 Yn ymgyrchau toeth gwaith o modd i môer 1,0915, ar y name sy'n genny Minto ar Hyader Black sgirニol Meche. Felly fyddon ni'n nhw gan gweithio â'r moddd? Felly sgir ni'n nhw compares yr ymgyrchau gwybod yn llwyteriaeth yma… Ac rwy'n gweithio gyd yng Nghymru ac yn meddwl y modd, byddai mwy o mwy o mwy o sgirnyol meche yn aíu. I speak today to move the motion in my name on the impact of transvaginal mesh on women's health, which this Parliament has rightly debated on a number of occasions in this and in previous sessions. That our Parliament has addressed this issue regularly underlines the seriousness of the harm experienced by women who continue to suffer painful complications after having had mesh implanted. I know that I will not be alone in hearing from women who have described how their lives have been blighted both personally and professionally by complications after mesh surgery. What is worse, for some, their suffering was added to when they felt their pain was downplayed, dismissed or ignored altogether. However, members of this Parliament did listen to women. They believed them. They raised women's experiences and pressed their concerns and the Government has listened to. By working with the Parliament and with committed professionals in the NHS, it is fair to say that improvements have been made to the care offered to women affected by mesh. One of the ways in which the Government sought to respond to affected women was in the establishment of the transvaginal mesh case record review. The review was led by Professor Alison Britton with the assistance of an expert panel and conducted entirely independently of the Scottish Government. We had no contact with the participants as part of the review nor site of any records. It was established to examine the medical records of women who feared that their treatment had been recorded inaccurately. Women considered that they had been informed that their mesh had been fully removed but subsequently discovered that it had been removed only in part. I would like to thank Professor Britton for her meticulous work and echo to her thanks to the women who shared their experiences and insights. Professor Britton notes that, despite their personal and emotional cost, women engaged in the review not only or even mostly for themselves but to make a difference to the quality of life for other women. The approach of the review was not to seek to establish blame or necessarily to find fault, but rather to allow women an opportunity to discuss and better understand their own health records with an expert panel. 47 women who had been involved in a meeting in 2019 with the then First Minister and Cabinet Secretary for Health were invited to take part. 18 women took up the offer of a report on their records of whom six had had mesh removal surgery. Each of the women received a bespoke report about their circumstances and their records. Women were offered an opportunity to talk to the panel about their report. Time was allowed for them to talk again after reflecting on the report and their first discussion. It will, of course, be for the individual women involved to judge the benefit of the process to them, but the panel noted that there was a general appreciation of not being rushed and being able to define their own journey in their own way. From the Government perspective, we are grateful to Professor Britton, the panel and their staff for fulfilling their remit so thoroughly and in a way that has respected women's experiences. It is not an easy report to read. We note with concern the following observation, and I quote directly from the report. Every patient is entitled to expect and receive accurate information both before any treatment is chosen and to be advised on the effectiveness and consequences of any intervention. Most of the cases that we reviewed did not meet those standards. That is a critical point, which I will return to. The remit of the review also sought a wider report, and Professor Britton published that in June with 21 recommendations. As was only reasonable, most of the recommendations are about care now available to women affected by mesh. They addressed communication between clinicians and patients and between different parts of the NHS, information and support made available before and after removal surgery and collaboration across the UK in the establishment of a register of surgery. The Government endorses all of those recommendations. Moreover, we believe that the NHS in general and the complex mesh surgical service in Glasgow in particular are acting now to make substantial progress towards achieving the objectives that the recommendations pursue and also responding to comments from women. As I noted in my letter of 22 August to the Health, Social Care and Sport Committee, it is accepted by all that there remains a need for continuing improvement in the Glasgow service. At the same time, however, we know from patient feedback, gathered annually, that changes in the service made in response to previous feedback are already better matching women's needs. The complex mesh surgical service in Glasgow is centred on a published national clinical pathway. I am very grateful to the minister for giving way. I think that she highlights important issues identified by this review. I think that what is important to understand is that this is not a historic case or set of affairs. What it represents is women who currently do not know their status, currently do not know what actually happened to them and critically do not know what the future pathway for treatment and care looks like. When do you think that that will be resolved so all women who need corrective procedures know where they are in terms of the process and know when they will receive treatment? I thank Daniel Johnson for that intervention and I believe that the rest of my speech answers a lot of his questions. I would say that the Glasgow mesh service is listening to women and amending the way that they work to ensure that they are providing the best service for women. Referals are made on the basis of a single national form provided by the Glasgow service. Patients attending the centre have access before their visit to a range of information available on one website operated by NHS Greater Glasgow and Clyde. The website explains what to expect as a patient visiting the centre, including how long the consultation may take and what will happen. It is being further improved now based on patient feedback. Patients are encouraged to bring a companion and are free to record consultations on a personal mobile device so that they are under no pressure to remember everything that is said. Patients can see and discuss any scanned pictures taken during investigations. The service is not just about surgery, women are supported by a multidisciplinary team of psychologists, physiotherapists and specialist nurses and can access advice about diet, lifestyle and pain management. It is also made explicitly clear that women can choose to have surgery elsewhere and there is information provided both online and in hard copy about mesh removal surgery with one of the independent surgeons. Patients on the multidisciplinary team can take time to reach decisions about care, which are only taken after the patient has been given time to reflect on their options supported by high-quality decision aids and consent forms. After surgery or after treatment is concluded, patients are referred back to their local health board for on-going support. Patient feedback shows good and improving results. As I noted earlier, that has led to changes such as having fewer people present in examinations. I am listening with interest and obviously I have an opportunity to say more in my own contribution. Does she not accept that the pathway for most women at the moment in terms of the removal of mesh is to be treated by the very same surgeons who implemented the mesh in the first place, in whom they have no confidence whatsoever and that so much of what Professor Allison Britton recommended in both this report and in her last report, it is, although embraced by the Government, vague to follow in a transparent route how those recommendations have actually been implemented. I thank Jackson Carlaw for his intervention. I would like to recognise the fantastic work that he has done supporting women in this situation. To answer his question, women have the option to choose an independent surgeon to remove, but I absolutely understand the point that you make about trust, having heard about that myself directly. However, I think that what we are focused on is finding solutions to rebuild that trust, and that is what we learned from Professor Britton's report. The service continually reviews its operations and listens to patients to ensure that it is getting it right. The Glasgow service is part of a UK-wide network of 10 specialist mesh centres. It will be a key partner in the development of a pelvic floor register, one of Professor Britton's recommendations to which the Government is committed. Further recommendations address training and information for GPs and surgeons. The Government has acted on those already. A training package intended to help GPs feel more confident in supporting women with mesh complications can now be accessed through the NHS Scotland online learning service. The Government also continues to make progress with partners to support the development of a GMC-regulated credential in mesh surgery. We know that clinicians in Scotland are keen to take part in a pilot stage. I would like to return to the observations offered by the review about the accuracy of some medical records that they examined. As I said at the outset, the Scottish Government has had no access to any records and no contact with any patients as part of the review. Nevertheless, the chief medical officer has taken careful note of those findings and notes with significant concern observations around content and record keeping. As a consequence, Professor Smith has now written to all health boards to draw their attention to the report of the review and to the failings that it identified. It is clearly unacceptable that any medical records in Scotland might, in the words of the review, not bear any reflection to the surgery that has occurred nor its outcomes. I am very sorry on behalf of the Government that those failings happened. As the review fairly reports, those failings might not have come to light without it being commissioned. Both the chief medical officer and I have confidence in the professionalism and dedication of doctors across Scotland, but we also look to everyone in our NHS to take careful note of the report and to reflect anew on how all act to maintain the highest standards of professional practice. Let me conclude by repeating the welcome that I offered earlier for Professor Britton's report along with the Government's thanks and, importantly, a thank you to the women who were able to share their experiences and be heard. The report and its recommendations put new and welcome focus on what is already an important agenda for the Government. We want women to feel empowered and encouraged to ask questions, to share concerns and their expectations about their care and to be treated all times with dignity and respect. The NHS should continually reinforce good practice in confirming and recording consent in the treatment that is offered to patients. Presiding Officer, at the outset, I want to recognise the hundreds of meshingured women who have fought so hard and for so long to have their voices heard. They've lived with debilitating pain. For some, their symptoms and internal injuries have been so excruciating that they've had to give up their jobs. Others have become socially isolated because managing their symptoms is so difficult and depleting. The impact on their physical and mental health has been horrendous, compounded by the betrayal of a healthcare system that repeatedly told them that there was nothing wrong. Those women felt diminished and disempowered by the clinicians they trusted to care for them. Heart-breakingly, one woman said that she felt like an insignificant nothing. I pay tribute to Elaine Holmes, Olive McElroy and the Scottish Mest survivors who started a campaign with a parliamentary petition almost 10 years ago to rectify the mistakes that meshingured women have endured. My colleague Jackson Carlaw and former MSPs Alex Neil and Neil Finlay heard their call