Seòmar agus comataidhean

Absolutely. The review is now well under way. It was established following the serious concerns that were raised by some of the women about whether their case records accurately reflected the treatment that they had received. It is expected to conclude later this year.

In Scotland, we have a system that is based on realistic medicine—I am sure that Professor Sir Gregor Smith will want to come in on this. We want all patients, at all times, to be well informed and to be part of the decision-making process. We use the acronym BRAN to remind everybody who is involved to consider the benefits, risks and alternatives, whether the intervention is needed now, and what will happen if we do nothing. That type of conversation is vitally important when people are considering surgery.

There is no risk-free option when someone has a hernia, and it is important that people are well able to ask questions about, and understand, the proposed treatment—not just the risks in general, but how those risks apply to them—in order to make a fully informed decision on how they want to proceed.

I will let Gregor Smith say more on that.

I understand why you ask that question. I know from debates that have taken place in my constituency that there is a real tension between accessing healthcare as close to home as possible and being able to access national expertise when that is required. I get many more expressions of concern from constituents who have to travel within the constituency to access care than I do from people who want to travel to benefit from specialist expertise.

In NHS Scotland, the way we tend to work is that it should be possible for people to access routine care as close to home as possible. There are lots of good reasons for that. From the point of view of not just the medical model of health but the biopsychosocial model of health, with routine procedures it is important that people are treated close to home, have support around them and are able to recover well within their family and their community.

However, with particularly challenging or complex procedures, we need to build in expertise. We will have to work in a networked way across Scotland to deliver that. We have said that there are challenges with volume. If people are to train in natural tissue repair, they will have to see enough people to maintain that training. We will certainly consider what is the best model for Scotland but, at the moment, I am not minded to reconstruct the unit in Canada here in Scotland.

I will hand over to Mr O’Kelly, who is keen to come in.

Certainly. The Shouldice hospital deals with more routine operations and at quite high volume. In order to give people options in highly skilled and trained surgeons who are using those techniques, that is something that we need to explore on a national basis, although we can also build up local expertise.

I agree that there needs to be a national multidisciplinary team to look at those particularly complex cases. Clinicians from all over the country need to be able to access that expertise. It is difficult to understand how challenging it can be to communicate across boundaries in the NHS. That is a theme that comes up time and again. We are very keen to bust those boundaries to ensure that clinicians can access the expertise that they require for their patients, wherever they live in the country.

We are also mindful of developing systems that mean that patients, wherever they live, can access the right level of expertise. People in Lerwick are probably more comfortable with travelling than people on the mainland because they travel all the time. Patient choice needs to be part of it. We need to make shared decisions with patients about what is the best option for them.

I am not sure that I entirely understand your question, convener. Do you mean a sampling of records or of data? There is a recognition that, where medical devices in particular are used, they need to be more traceable. More clarity is needed on which devices were used where, and we need a system of retrieval in place. We are working closely with the United Kingdom Government on that aspect, so that, in future—I guess this answers your question, as we found ourselves in a situation in which it was quite difficult for us to tell precisely what had happened—that data should be gathered much more routinely. Where there are issues with a product, it should be perfectly straightforward to find out where that product has been used, and there should be a strong audit trail in a patient’s notes.

I see that Mr O’Kelly is raising his hand—I am sure that he is very keen to contribute, as a practising surgeon who has to go through such issues with patients time and time again, day in and day out.

You are absolutely on the button, Mr Stewart—it is really important that these decisions are shared, and that is what we are talking about with regard to realistic medicine. We are moving away from what has happened in the past, when we had a paternalistic style of medicine. Back then, the doctor was all-powerful and told the patient what to do, and their advice was almost always taken as law. We now recognise that health is much better when it is delivered in a shared way. People are much more likely to attain good health if the decision making is shared.

The individual has to be party to a decision, and they must be able to discuss it with their clinician. As I said, that discussion should cover not just the general risks, but how those risks apply to that person as an individual. It should be a very individual discussion, and a patient should feel that, instead of having to access the internet in order to find and assess the data themselves, they can, as they make their decision, talk to their own health professional and have the risks explained as those risks apply to them specifically.

Patients are often in a very difficult situation in which there is no risk-free option. If someone has a hernia, continuing to live with it is not a comfortable situation for them to be in, but the options for treating it are never going to be risk free. As you said, an honest, transparent and well-documented discussion about those risks is a very important part of the process.

Secondly, you raised the point that there is sometimes a sense that people are not listened to. As a politician, I—and we all, as politicians—probably hear about that more than it actually happens, through a select few, or even many, stories. We hear from people who have been to see their health professional and have felt that their concerns have been dismissed or their health problems minimised. Again, we are working hard to improve that situation so that people, when they present to a healthcare professional—often, five years on, it will not be the same surgeon who operated on them—will receive a response that is more empathetic and understanding. We want to ensure that they are suitably directed to people who might be able to help them to disentangle whether what they are experiencing is related to the surgery that they have had.

I am sure that Mr O’Kelly will want to come in at this point.

I will let Mr O’Kelly answer the bulk of that question. He can certainly give you a picture of what clinicians are doing to understand those issues. As with medicines, it is possible to do randomised controlled trials with these medical devices in order to learn more about them. It is also possible, as the unit in Canada has done, to collect anecdotal and observational evidence. That happens on an on-going basis in this area of medicine as in any other.

I go back to your concern about how we find out about different types of mesh and which types may have defects. The Cumberlege report focused on the regulation of medical devices, and it found the UK environment wanting in that regard. As a Government, we are absolutely committed to taking forward the recommendations that were made by Baroness Cumberlege and her team, and we have made significant progress on them since the report was published, last year.

We in the Scottish Government are certainly working with the report and taking positive steps. There is still work to be done to ensure that patients’ voices are heard and listened to—that is why we proposed a patient safety commissioner in our programme for government; it was also a manifesto commitment. We consulted on that recently. The consultation has now closed, and we recently published a report that provided an analysis of the results. We are going to take that into account as we continue to work with patients and experts to develop the commissioner role. We are keen to do that in Scotland, and we are keen to deliver what patients are asking for on that front.

With regard to UK-wide discussions with the MHRA, there has been slow progress—as has often been the case over the past couple of years—which is understandable, given the situation that we are in. Nevertheless, we are pretty keen to pick that up as a priority and to make UK-wide progress on these issues.

I will bear that in mind, convener, and I will take up your offer if necessary.

Certainly. Overprovision is a tool by which licensing boards can prevent new licensed premises from opening in areas where they consider that too many licensed premises are already in operation. It is a valuable tool. I am not sure whether you are asking me to support local authorities to use it more or to encourage them to do so. Again, that is absolutely the way to consider the issues going forward.

I do not know whether either of my officials today has anything to say on that. I will speak to officials to see whether there is anything that the Government can consider. We are not planning to change the licensing laws, but, if there is anything that I can do to support local authorities to be more confident in applying them and achieving the balance that we all seek to achieve, I am more than happy to consider that.

There is always a challenge in that regard. We are asking councils to make a decision that is based on balancing the rights of people who drink responsibly with the need to protect people who might be harmed by the more ubiquitous availability of alcohol. There are five high-level licensing objectives, which are

“preventing crime and disorder, securing public safety, preventing public nuisance, protecting and improving public health, and protecting children and young persons from harm”,

and those objectives are ranked equally.

Councils already have the powers and the guidance on what they need to consider as they make those decisions, and public health should be part of that consideration. As I said, if you have a particular suggestion that you want me to consider in order to strengthen the hand of local licensing boards, I am more than happy to hear it.