiently strong to withstand the subsequent pressure.

You have explained the preparatory criteria that you have for people you think it would be appropriate to operate on, but when it comes to—how can I put this?—what you find internally, are there times when you look at what is there and think, even though the patient has taken all the necessary action, the tissue wall might not be sufficiently strong to withstand the procedure? Does that happen from time to time, with the result that you have to fall back on an alternative?

With regard to that rather uncomfortable thought that you had in relation to men, does that happen from time to time?

I want to understand one final thing. How is the procedure financed in the healthcare system in Canada? Obviously, we have a national health service here, so everything is part of a national healthcare plan, but in relation to the patients who present to you, what is the financial underpinning of the procedure that is undertaken?