to action and took up the cause in the Scottish Parliament. They helped to provide a platform for women to share their experiences of surgical mesh, but it should never have had to come to that. Our healthcare system should be patient-centred, not stacked against them. The latest review from Professor Alison Britton makes for grim and difficult reading. It examined 40,000 pages of medical notes and 18 case records of women with transvaginal mesh implants and found that many of them were not informed of the risks and implications of the treatment if it went wrong. Some had conditions that would not have been helped by mesh implants in the first place and horrifyingly many were misled about the extent to which the mesh had been removed by the NHS. One patient lost her bladder and she said what had happened to her was bordering on criminal. Another described the feeling of being deceived and gaslit by clinicians. The legacy of distrust from the transvaginal mesh scandal will endure for a very, very long time to come. Professor Britton's review has made 21 recommendations spanning communications with patients, the creation of a mesh register for procedures in Scotland, the wider UK and abroad, clarification around the mesh referral and treatment pathways from the patient perspective, requirements for post-operative care following surgery abroad and improvements to the consent process. The Minister today thanks Professor Britton so I'm sure she will agree that these are reasonable and common sense suggestions that the Scottish Government should implement at pace with the appropriate partners. I know that the Minister's motion suggests that support for mesh injured women is already well aligned with Professor Britton's recommendation but a polite way of replying to that is it's a striking example of non-committal political parlance if ever I heard one. Professor Britton did of course author the 2018 investigative report into the initial review into transvaginal mesh. The Minister says today that she's grateful to Professor Britton and she wants to find ways to build that trust yet five years on from its publication Professor Britton confirmed that not a single one not a single one of the 46 recommendations have been implemented by the SNP government. Hardly a track record to fill you with confidence. I will take an intervention. I'm very grateful to the member for going. Does she agree with me that the alignment will only be there once every person who has survived at mesh knows what treatment they're going to get and is satisfied with the outcome of that treatment and the reality is is that too many women are still in the dark as to actually what is going to happen to them. I strongly support and echo that Mr Johnson and I think that the women need to build back trust and the minister talks about building trust but the very fact that not a single one of Professor Britton's recommendations have been implemented which is absolutely disgraceful. Presiding officer effective treatment for mesh injured women has been a hard one prize but serious systemic problems remain as our amendment highlights today waiting times are far too long and I raised a case with the minister earlier this year of a woman who had to wait a shocking 82 weeks simply for a referral to the specialist mesh service in Glasgow 82 weeks. Part of the issue is that the referral pathway as my colleague described as a complex diagram that is as clear as mud for most patients. It requires women affected by mesh to be seen by a local urogynaecologist for referral to the specialist service in NHS Greater Glasgow and Clyde. Their GP must refer them to the health board who then refers them onwards. There is no direct pathway. It's a lengthy process especially when urogynaecological services are under so much pressure. The process could be much better integrated to reduce waiting times. In the meantime, GPs and other clinicians must become well-versed in how to support women with surgical mesh implants to manage their physical and their emotional pain. Postoperative care in the NHS needs to be more clearly defined for mesh patients when independent providers of surgery are involved and women have described being in limbo. They don't know if they've been discharged or if they require follow-up care. One patient in NHS Tayside who had her mesh removed at South Mead Hospital in Bristol said, nobody in Scotland has asked me if I'm okay. I've had no communication from my health board. A mesh register, a long-standing initiative that has yet to be implemented would help in this regard. On the reimbursement scheme, Presiding Officer, welcome though it is, patients have expressed concerns about a pedantic penny counting for treatment they had to arrange abroad because options were so limited closer to home. Presiding Officer, the transvaginal mesh scandal has shone a light not just on one particular procedure but on the way the healthcare system manages women's healthcare more widely. Let's not forget why women were given mesh implants in the first place. Often it was to treat urinary incontinence and pelvic prolapse. They have gone from one trauma to another. There's still so much to be done to ensure women have equality of care and that they're listened to and respected by clinicians I urge the minister and the Scottish Government to heed the words of Professor Britain. After the wealth of knowledge and evidence gathered it would be an appalling waste if this was not put to good use to prevent further medical scandals, she says. This cannot be allowed to happen again. I move the amendment in my name. Thank you Ms White. I now call Jackie Baillie to speak to and move amendment 10915.2 up to seven minutes. It's been many years that mesh campaigners have had to fight for action on their concerns and the reality is that despite the parallel universe set out by the minister that fight continues. Promises have been made by the Scottish Government to listen to and support women involved in this but progress has been glacial. There are reports that the complex mesh surgical service is not working. Set up three years ago the story now is one of long waiting lists and no follow-up care. I've been contacted by many women including Lisa Megenson who having had mesh surgery herself now supports women to access treatment through the complex mesh surgical service. She points to delay, she points to the lack of aftercare. In the real world the government figures revealed that women have waited up to 448 days for a first appointment at the service with a subsequent wait for mesh surgery lasting up to 341 days. My information is the same as Tess White's. Urgent referrals have in some cases taken 82 weeks, a year and a half and women being referred now are being offered appointments in 2025. Women have been left suicidal by the weights that they face and they suffer daily the risk of developing sepsis because of the constant infections caused by mesh. Does someone need to die before the government takes swifter action? When it comes to surgery the story is not much better. In a letter to the health committee, the minister outlined that by the end of July only 89 women had undergone surgery in Glasgow, 26 had travelled to the United States or indeed Bristol for surgery and just 20 women have been reimbursed for surgery that they sought and paid for out of their own pocket. Now whilst I understand that Dr Veronica's has been awarded another year-long contract he is being told not to carry out any repairs he finds and to only remove mesh devices. When patients have already undergone removal surgery that was carried out in Scotland it is only once they are on the operating table in the US that Dr Veronica's can see the damage caused. It cannot morally be acceptable to instruct a world-class surgeon to ignore the internal damage that he finds and stick strictly to mesh removal only. So his contract needs to be reviewed and should be extended until all the women who need mesh removal are treated. For those who have been able to access the clinic and have received mesh removal they report that follow-up support has been non-existent, leaving many feeling like they are in the same boat as 10 years ago. Let me talk about Maureen Cain from Fife. She underwent mesh removal surgery last November. Since then Maureen feels as if she has yet again been left to suffer. She said, it's like we've been forgotten. It's just the same as before. I didn't expect miracles from the operation but I did expect there to be some follow-up. I just feel like as soon as they've got the mesh out they're done with you. Women like Maureen are on a merry go round of misery dealing with the failure of this Government to provide any follow-up care. Another woman returned from the United States with a catheter still inside. She contacted the complex mesh service. They didn't get back to her. She went to the Queen Elizabeth university hospital to be told that they didn't provide treatment for those who had procedures done overseas. They eventually reluctantly agreed to help her. She could have contracted sepsis and died. Why is there no follow-up? There needs to be proactive follow-up services set up immediately to provide these women with essential aftercare. Mesh injured women faced lifelong pain and disability. They will require house adaptations, funding to support their lives. Many have lost jobs, careers, their partners, their homes as a direct result of becoming disabled due to the use of mesh. The Cumballage report, welcomed by the Government, called for a redress scheme to be set up. Why is it not yet set up? Why is there still a delay? This is simply unacceptable. Let me turn to the reviews of which there have been a number, Presiding Officer. The independent review on transvaginal mesh implants, which came to a series of conclusions and recommendations in 2017. How many of them have been implemented? The first of Professor Britain's investigative reviews in 2018 made, as we have already heard from Tess White, 46 recommendations, and it would appear that not one has been implemented. Then, of course, we have the second Professor Britain report in July 2023. That, of course, is extremely welcome. But what will the SNP do to implement those 21 recommendations? Not just endorse them, but make them real, or are they just simply to gather dust? Will the Government simply proceed at snail's pace? The report exposed damning evidence of women being blatantly lied to and told that they had a full mesh removal when that was not the case. There are cases of women given mesh implants when they were told that they should never have been treated with them, causing them life-changing injuries. I asked the minister, are they subject to criminal investigation and can the Government explain why surgeons that were found to have lied are facing no consequences for their actions? Can she explain why those same surgeons are providing their opinions on the future care of the very women that they harmed? The problems are not just with transvaginal mesh. There are petitions before the Parliament calling on the Government to suspend the use of all surgical mesh and fixation devices. Similarly to transvaginal mesh injured women, people fitted with mesh to treat things like hernia, have reported debilitating pain and issues with their mesh devices. There is a need for a viable and safe alternative to mesh. Transvaginal mesh injured women were ignored for years and now other mesh injured survivors find themselves in the same position. The issues are clear that the Scottish Government must urgently address delays in the Glasgow service, tackle long referral times, provide an aftercare service and actually listen to the experiences of patients, extend the contracts with specialists in the United States and Bristol and put in place a redress scheme. Failure to act will amount to a further betrayal of mesh injured patients. The promise to listen to these women is one that the Scottish Government must not continue to break. I move the amendment in my name. Thank you, Ms Bailey. I now call Alex Cole-Hamilton up to six minutes, Mr Cole-Hamilton. Thank you very much indeed, Presiding Officer. In the seven years I've been an MSP, I've spoken on the subject of transvaginal mesh several times. As have many of the speakers in this afternoon's debate, I am gratified to be speaking in a debate in Government time. For far too long we had to debate this in opposition time and in