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To be absolutely clear, the process of informed decision making is about the patient and the clinician sitting down together, understanding the condition that the patient presents with and talking over the options. It involves consideration of the elements of the acronym that is gaining popularity in realistic medicine circles, which is BRAN—the benefits, the risks, the alternatives and the effect of doing nothing. Alternatives are absolutely part of that process. That approach is becoming ingrained in medical practice—for example, the acronym appears in advertising campaigns in the virtual waiting room for NHS services in my area. The intention is to normalise that process.

The clinician should be sitting with someone and discussing alternatives. They should say, “Here’s what you’ve got and this is my understanding of the factors that are significant for you as an individual. What do you need me to understand about you as an individual? Let’s see what alternatives are on the table and make a decision together.” That is how it should be. The onus should not be on the patient to ask questions. We intend to create an atmosphere in which it is normal for the patient to ask questions. It is their body that is the subject of the process, and it is altogether more satisfactory if the patient is empowered to make a decision in such situations.

That is a clinical decision, on which I will defer to Mr O’Kelly. Comparing the two techniques is way beyond my level of expertise. I ask Mr O’Kelly to give you some information about whether a process is under way to gather evidence on pioneering techniques and to compare them with existing techniques.

Medicine is slow to change practice. You will know that, in my past life, I was a clinical pharmacist. When I first started out in my practice, there was a gap of about 15 years between evidence and practice. The internet has speeded up the ability to obtain and review evidence from all over the world. We are faster at gathering evidence.

We have seen a brand-new virus that nothing was known about. During the pandemic, scientists and clinicians from all over the world collaborated to find a way forward in the emergency in which we found ourselves. I am very hopeful that some of that collaborative effort will survive into future practice and mean that we will solve some of the big questions. I also hope that, at the heart of that, there will be fewer commercial concerns and more altruism when it comes to solving some of the medical problems.

That was a bit of a philosophical answer. I will let Mr O’Kelly give you the clinical answer.

I think that we do. Perhaps Terry O’Kelly can confirm this, but my understanding is that more than 5,000 procedures a year are carried out in NHS Scotland, and I think that the rate of complications is somewhere between 0 and 5 per cent. I will ask my clinical colleague to confirm that to ensure that the committee gets the correct information.

I will pass to Terry O’Kelly to go into the issue in detail, but we are certainly aware that, when women came forward with concerns about transvaginal mesh, they had to go through a long process of feeling that they were not being listened to and that their concerns were being dismissed. Again, that partly reflects the power imbalance that operates throughout healthcare, but there was a feeling that it was difficult to raise concerns.

I am sure that every MSP around the table will have received mail from constituents who feel worried about raising concerns about their medical treatment and who worry that, if they do, they will somehow suffer in their passage through healthcare. Some of the experiences that we have heard about with regard to women who had transvaginal mesh implanted will be common to that situation, but I would like to think that, since 2018, we have put procedures in place and communicated well with healthcare professionals to ensure that that is not the case any more. Moreover, as I have said, the general thrust in NHS Scotland for a number of years now has been towards realistic medicine and holistic and patient-centred care. I would like to think, therefore, that that sort of thing will be less problematic than it might have been in the past.

I will ask Mr O’Kelly to talk you through the process of presenting with complications and then accessing surgery to remove mesh.

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.