Seòmar agus comataidhean

There absolutely are challenging times ahead. I am thinking, for example, of the cost of fuel and energy price rises, and their impact on public services. The cost of heating a nursing home, a hospital or even a sports hall is higher, as is the cost of running a swimming pool. All those things were, largely, not calculated for when budgets were being set just a few months ago. That inflationary increase in energy costs alone is having an immense impact on people’s ability to deliver public services.

There is also inflation in capital costs. I was recently chatting to a sports organisation that had managed to get a great deal of money to renew its ground, but it had realised that, within a year, £1 million had become £0.9 million. That is how high inflation currently is, and how fast the pot of money is going down. These are challenging times for absolutely everyone, and they are particularly challenging for those who are required to deliver public services. It is a challenge for the Scottish Government, for local authorities and for our NHS boards.

What is required in order to rise to and meet that challenge is innovation, creative thinking and careful prioritisation on what it is that we need to do. It comes back to what was said very early in the evidence session about the need to work collaboratively in a way that might not be particularly natural for us. The fact is that, in order to achieve some of the outcomes that we want to—and have to—achieve in Scotland, we will absolutely have to work together and pool our efforts. There is no way around that. Financially, things are currently really difficult, and it will be necessary for us to collaborate to an extent that we never have before.

The use of nicotine vapour products is not affected by the regulations. We do not have the power to include NVPs in the regulations, because they were not included in the 2016 act. The permitting of NVP use within the perimeter of hospital grounds will continue to be at the discretion of each health board. I know that that is likely to lead to a lack of clarity.

The evidence on the safety or otherwise of second-hand exposure to vapes is not yet clear. I think that vapes are potentially a useful tool for smoking cessation, and they are likely to be less harmful than smoking tobacco is, but I am deeply cynical about the efforts of tobacco companies to market them widely and to ensure that they find a replacement market with the reduction in smoking. We need to go very carefully with our use of vaping products in health promotion.

I would not rule out looking at vaping products should the evidence firm up that second-hand exposure is problematic. I would not rule out including them or considering future legislation on that. It seems to me that new primary legislation would be required, given that the 2016 act does not give us the ability to regulate.

Absolutely. I expect the instrument to be effective in preventing the problem, but you are right: if financial costs arise that have not been predicted, we would be more than happy to hear from local authorities.

As a Highlander, I have to say that, although Edinburgh might have more hospitals, a lot more travelling distance would be involved in monitoring the hospitals in the Highlands and Islands. Those are just the challenges that our local authorities and health boards face.

No, thank you.

Thank you for inviting me and giving me the opportunity to return to this important topic.

I am pleased to say that we have made significant progress in our action on transvaginal mesh. We have established a national service for the management of mesh complications, and women have options with regard to their treatment, which can be undertaken in Scotland or elsewhere in the United Kingdom and with an independent provider if desired.

Most recently, the Transvaginal Mesh Removal (Cost Reimbursement) (Scotland) Act 2022 was introduced, and the associated scheme opened on 6 June—just this Monday. The contract with Spire Healthcare has been concluded, and arrangements are being made for the first patients to attend for surgery. Meanwhile, discussions with Dr Veronikis are progressing.

I am mindful of the concerns that have been raised by campaigners over the years about the use of mesh in other sites, such as in hernia repair. That is what I will focus on. I am sorry to hear of any instance of complications and the adverse effect that they have had on individual patients and their wider families.

As members know, the Scottish Health Technologies Group has looked into the use of mesh in hernia repair and published two reports on the subject, one of which was published shortly after my previous committee appearance. Those reports, which are based on current published evidence, support the continued use of mesh in a variety of abdominal wall and groin herniae. That is, of course, subject to all the tenets of realistic medicine: ensuring shared decision making and informed consent with knowledge of the benefits, risks, alternative measures and the possibility of doing nothing.

We have discussed the findings of those reports with professional bodies, including the royal colleges and the British Hernia Society, and we will continue to work with them on that important issue. Work is also going on to establish the medical device information system—MDIS—which will provide important surveillance and outcome information.

Since I last appeared before the committee, the chief medical officer has—in December 2021—written to board chief executives and medical directors to draw their attention to the SHTG report. In the letter, the CMO asked health boards to consider the availability of non-mesh surgery, how best to address skill gaps, if they exist, and the development of broader clinical networks for the management of complex cases. The actions resulting from that will be discussed at a meeting of the Scottish Association of Medical Directors in August.

I know that the committee has received a report from Shouldice hospital in Canada. Although the results reported are notable, it is important to remember that Shouldice hospital is a specialist centre dedicated to natural tissue repair and that it operates in a healthcare system that is very different from the national health service in Scotland. For that reason, the report should not be considered in isolation; rather, it needs to be considered in the context of the wider available evidence.

As I have said before in front of the committee, there are, of course, still some gynaecology procedures for which the use of mesh has not been halted. In those circumstances, there is a high vigilance protocol in place across NHS Scotland. It is important to remember that some of those procedures are complex and long established with few, if any, viable alternatives. Therefore, to suspend the use of mesh would leave a cohort of people with limited or no treatment options.

I reassure committee members, as well as the campaigners who lodged the petition, that the Government is absolutely committed to ensuring that everyone with mesh complications gets the care and treatment that they need.

I look forward to answering any questions that members have on the matter.

It is probably worth going to Mr O’Kelly on that question. As I understand it, Shouldice has a very specialised unit and patients there are somewhat pre-selected. It is therefore not a population that would be reflective of the general population who seek surgery in Scotland. That aside, its results are impressive and we are very interested in the work that is being done over in Canada. However, as I understand it, if we were to compare the population who use the unit in Canada with that seeking hernia repair in Scotland, there might be significant differences, for example in terms of obesity or ambulation.

I will hand over to Mr O’Kelly, who will be able to give you a better explanation.

It might set the context and answer some of the questions that you are keen to put to me.

Convener, I have an opening statement, if you would like to hear it.

No. I have to commend NHS National Services Scotland, which is pursuing the conclusion of that contract. It is very close to finalising that. I know that it is frustrating but, if we stop and reflect on the differences in the medical and legal systems in the two countries, we see that it is understandable that there has been a deal of to-ing and fro-ing. However, I am confident that everything is being done to conclude that contract, and I hope to be able to update Parliament on it soon.

Mr O’Kelly will want to come in on this but, as I understand it, there is real interest in improving the expertise within Scotland in natural tissue repair and they are looking at centres that use those techniques in Europe—just because of the ease and practicalities of links with Europe versus links with North America.

I will let Mr O’Kelly tell you a little bit more about that.