members' debates. It's good that the SNP Government is now taking this with the seriousness that it requires. It's fair to say that there is an issue around which members of coalesce that there is an agreement, and I think that's right. We come together to support those women who have been harmed through no fault of their own. I've often shared in the speeches like this the story of my constituents, Cathy, whose account echoed that of hundreds and many of whom we've heard about today, who were referred to GPs and physiotherapists to receive mesh implants, or by physiotherapists to receive mesh implants. Cathy was given very little information other than being told that the procedure would alleviate the mild incontinence that she had. What followed was five years of crippling pain, gaslighting, as we have heard many others describe, and her mobility, her mental health and her intimacy with her partner all suffered as a result. Her quality of life was absolutely devastated. It was an important moment for this Parliament when, in January 2022, we passed the legislation to reimburse those victims of transversional mesh for the surgery that they would have to undergo to have it removed privately. However, as Jackson Carlaw rightly pointed out in his intervention to the cabinet secretary, care pathways are still uncertain for victims and often, more often than not, lead them to the very surgeons who harmed them in the first place, about whom they have no confidence at all. I also echo the points made by Jackie Baillie about the contract under which Dr Varaniacus is removing mesh in America. That desperately needs to be reviewed, and we need to make sure that they have wraparound holistic care in that removal. I'd also like to pay tribute to the many people who have campaigned to get us to this point, and Jackson Carlaw, whom Alex Neil and Neil Findlay all deserve recognition for their tireless efforts to get us here. I certainly will. I mean to disrespect the minister, but Mr Cole-Hamilton referred to the many debates in which he has participated. In nearly all of them, the cabinet secretary for health was present and actively engaged. Is he just a little bit surprised, like me, that the recently appointed cabinet secretary for health is not? Does that not reinforce in him a worry that there is a sense that we've moved on when, in fact, for many of the women we haven't? I'm grateful to Jackson Carlaw for that intervention, and I think that observation is correct. The debates that have preceded it on this subject will be watched far beyond this chamber by the many victims of mesh implantation in this country. They, too, will share his and my dismay that the front benches of the Scottish Government are not represented here today. Although nothing can take away from the trauma endured by far too many women, at least they did not have to bear the hefty financial cost of having those implants removed. It's the access to that surgery that's the problem. However, that legislation was not the panacea that many hoped it would be. The reimbursement scheme did not include the victims of other mesh implants, for instance, who have suffered complications from devices associated with things like hernia mesh. We've heard some very graphic descriptions of those cases. That is why I was one of the first to raise hernia mesh in this chamber, along with a number of other MSPs. We have all probably met constituents who are still missed out. One of my constituents was, in fact, left crippled by her hernia mesh. In January, we debated a petition to suspend the use of mesh altogether. I was mindful, then, of the concern that suspending the wider use of mesh could leave some people with no or very limited treatment options. There are, of course, some life-and-death cases where the use of mesh for some surgical implant is essential. What is utterly essential, though, is that every patient is given access to the full facts before going ahead with any kind of treatment of this nature. What many cases involving the use of transvaginal mesh had in common was the abject failure of those who provided the treatment to make those patients fully aware of the attendant risks that were involved in the use of these implants. Informed consent is one of the key principles of our health service, or it should be. It is right for every patient to be given the full information about what their treatment involves, what is being put inside their body, and what it has the potential to do to them. That is realistic medicine. That is treating people like grown-ups. That information must include those potential risks, as well as the benefits, and patients must always, always be offered a reasonable alternative treatment wherever that is possible. It is also important that we ensure that health boards are provided with all that they need to ensure the availability of non-mesh surgery and that any skills gaps in their workforce that impact the treatment of complex cases are addressed. Presiding Officer, I am very glad that the transvaginal mesh case record review conducted by Professor Alison Britton, which we have heard about already today, was finally published in June. What is worrying, however, is that in the introduction of the report Professor Britton makes clear that none of the 46 recommendations that she made in her previous 2018 report have so far been properly implemented by the Scottish Government, not a single one. I am grateful to the Government for the work that it has been done for using Government time in this debate, but I am sure that the minister will agree that that glacial lack of progress is unacceptable and I hope that she will address it in her closing remarks. The harrowing experiences of many of the survivors of mesh implants have seriously damaged their trust in the NHS. It is therefore vital that we now get this right and that all the recommendations are implemented as a matter of urgency. Thank you, Ms Cole-Hamilton. Just a reminder as we move into the open debate, we are very tight for time, so we will be sticking to the allotted time. I now call Rona Mackay to be followed by Sandra Cole-Hanne up to six minutes, Ms Mackay. Thank you, Presiding Officer. Like Alex Cole-Hamilton, this is one of many debates that I have taken part in on this tragic and complicated issue since being elected in 2016. I welcome the fact that we can have further debate in the chamber today on the recent report of the independent transvaginal mesh case record review. I believe that the misery and devastation caused to so many women, not just here in Scotland, but globally, will go down in history as one of the greatest medical injustices ever suffered by women. The severe and painful complications experienced by so many women who were implanted with mesh were exacerbated because they were let down by those that they should have been able to trust. By that, I mean the health boards, the medical establishment, a disgraceful flawed review and, frankly, politicians. Presiding Officer, cross-party consensus has existed since the horrendous problems with mesh implants came to light, which resulted in the ill-fated moratorium on implants in 2014. I commend Jackson Carlaw for his unwavering commitment to this. It is not constructive to revisit the distressing history of problems during this debate, but thanks must go to Professor Alison Britton who chaired the review and the 18 women who agreed to take part in what was to become a two-year process. The report reveals that only two of the 18 women taking part had undergone either full or partial mesh revision surgery, with a further four receiving it over the course of the next two years. That meant that the majority of those who participated in the case record review had not undergone any revision surgery, and the review group had to rethink their framework regarding how they would tackle the broader range of issues regarding the treatment and experiences of the healthcare of the majority of women who had experienced implants. Practically that entailed the review group requesting more than 40,000 pages of records. From the initial meeting with each participant, the subsequent request of case records to the completion of each report, the group spent some 45 to 50 hours on each participant's case and wrote 18 bespoke participant reports. It is not rocket science to see how labour and resource intensive this undertaking was, but the group concluded that it was worth it to get an in-depth study of the experiences of the volunteers. Where are we now? Crucially, the implantation of transvaginal mesh has been halted since 2018, and there are no plans to lift that halt. The review group supports the Scottish Government's continuing commitment to offering women a choice of surgeon if mesh removal is considered appropriate and to reimbursing women who had previously arranged to have mesh removed privately. Scotland is the first UK country to reimburse people for private treatment previously sought. The Scottish Government is determined to ensure that those with mesh complications get the treatment that they want and need, but I acknowledge the points that are made here today by Tess White and Jackie Baillie, and I will not defend anything that exacerbates the suffering of these women, and I would like all the problems that have been raised here today to be addressed urgently. The Government has introduced new training on mesh for general practitioners and has improved information for patients about the specialist service in Glasgow. As we have heard, it can also have the surgery in an English NHS centre or at one of the independent providers in Bristol or the United States. Women who previously used their own money can apply to have that money reimbursed by the end of March next year. The mesh service in Glasgow offers specialist assessment and care in the treatment of complications. It is hosted by NHS Greater Glasgow and Clyde informs part of the UK network of 10 specialist mesh centres, and it is recognised for its clinical expertise in this field. The report makes recommendations only some of which I have time to list here, and we have heard some of them. It recommends that bespoke data sharing agreement should be put in place prior to the commencement of a large case review. It advocates for Scotland having a mesh register, which records surgery in Scotland as well as surgery, which is occurred in other parts of the UK. Women should have access to information and additional support mechanisms should be put in place for GPs and practice teams to aid understanding and the concerns women raise with them. There should be clear and transparent communication with patients regarding the type of surgery that will undergo and a detailed set of medical notes and dialogue. What counselling advice was given and the risks and potential complications, all of those things have to be clear and transparent. There should be the creation of a national specific consent form for use across the country to improve consistency of information covered during the counselling process. I also recommend that information should be drawn together on a single website. That information around referral and treatment is clarified and published on the website. Training and credentialing of surgeons in Scotland is a critical element, and its process has to be clearly articulated not only for clinicians but for women using the service. Parents must be informed that they have the options when they turn up for appointments of having a trusted person with them, and they can record discussions that take place during the appointment. All of that will restore some trust. It is crucial that there is an agreed system of NHS follow-up and on-going support in place for parents who are returning from mesh revision surgery, which is taking place outside Scotland, and that that status is captured and curated. All of those recommendations are sensible and necessary, and I hope that those that have not been enacted are as soon as possible. Many people, including myself, regularly call the mesh survivors group brave and courageous for taking on this fight, which they are. I am sure that most days they do not feel brave or courageous as they struggle to cope with the basic things that most of us take for granted. The damage has been done for them, but they simply do not want a sister, a friend, anan or any other woman to go through what they had to endure. That, in my view, is dignified, unselfish and inspirational. I refer members from every register of interest as a practicing NHS GP. Over the past two decades, some 20,000 women in Scotland underwent transvaginal mesh implant surgery. They were advised to do so in order to treat conditions such as incontinence and prolapse, often as a result of trauma at childbirth. Tragically, some 600 women who underwent implant surgery have suffered painful and life-changing side effects. There have been complications from surgery because of erosion of the mesh inside the body, causing nerve damage, chronic pain and vaginal scarring. There have been cases of organ perforation with synthetic propylene mesh actually becoming exposed inside the vagina. In health committee, we have heard from women who had to endure harrowing experiences following mesh surgery, pain, infections, reduced mobility, difficulties with intimacy and psychological strain. Many of those women were simply not believed when they were crying out for help, nightmarish. Despite their pleas, those suffering women were forced to wait and wait before remedial intervention was offered. Having lost all confidence in our NHS, those with the means turned to the private sector, including travelling to the United States. They sought out specialists who did believe them and had the expertise to correct our health services mistakes. We have come a long way since 2014 when sufferers brought a petition to the Scottish Parliament calling for action. The implant procedure was halted in 2018. In July 21, the Scottish Government agreed to meet the costs of private treatment to remove transvaginal mesh, while in January 2022, Parliament passed a bill to reimburse women who had already paid for private healthcare. We now have specialist clinics in NHS Greater Glasgow and Clyde to support women experiencing complications from mesh implant surgery. There has been cross-party support since Parliament began trying to right the wrongs of failed transvaginal mesh implants and support those who are suffering. However, have we done enough? In her motion, the Minister, Jenny Minto, highlights a continuing improvement in support offered by NHS Scotland. That is well aligned with the recommendations of a major case review of records. The motion also notes the assurance that affected women are able to access the national mesh removal referral pathway and that the Scottish Government is committed to offering women a choice of surgeon. Are the processes in place today robust? Do women still find themselves at the mercy of an absurd, catheter-esque bureaucracy? There is still a long way to go to rectify the injustices of Scotland's implant mesh failures. Far less posits Scotland as an example for others to follow. Waiting times for mesh-injured women to access specialist surgical services are still unacceptably high. The referral pathway is still lengthy and complex, especially when patients seek care out width of the NHS. Complex mesh surgical services, which is hosted by NHS Greater Glasgow and Clyde. Despite agreements being in place with private providers, there are real concerns that bureaucratic gatekeepers at the Glasgow Bay Service may obstruct the signing off on patients' preferred plans to seek treatment out width of Scotland. Patients that return from abroad are left with no follow-up. There is a reason why some patients may want to look elsewhere. Professor Britton's review found that trust in the complex mesh surgical service was all but completely depleted. The review found evidence that women have been repeatedly misled, told that they had undergone full mesh removal, when, in fact, just small amounts of plastic had been surgically excised. With no groin incisions, full removal was impossible. Our health committee also found that many women face long waits on treatment on the NHS service, with one woman saying that she had waited nearly two years between appointments. There are more. GPs cannot refer patients directly to the complex mesh surgical service. Patients have to first see a local urogynecologist in their local health board before being referred on. This means another layer of bureaucracy, significantly more time waiting, significantly more time in unnecessary pain. This is unacceptable. We must make it easier for patients to get the help that they deserve. The SNP Government talks the talk, but having not implemented any of the 46 recommendations by Professor Britton and thinking about other changes, they do not walk the walk. A complete failure of implementation despite cross-party support Minister, you must do better and perhaps some contrition for these women who are suffering. As we have already heard today, complications related to the use of vaginal mesh have caused widespread and severe symptoms in thousands of women. These patients have been failed once. As it stands, the complex mesh surgical service or CMSS, a service designed to remedy the pain and the suffering of these patients, is continuing to fail some. In its scrutiny of the CMSS, the health, social care and sport committee took a variety of evidence. Some reported positive experience, which is to be welcomed. However, others reported barriers to accessing long-term holistic care and support that they feel they need and that they should be entitled to expect. Evidence that we heard demonstrates a lack of urgency. Without intervention, the service could exacerbate the trauma of some patients. I am pleased to hear that the minister acknowledged that and to have the opportunity to highlight some of the key issues that the committee heard here today. Uncertainty around referral pathways is rife, with variation between different NHS boards and confusion among medical professionals. If those working in the sector are not clear on how that works, what hope is there for patients? The minister has set out plans to remedy that, including a letter to GPs clarifying the referral pathway. I seek detail on how the Government will ensure that those measures are effective. Once referred, patients report living in limbo, treading water, whilst waiting for a mesh complications consultation that are pushed from pillar to post and endless conveyor belt of humiliating tests and red tape, with no-one really knowing what to do. During that uncertain time, patients have told us that it was difficult to contact the CMSS. Poor communication is an on-going theme, with limited information provided to patients. Waiting Well initiatives could help, and I eagerly await an update as well as detail on how the Government will ensure that information is accessible to patients from whom English is not their first language. On top of years of life-changing symptoms, those patients face difficult decisions, and a complicated procedure, described by participants in a study as taking fish bones out of chewing gum. Its clear emotional support is much needed. Demand for proposed peer support groups was limited, but is that surprising when peer support groups put onus on patients to support each other. That lack of uptake absolutely should not be taken for a lack of need for emotional support. That is very much needed by those women. The minister has acknowledged the struggles of patients facing doubt from medical professionals. Indeed, academic research has found that patients felt that the medical community denied that symptoms were caused by mesh. Some felt treated as if they were hysterical. Some report months, if not years, of trying to be heard. Studies from UCL show that healthcare staff routinely underestimate women's pain, and not everyone who will have a complication from surgical mesh has started having symptoms. That issue is on-going, and we have a chance here to learn from previous mistakes. Bias creates shame and taboo around women's health that makes it difficult for women to communicate their pain and the issues that they are having. When they finally find the words and the courage to talk about it, they have not been listened to. I seek assurance from the Government that they will tackle the bias present in the healthcare system so that we do not fail another wave of patients adversely affected by transvaginal mesh or any other healthcare issue. We must also grant attention to prevention. Many do not know about stress, urinary incontinence until they give birth. Open and frank conversations on the importance of pelvic floor strength are required, and I am pleased to see the Government accept the health committee's recommendation on the matter. On-going monitoring of the success of those initiatives and changes made accordingly will be vital. Reducing stigma is an important factor in prevention. Presiding Officer, I would like to thank those who shared evidence with us. There can be no doubt that we have failed those patients and that they quite rightly expect more. Presiding Officer, I want to start by paying tribute to the tireless campaigning of mesh injured women. It is their campaigning that has been the driving force for much of the progress that we have seen on transvaginal mesh. The independent reviews, the creation of the complex mesh surgical service and the reimbursement scheme are all testament to their efforts, which is one of the reasons why it is so disappointing that many of those women continue to experience so many problems in accessing the medical care that they need. Some have shared publicly their experience in dealing with GPs who still lack basic knowledge and understanding about the complications arising from transvaginal mesh implants. Others have spoken about the long referral times in order to access care and support at the mesh surgical service. Women who have been referred to the complex mesh surgical service have also described the lack of a full range of treatment and support options. Those women who have had mesh surgically removed have also spoken of the lack of aftercare support in relation to their mental health and the trauma that they have endured. According to Professor Britton, whose initial report into this issue was published back in 2018, the Scottish Government has yet to act on her recommendations, as has been said a number of times in this debate. In her second report earlier this year, Professor Britton has made a series of recommendations to improve the healthcare experience of mesh injured women. Those recommendations include improving support mechanisms for those women who wish to raise concerns with their GP following a transvaginal mesh surgery and the creation of a mesh register to keep track of surgeries carried out and also putting patient consent at the heart of healthcare. Labour is urging the minister to come forward with recommendations and to deliver, and we hope that she is able to give that commitment today. I know from my own office that I am still receiving new situations presented by mesh injured women who are getting in touch under suffering complications, who are currently not getting adequate support from their GP and who are unaware of the complex mesh surgical service. It is clear that the Scottish Government must do more to support those who are injured and that that is an issue that continues to have an impact on too many lives, even after a decade of campaigning by those affected. The minister will be aware of the work that I have been doing with my constituents, Rosanna Clarkin and Lauren McDougall, on the issue of surgical mesh used to treat hernairs. There has been discussion in this debate of informed consent and Rosanna has given me permission to say that she was told that it would be pig skin that would be used in her procedure, not the mesh that was used. Does mesh differ from transvaginal mesh? Many are now suffering from similar complications and life-altering injuries that were observed in women implanted with transvaginal mesh. Rosanna Clarkin and Lauren McDougall currently have a petition before Parliament that calls for an independent review into the use of this mesh and for its use by NHS Scotland to be suspended pending the outcome of that review. I am very grateful to the citizen participation and public petitions committee for their on-going work in relation to that petition. I know that many members of that committee were involved in the initial petitions around transvaginal mesh and recognised the parallels in the experiences of those who have been implanted with surgical mesh to treat hernairs. Despite years of campaigning, Rosanna and Lauren have found that the Scottish Government is either unwilling to engage or failing to take their concerns recently. It is the same disregard for lived experiences of mesh injured people, which delayed progress on addressing issues relating to transvaginal mesh. I fear that we are at risk of making the same mistake when it comes to surgical mesh used to treat hernairs. I therefore very much welcome that the minister has recently agreed to meet with my constituents and indeed myself in the coming weeks to discuss this issue, the need for an urgent independent review could now not be clearer and I hope that the minister will give that further serious consideration. I previously submitted freedom of information requests to every health board across Scotland in an attempt to establish the scale of the problem with surgical mesh used to treat hernairs. Many health boards either did not hold the information or did not respond, but those health boards that did provide information showed the scale of the problem, with 8 per cent of NHS Ayrshire and Arran patients implanted with surgical mesh to treat hernairs, saying that it had complications and 10 per cent in Lanarkshire. I look forward to hearing the minister's response to the points that I have made. I want to speak in today's debate, because, as I have previously mentioned in this chamber, I met with several of my constituents who have suffered with the horrors of transvaginal mesh. I have also spoken with and supported women who have travelled outside of Scotland to have the removal procedure carried out. I think that this unfortunate highlight is the extent to which the relationship has broken down between some patients and also NHS Scotland when it comes to the issue of transvaginal mesh. The thought of travelling to the US to have surgery whilst in excruciating pain clearly will not be pleasant, yet some of our constituents have felt that they had no choice but to do that. That is why I note the Scottish Government's motion, which states, and I will quote this part, that acknowledges the severe and painful complications endured by women after the implantation of transvaginal mesh and regrets that the trauma may have been exacerbated by initial service responses that doubted their lived experiences. Some of the most harrowing conversations that I have had as an MSP over the last 16 and a half years have been with constituents who have suffered because of transvaginal mesh. How any of those women could have been doubted is certainly beyond me. I am sure that some will welcome that the Scottish Government is accepting that more could and should have been done to support women's suffering from those terrible complications. I also welcome the Scottish Government's commitment to offer women a surgeon of their choice if mesh removal is considered appropriate and that women who have paid privately to have mesh removal surgery have until 31 March 2024 to apply for reimbursement. It has been commented already regarding the length of time that it takes to go through the paper process to get the money back. It is not really an easy process, but the fact that that process is there is helping some women. Scotland is also the first country in the UK to reimburse women for a private treatment that previously sought, which I genuinely believe is very much the right thing to do. The hindsight is always a great thing, and that said that we should always strive to ensure that we don't need to say in hindsight. Too many lives have been impacted, too many women suffering at the hands of transvaginal mesh and too many families and friends who have had to watch them suffer over the years. It was back in November 2019 that the former First Minister and health secretary met the women who had experienced complications after having had surgery for mesh implants. Following those meetings, the then First Minister confirmed that those women would be given an opportunity to raise their concerns and offer them a review of their case records. It then took until 12 February 2021 for the transvaginal mesh case review, so it had a case record review to be introduced, which was reported in June this year. I accept, as I am sure others will, that the Covid pandemic had a part to play in the length of time that it took for that to actually happen, but it should have happened sooner. However, women across Scotland have continued to suffer, while others who may have had the removal surgery before now have been waiting for answers. I hope that the recommendations published earlier this year will go some way to answering some of those questions. The fact that the Scottish Parliament is again debating the subject demonstrates that this Parliament is listening, and we want to ensure that women get the treatment that they need to recover. Daniel Johnson is right that this is not about hindsight, but the reality is that acknowledging recommendations is not enough. The reality is that, for too many women, they are still in the dark, they still do not know what is happening and they are still in suffering. That is not in the past yet. We need action now, not just acknowledgement of action points in the report, which seems to be all that we are getting. Does he not recognise that point? I do not disagree at all. At times I have spoken in debates like this in the past in the chamber, and my comments are on the record. If the member wants to go and have a look at them, he certainly can, because this is still very much a today issue. It is not something purely about the past. I have met women who have recovered. I know that the removal surgery can actually help to give women their lives back. In the contrast that I saw with some of those women, it has been absolutely stark. The pain, the suffering that they had before they had the operation in contrast to what they have managed to give, to what their lives are like now, was certainly stark. I welcome that, but it does not take away the mental challenges that they have had to endure for many, many years. I would normally take them into intervention, but I am running out of time. We should not lose sight of the fact that the work that has been done here is certainly welcome, but there is still that challenge for NHS. In conclusion, more work is very much required, but I welcome the minister's comments on the 21 recommendations. We cannot change the past, but we have an opportunity to write some wrongs and implement changes that will have a lasting positive impact. We are sitting consistently in this Parliament. We have heard that MSPs should listen to the clinicians as they are the experts. This is the case in many disciplines and in many, many health debates, but we have heard that over the years. In the case of the women suffering from transvaginal mesh issues, I am glad that those women did not listen to the clinicians, because they fought the system. I want to thank them for all the work that they have done, because they have pushed that particular issue to the fore consistently. We all owe them a huge debt of gratitude. I, too, would like to pay tribute to the incredible efforts of the mesh survivors to bring this issue to light and secure justice. Their bravery and determination is an inspiration to us all. I also want to mention the efforts of those MSPs who have raised this before us, including the mesh cutiers, Jackson Carlaw, Neil Findlay and Alex Neil. I know that all three have been champions of this issue for a long time. The final report of the transvaginal mesh case record review carefully sets out what a long journey it has been for mesh survivors and how far we still have to go to restore justice fully. I want to focus on a few of its findings and how they relate to transparency and the rebuilding of trust. One such finding is that, in a number of cases, there was a lack of clarity in the case records and that some notes were misleading, while others did not bear any reflection to the surgery that had occurred nor its outcomes. The report notes that, in some cases, misleading or missing information from case records led to a breakdown of trust between a patient and their clinician, as women felt that they could not trust what was in their records. That fed into many wider areas within the NHS. One quote from the report stands out. I have lost a loss of trust in the NHS and that does not just apply to mesh, it applies to everything. The health service is meant to care for us, keep us safe and well. I cannot imagine the betrayal that some of those women must have felt. Rebuilding that trust will necessarily be a long process and the report makes a number of recommendations around that, such as organisations providing an explanation to the patient why certain information has been redacted and keeping a detailed set of medical notes of the dialogue between clinician and patient. I would appreciate if the minister could set out any work that is being done to provide that to patients. Another important point made in the report is that we need to continue to listen to the women affected by mesh. It states that, and I quote, having to exclude the lived experiences of the women from the practicalities of what could be evidence in the case records, has made the panel realise that the mechanics of a case record review cannot address the more nuanced parts of a lived experience. Something more inclusive is required. It is essential that we continue to listen to and record people's lived experiences to gain a comprehensive understanding of the impact of transvaginal mesh. The case record review provides us with valuable evidence about what went wrong and where improvements can be made, but it cannot capture the pain, anguish and frustration that many mesh survivors have felt. We need to support them to tell their stories not only so that we can learn from them, but because they deserve to be heard. Many of the personal testimonies included in the report were heartbreaking to read, with women describing feelings of awkwardness, shame and embarrassment, as well as a loss of autonomy and self-worth. Many also cited social isolation as a result of mesh complications that will inevitably have been worsened by the Covid-19 pandemic. Some find themselves having to plan going out around when and how they can access a toilet or having to explain to friends and family members being unable to sit for long periods of time. The review also spoke to women who are now being advised by clinicians that there is nothing more that can be done for them surgically, which may result in additional trauma. The report illustrates the importance of providing mesh survivors with wraparound support that addresses their emotional as well as their physical needs. I have previously spoken about the need for on-going mental health support for mesh survivors in committee and in this chamber. Mesh survivors need targeted specific counselling that takes account of the trauma that they have experienced. We also need to ensure that people are properly supported to engage with information gathering. The review heard from women who describe their fatigue at continually having to tell their stories. I quote, wherever you turn, you just don't feel heard. You really don't. It's like, here's another survey or here's another whatever. You know the wee bit of energy you've got, you're trying to fight for help. People need to know that action is being taken as a result of them sharing their story. The worst thing we could do is cause people to disengage with the process. It's been such a long road for them and they've had to fight every step of the way. The report identifies several steps in the patient journey where improvements can be made. One example is the referral process. The characterised the operation of the referral system is confusing and in need of further explanation so that it is clear where the responsibility for patient care may lie at any given point and what might be expected from their care journey. I'd like to end by once again paying tribute to mesh survivors. As the motion states, there is continuing improvement in support and this is being informed by the views of affected women and we are taking significant steps towards writing a terrible wrong. The report highlights the importance of centering lived experience as we continue along this journey. Like many, if not all, in the chamber, I've heard from constituents over the years whose lives were devastated as a result of mesh implants. As we know, mesh has been implanted in patients to support weakened or damaged tissue and has been used to treat conditions some women suffer after childbirth, such as incontinence and prolapse. Over 20 years, more than 100,000 women across the UK, including more than 20,000 in Scotland, had transvaginal mesh implants. However, its use was halted in Scotland in 2018 after hundreds of women were left with painful life-changing side effects. The physical symptoms and trauma that some women have endured is unimaginable and unacceptable and that was often made worse as they felt that their experiences were not taken seriously when they sought help. I have constituents who travelled to the USA and paid privately to be treated as they had understandably lost trust in those who would treat them here in Scotland. One of my constituents had sought help from Dr Varaniacus in the period between the Scottish Government procuring an NHS referral route to private removal surgery and the Transvaginal Mesh Removal Cost Reimbursement Scotland Act coming into force. Initially, she would have missed out on being reimbursed due to a cut-off date for reimbursement. I am sincerely grateful to the then health secretary and current First Minister for accepting an amendment at stage 2 of that bill to adjust the date to ensure that my constituent and many other women affected would benefit from that support. Quite rightly, the Scottish Government listened to the women impacted and ensured that no one was penalised for using their own funds to seek mesh removal surgery privately. People turn to our NHS at times of need and expect our health service to do what it can to alleviate their health problems. Sadly, for too many women, their medical procedures only exacerbated the pain and suffering that they felt. The complications of transvaginal mesh surgery can have long-lasting effects even after the mesh has been fully or partially removed, all of which contributed to a breakdown in trust for many. I know that the Scottish Government is working hard, as is our health service, to rebuild that trust. The Scottish Government has taken decisive action on mesh, and it has taken many steps already that address a number of Professor Britain's findings in the Transvaginal Mesh case record review. Scotland is also the first country in the UK to reimburse people for private treatment previously sought. And rightly, the Scottish Government has agreed with the principle that women should be supported and empowered to make decisions about their own treatment. A range of other measures are being undertaken to improve the services for people with complications arising from a result of mesh surgery. Whether that is through the reimbursement of costs that I have previously mentioned, the procurement of private providers in Bristol and Missouri, or the specialist service here in Scotland. It is on that last service that I want to speak about, particularly through the lens of the work of the Health, Social Care and Sport Committee. Members will be aware that the committee has been taking evidence on the complex mesh surgical service throughout this year, which is on top of the previous scrutiny of the Transvaginal Mesh Removal Cost Reimbursement Scotland Act 2020, which took place before I became committee convener. The committee's primary purpose in carrying out its scrutiny of the CMSS has been to highlight the issues raised through the consultation process to those responsible for delivering the service and to explore what is being done and what further can be done in the future to improve the service so that it properly meets the needs of its patients. As convener, I have written to the Minister for Public Health and Women's Health on a number of occasions recently when the committee shared a number of its concerns that have been raised with us in evidence. Those include concerns with the referral pathways, which have been mentioned by some other contributors this afternoon, waiting times to see the CMSS, perceived inconsistent information being provided and, among other things, the need for an integrated system that provides holistic support to women. In the minister's most recent response, she acknowledged that there is scope for further improvement in the service. I know that the Scottish Government wants to ensure that the satisfaction levels of women attending the NHS specialist service in Glasgow continue to grow and that waiting times fall. I also note that the minister's comments on the progress being made regarding a training pathway for mesh removal credentials, as well as the recruitment for a specialist consultant to work with the core Urogyn Ecology team at the Queen Elizabeth university hospital campus. Additionally, I welcome the action by the chief medical officer who has written to all GPs to raise awareness of the referral pathway and to encourage GPs to access a mesh learning package that has been made available on NHS Scotland's online learning service. Those actions will continue to improve the support on offer to the women impacted. I also know that the whole of the chamber is united in our determination that everything is done to help those whose lives have been impacted by mesh complications, whether women opt in or out of surgery. It is only from the courage of the women affected that has brought us to this point that, of course, it should not have taken their retailing of their experiences to have them being listened to. As the First Minister has previously recognised, those women were badly let down by the initial service responses that doubted their lived experiences. We owe it to all those women and their families affected to continue listening to their concerns and to act upon them. I have raised questions about vaginal mesh in this chamber before. I have written articles in support of the women affected and welcome the chance to speak in this debate this afternoon. Like many of my fellow MSPs across the chamber, I have constituents that have come to me regarding their post-operative experience of transvaginal mesh surgery and of the circus of on-going referral that continues to this day as they seek help. I know that there are countless women who have had this procedure and have benefited greatly from it. Their pelvic organ prolapse is cured or their stress urinary incontinence reversed. However, we cannot ignore those women's voices that have experienced life-changing complications from this procedure and continue to struggle as a result. When I look at the motion presented to us today from the Scottish Government, I did feel a sense of disappointment. Perhaps even a shared sense of bewilderment with the women, the motion does not appear to recognise that many are still unable to access treatment that they are so desperate for. Whether that treatment being Glasgow, Missouri or Bristol, many women no longer trust the services provided by NHS Greater Glasgow and Clyde, albeit at the new ACH hospital in South Glasgow. In fact, at Health Committee in April, 75 women came to share their experiences on the complex mesh surgical service. Women with long-term negative experiences felt those views rightly or wrongly coloured their views of the current west of Scotland services. In fact, things were so bad that it was said that trust in many medical professionals that they had encountered was all but completely depleted. A constituent of mine told me that she was in constant pain since her operation 17 years ago. The plan that the Scottish Government unveiled in July 2020 gave her hope, but she is living proof that the promise has not been fully honoured. She said, I find it impossible to trust the NHS to care for me with mesh issues. A life with mesh is painful, humiliating and soul destroying and has already destroyed so much of our lives. The Scottish Government motion today makes no reference to this on-going pain and that is of deep concern to me. We hear time and time again that the Scottish Government is listening to the views of women, but I am afraid that actions taken do not appear to reflect this. The women deserve to get free specialist treatment after many of them were rebuffed by their health authority. Our Conservative Party motion today reflects the unnecessarily complex referral pathway that women must endure and the lengthy waits as they ping between services. Evelyn Tweed earlier today commented on how the women were pinged or not pinged, moved from pillar to post. As of April 2023, the median wait for referral to the complex mesh surgical service in Glasgow was 236 days and the longest wait was 448 days. Women then need to wait a significant length of time to start treatment that may or might alleviate or even remove their symptoms. However, that does not include the time that it takes to get appointment with their local health board first. It also acknowledges that today there is no clear pathway to be referred to an independent external service, whether that be in England or Missouri, should the women not want to go to Glasgow. In 2019, First Minister Nicola Sturgeon promised that she was absolutely committed to and determined that we will do everything possible to get these women the treatment and the care that they need. However, when he was Cabinet Secretary for Health, Humza Yousaf agreed to the principle that the treatment that these women desperately need can only be accessed after approval from the same authorities that have been obstructive in the first place. I do not believe, nor do the women who have contacted me over the years, that enough has been done by the Scottish Government to engage with the mesh survivors or help with their heart-breaking plight. The victims must receive the treatment to which Mr Yousaf now says that they are entitled to receive for free. Unfortunately, I am not certain that the commercial terms for these referrals, such as external referrals, have been arranged on a long-term basis. The Scottish Conservatives supported the transvaginal mesh removable, and we have been supportive since the issue was raised at the Scottish Parliament by the public petition. However, the SNP Government must do more to ensure that women affected by mesh can access the services that they need. Daniel Johnson, to be followed by David Torrance, up to six minutes. Thank you very much, Deputy Presiding Officer. In previous debates when we have discussed transvaginal mesh, I have started by paying tribute to fellow MSPs of campaign on this issue. Do you know what, Sutton? I do not think that I can do that, because it has been nine years since that petition first became before the Petitions Committee. Nine years of debates in this Parliament, nine years of people expressing concern, expressing bewildrennment about the pain that women have had to endure, and nine years of failure to act. I do not think that I can pay tribute. In fact, all I can do is apologise to those brave women who have campaigned so hard, because, frankly, right now, standing here today, I just wonder how much progress we have really made, because we have heard today from the Government an acknowledgement about what women have had to do. We have outlined initiatives that might take place, funds that might be available if you qualified and you applied in time, that there might be training in place, that might be a register, but the reality of the fact is that the most recent report said that not one of the 46 recommendations of the 2017 report has been implemented, not one. The simple reality for too many women, notwithstanding those facts and whether or not those reports have been adhered to, is that these simple questions are not being answered. There are simple questions that they rightly have about what is happening to them. When is it going to get better for them? When will they receive treatment? How can they get information? The reality is, speaker after speaker this afternoon is basically saying, we do not have answers for them, or if there are answers, they are incredibly difficult to get, and that is why it is not good enough. So we can talk about policy, we can talk about reports, but the simple reality is that this is an issue that we have been discussing for nine years, but it is an issue built on individual women's pain and suffering over many, many years. That is how I have come to this issue through one of my constituents, Samantha Hindall, a woman who has endured 18 years of pain, somebody who I have written time and time again to the Government and to the health board to try to get her some updates and information about what is happening. After those 18 years, let me outline what happened. She first approached me in 2019 after she had exhausted every other avenue, and so I wrote and wrote, and finally we got a referral in July 2022. That would I would note as a month after the fund closed for people accessing reimbursement if they had already received private treatment. We then followed up about when an appointment might be received. I wrote in December twice, and we finally got a letter back from the health board in February saying that my constituent had received her treatment, and on January 23 she had apparently had the mesh successfully removed, except that was news to my constituent. No such appointment had taken place, no such procedure had been embarked upon. What is more and what makes this worse is what she then did get was an appointment to an ultrasound appointment, which was apparently in order to locate the mesh and see where they were removed. When she showed up for that appointment, the ultrasound wasn't to identify where the mesh was, it was to investigate her, or a varian cyst, a varian cyst which she didn't know was suspected, and guess what, were never found. If this is a person who is presenting with mesh through her MSP, when the MSP has written time and time again to the Government and the health board, and the health board can't even get these basic facts right, what progress are we making? After that saga, I wrote to the First Minister just saying, look, putting aside the policy, putting aside the commitment, surely on a human level, this isn't right, just really appealing for an acknowledgement on that basic human level, that leaving people in the dark, leaving people with those as answers just isn't right. Unfortunately, and this is no reflection on the Minister, it got handed to the Minister that the First Minister didn't even reply to himself, and what did we get? We got a list of those self-same initiatives, that apparently a letter had been written, so the Greater Glasgow and Clyde would make contact, that work was undertaking, that training would be in place, that there was a fund that was now closed, but she couldn't apply for it, but above all else there would be this prospect of quote unquote waiting well. I have to say that phrase waiting well is a little bit hollow to my constituents, Amanda Hindo, because the reality is, after nine years, she still doesn't know when she's going to get her appointment, she still doesn't know when it's going to be a case, she still doesn't know what treatment she can get, and until we can have that answer for her and the hundreds of women like her, we will still continue to fail women who have been implanted with mesh. Thank you, Mr Johnson, and I call the final speaker in the open debate, David Torrance, up to six minutes, Mr Torrance. I welcome opportunities speaking this important debate, and as always, we'd like to extend my gratitude to campaigners, medical professionals, researchers and constituents when valuable efforts continue to put this important issue of transvaginal mesh implants on the agenda. Transvaginal mesh implants, once deemed a medical solution, have now become a source of debilitating complications for many across Scotland. As we will be aware from numerous occasions issues have been debated in this chamber, where complications arising from implants are not merely physical, but extend to psychological distress as well. We have made a significant process in recent years, which we can comfortably attribute to joint efforts of campaigners and individuals who have been massively affected by this issue, and I am absolutely certain that future generations will benefit from better healthcare, thanks to our incredible work. I acknowledge the work of the Scottish Government that I have taken to mitigate the suffering and the effect that patients and many of our constituents have suffered at the hands of life-changing complications related to mesh implants. I support the Scottish Government's decision to establish a fund that will support ways with mesh complications and provide assemblies of relief to patients and families. I am proud that Scotland is the first UK country to reimburse people for private treatment that was previously sought. This is a reflection of our commitment to providing holistic care and financial support to those in need. Despite these achievements, there is more to be done. That brings me to a main focus of today's motion, a transvaginal mesh case record review. The review has been a massive and impressive undertaking by Professor Alison Britton of Glasgow Caledonian University, and I commend the 18 women who came forward to have their case records reviewed as part of this. It is a significant initiative commissioned by the Scottish Government to address the profound concerns raised by women. Their experiences will be integral in informing the future of mesh procedures, and we must take this important opportunity to learn from their experiences. As a member of the Health and Social Care and Support Committee and the Public Participation and Public Petitions Committee, I have had the privilege of hearing invaluable evidence from medical advisers, NHS experts, campaign groups and, most important, patients. The recommendations made in Professor Britton's review are very much consistent with the evidence that the committee has taken over the years, and the committee's evidence sessions have helped us to ensure that patient voices are heard, amplified and carefully considered. I would like to thank each and every one of the witnesses for the influential contributions. The discourse surrounding transvaginal mesh has brought to the importance of ensuring that medical interventions are not only safe and affected but also transparently documented and communicated to patients. unanimous backing of a patient safety commissioners bill early this year also exemplifies Scotland's commitment to amplify the voice of patients, including those that are impacted by mesh and plant complications, and will drive safety improvements across our health service. The insight from the review are testament to a collective endeavour of addressing the concerns of affected individuals and proving the standards of patient care. Jackie Baillie Very grateful to the member for taking an intervention. We have debated before the Cumballage report. The Cumballage report proposed a redress scheme. Can he shed any light on why that has not happened and would he support it being implemented quickly? I think that Jackie Baillie knows my views on that and I would be very supportive of it because he knows how many times I have debated this in the chamber. I think that Jackson Carlaw and myself are the two original members of my public petitions committee, so it shows how many times I have taken part in debates here. Although we as a country have made progress in this area, we must continue to scrutinise a complex mesh service and many issues surrounding the procedure. For example, our healthcare system must be equipped with the necessary resources and trained personnel to provide both physical and psychological support to effective patients. This establishment of specialised clinics for post-mesh surgery, care, psychological counselling and community support groups are vital to steps towards addressing most of the assisted needs of those affected. Furthermore, robust monitoring and regulation of medical devices alongside comprehensive informed consent process are imperative to prevent any future complications. I am confident that the Scottish Government will continue to work closely with stakeholders and expects to ensure that patients can access the care that they need and are fully supported by their GPs and clinicians. Scotland can also learn from our international partners in Australia and New Zealand, where groundbreaking research found that there is a significant lack of available data regarding the exact numbers of women who received transvaginal mesh implants and how many also experienced complications. In 2017, Western Australia established a confidential free-tel phone line, as well as a mesh register to aid with data capture, which has been found to be informative. Professor Britton's review recognises that its lack of reliable data is also an issue in Scotland and that it very much supports the review's recommendations to address this matter. Scotland can also learn from New Zealand's restorative justice approach of mesh implants, which is centred on the patient involvement and focused on enabling women to share their experience in a safe environment. It is reassuring to know that the Scottish Government has already taken a number of steps to address the recommendations in Professor Britton's report. That includes making a mesh learning package available to GPs to offer additional support to help to understand and address concerns that women may raise with informing mesh surgery. The Scottish Government is also taking steps to improve the information available to patients through online information and patient information leaflets. It is crucial that women have the information they need and make informed decisions about their care. Safety lies at the heart of delivering their health services and it is essential for the Scottish Government to act on the recommendations and to continue to be clear and strong voice for the patients. In conclusion, the Transfigurational Mental Case Records review is a matter of effect in both our achievements and the areas that necessitate improvement in the healthcare domain. As we will move forward, let us take the insights garnered from this review to heart, working collaboratively to foster a healthcare environment that is safe, transparent, supportive and every individual's healthcare journey. I am looking forward to achieving even more progress under the guidance of Professor Britton's review. Thank you, Deputy Presiding Officer. I think that my colleague for Edinburgh Southern hit the nail in the head nine years. The best part of a decade that we have condemned our fellow Scots to suffering in chronic pain in this way should be a mark of shame on our country. I acknowledge the apologies that have come from benches across this chamber today, but it is simply not good enough that the Government has failed to respond in the way it has, and indeed the latest insult, frankly, being the letter to the Health and Social Care Committee from the Minister. I am afraid that it simply is not good enough in failing to acknowledge the severity of the trauma faced by these women. Listening to my own constituents and those of many others through the Petitions Committee over the past couple of years has been harrowing in many cases, and to simply be talked down to in the form of being given advice about waiting well to being informed that there will be a leaflet published in due course is simply not acknowledging the sheer agony, not just physically but psychologically, the torment that has been endured over these years. This Parliament has been a champion for those voices in many different ways, but it simply has not moved quickly enough in pushing this Government to put in place the measures necessary to address the scale of the challenge faced by people in this country. The Minister acknowledged in her letter to the committee that there have been 135 women treated so far. There are 800 women, over 800 women, alone in the Scottish mass survivors group, yet there has been no engagement formally by the national health service with that group. However, it seems that it is sufficient that, by being a member of that group, you are noted in your patient records as being a member of that group, so surely it must be significant. What are we doing to engage formally with them, to understand what can be done to improve the pathways to treatment? It is not simply good enough to say that the health board is doing a consultation. We need to understand that the answers are obvious already, that the pathways are not simply sufficient to tick a box when they meet the nice guidelines. They need to be much more robust, much more customer-focused, patient-focused, and they need to be addressing the reality of the complexities faced by women, who are maybe just deeply distrustful of the medical establishment that has gaslighted them for so long, of surgeons who have continued to stand by the treatments and stand by the mesh. They simply do not accept that what has happened is something to be overly concerned about. That is simply the reality faced by women in Scotland today, and the whole system has failed them. Medical fashion has trumped their rights, and that is a devastating realisation. It is devastating that it has taken so long. Yes, I have to give way on that point. I wonder if the member would agree with me that what we are seeing is a failure of implementation and what the women want and need and deserve is a very simple process to get the help that they deserve. I cannot agree more with the member on making that point. He is absolutely correct. The establishment of the service in Glasgow is to be commended, but it is agonisingly frustrating that it is not achieving the outcomes at pace that we are still waiting for. I acknowledge that it happened and it was established during the pandemic, but we are now moving three years on from its establishment and we are not seeing the pace of change necessary. I say that 800 women alone in the survivors group, there is probably another 800 alone out there who have not got that access on that membership. The scale of this is huge and the treatment rate is not sufficient. The follow-up rate is not sufficient. We already know that some further complexities have arisen from surgery to repair mesh implants and they have not been followed up sufficiently. There is on-going psychological trauma that is not being necessarily addressed. I am afraid that we still have the issue that was acknowledged in the letter about the specialist consultant at the mesh service, still to be recruited. It is not good enough that it is co-located on the Queen Elizabeth University hospital campus. We need that dedicated consultant in post. We need to have a dedicated helpline for people, not just simply a leaflet published. We need to have clearer pathways. We know that the dissemination of advice to GPs is patchy at best. We know that many GPs are simply so burnt out, so hard-pressed that they do not have time to do the continuous professional development courses to necessarily entrain them in the latest advice, the latest options available. They are simply overwhelmed. We get that feedback loud and clear from GPs across our constituencies almost on a weekly basis. I encourage the minister to take those powerful comments that have been made by number of members across the chamber today on the chin and to note them with the modesty that is necessary to show real contrition for the failure of this Government to serve the needs of our fellow Scots. In her closing remarks, I refer clearly to what she will do about that to address those comments. I also encourage her to particularly take note of the transvaginal mesh case record review. There are 46 recommendations in that 2017 report. The minister should outline a grid of each of those recommendations and form as clearly as parliamentarians and their constituents what the Government is doing to meet each of those 46 recommendations. There are further series of recommendations in the 2023 report that was published in June, highlighting further additional support mechanisms that have been put in place for GPs and practice teams to aid understanding and address concerns that women may raise with them following a transvaginal mesh surgery. What has been done to ensure that that is happening, not just simply passively putting out letters, is that we have a mesh register. The minister says that it is too onerous for health boards to do that. I say that that is nonsense. The pain felt by those women has been too onerous. It is time that the Government stood up and recognised that. There needs to be a clear understanding of the language being communicated to people here. The biggest problem with communication throughout all of this is the illusion that it has happened. You need to conclude, Mr Swinney. I urge the minister to redress the huge inadequacy that the Government has delivered on this critical issue in Scotland today. Thank you, Mr Swinney. I now call on Jackson Carlaw for up to seven minutes. Thank you, Presiding Officer. Can I first of all thank all of those who have contributed to the debate this afternoon? There have been some season ticket holders, I think, to our discussions on this issue over many years. I am very grateful to them for having stuck with it, whether it was Jackie Baillie, Rona Mackay and Katie Clark. Gillian Mackay, who I thought engaged with quite a bit of what the report actually had to say, David Torrance, who was there right back in the initial days when this was all discussed, Claire Hawke's Sue, ever. Daniel Johnson said that we had made no progress, which I thought was slightly ungenerous. I mean, I do not blame the Scottish Government for the mesh crisis. It happened in Australia, it happened in America, it happened in New Zealand, it happened in England and it happened all across the world. The question is how did we respond to it and whether we have matched our expectation and the promise that I think we gave to the women in the response that we have managed to offer to date. It is there where I think some of the shortcomings are, but let us acknowledge that it was this Government, Jean Freeman, then Humza Yousaf, that passed legislation, which saw the first scheme to reimburse women who had incurred costs by going internationally to have mesh removed and who were able to go internationally to have mesh removed. It has seemed to me—I do not intend to repeat all the speeches that I have made before, but it seems to me at times that we have made two steps forward but one step back. I hope that none of the people in the chamber who have been on this journey—and I urge the Government—not to become defensive and to feel that what they now have to do is defend the medical establishment. If Mr Johnson will let me make a little bit more progress, because where we are at today—some may remember—I asked the First Minister just before the summer recess whether he would agree to a debate on the Government's response to the findings. If he would comment on Professor Britton's assertion that the 46 recommendations in her 2018 report had not been implemented, what the First Minister said to me in her written reply was that the recommendations have already been reflected in a number of inquiries and reviews established in recent years since the report was established. What does that mean? Paul Sweeney, who wrote at the end, said, could there not be a grid with the 46 recommendations that were made and something that we can interrogate transparently as to what happened to the 46 recommendations, because they have now been followed up with 21 more in Professor Britton's latest report. One of them is remarkable that the chief medical officer's response, which I think the minister has included in her motion, health board mesh accountable officers, has discussed Professor Britton's findings and have reported to Scottish Government officials that there are measures in place within the complex mesh surgical service in Glasgow and more widely in health boards to prevent a recurrence of the failings identified in the review, and I am grateful to have received those assurances. Will it be interesting to know what the assurances are? What are the procedures that are going to be implemented across health boards that are going to ensure that this does not happen again? I have never been a Government minister. Now, people will say thank God for that. I am never going to be a Government minister, but it does seem to me that part of the problem that we have had in relation to this whole mesh crisis is that we love and value our national health service, and we are reluctant to interrogate it when things go wrong. And it does seem to me that there has been three parts to this. Government ministers who have been advised by civil servants, who have been advised by the clinicians, only very lately did the patients have any look into any of this because they were told that they were talking nonsense, that they were psychologically disturbed, that they weren't suffering any pain whatsoever, and worse than that, that they'd actually had their mesh removed when centimetres of mesh was still within them. I fear that ministers all along, that clinicians who were responsible for all of this, who now are the clinicians who we've put in charge of remedying it, the very same people who put the mesh into the women, are now the people in the centre who are responsible for reassuring them that they can now take it out. In a different context, it would be like asking women to go and see Professor Eljamel to have the mistakes that were made with their brain surgery rectified by him, because that's how the women feel they've lost all confidence, so they wanted to go and see Dr Veronica's, a number of them have, thanks to the legislation, but they've come back and found that the NHS has disowned them and that there is no post-operative treatment or follow-up of any of the surgery that they had while they were in the United States, and that's just not good enough. Stuart McMillan, I think, at one point said he'd spoken to many of the women, they've got their lives back. Some have, but what do you mean by got their lives back? For some of them, it's just the knowledge that the mesh has been removed from their system. But for others, I'm sorry, they lost their homes, they lost their husbands, they lost their families, they lost their jobs, they lost their lives. They are going to need for the rest of their life, even if they don't have the mesh within them, on going care. That is why, in the Cumberlage report, there is a redress scheme that Jackie Baillie and others have referred to. The question is, why aren't we embracing a redress scheme to ensure that those women can have confidence in their future as we go forward from here? We've an awful lot yet to do, and I'm not going to extend, but I'm going to cut myself short for once, but do you remember that ghastly moment when George Bush sat on an aircraft carrier underneath a big banner that said, mission accomplished? There's just a whiff, just a whiff of that, from the whole NHS, from civil servants and encouraging ministers to think we've moved on. I said earlier that I was disappointed that the health secretary wasn't here. It's as if this has slipped down the agenda somewhat, and it's just not going to have the same urgency and attention as we go forward. Here's what one said to me. Jackson, please do everything in your power to ensure that knowledge and information gathered over two years by Professor Britton in particular does not go to waste. Personally participating in this review was the best thing I've done. It was difficult reliving things, but I was vindicated and believed, but don't let go, don't give up. I can only say to her and to all the other women of the time that's left to me in this Parliament that I won't let go and I hope the minister, who everybody acknowledges is really sincere and doing her best, understands that they simply do not think that we have gone far enough yet in getting to the point where women in the future can have confidence that there is a health service working for them. I'm very grateful to all the members who have taken part in this afternoon's debate. I will try to address as many of the points that they raised, but if I miss some out then I commit to doing it in writing. I think what's been incredibly powerful about this afternoon is that members across the chamber have reflected in their contributions the pain and continuing trauma of women who have been affected so severely by mesh complications. Yes, very powerful comments, Paul Sweeney. I agree. Jackson Carlaw, I'm very aware in the readings that I've done preparing for this debate that it isn't just Scotland that this has impacted to. I recognise that we have got further to go. However, just commenting on what Stuart McMillan and Daniel Johnson said, it is still a today issue and that's why we have created the CMSS in Glasgow as a national service. We're giving women the choice of surgeon. We're improving aftercare and information. I'm not saying that we have done everything that we can do, but we recognise that women have been traumatised and lost trust and we are working as hard as we can. I'm sorry, I'm not the cabinet secretary. I'm the minister for public health and women's health, so it takes two boxes for me. That's how important it is in my roles and responsibilities and it's something that is high on my list. I have also met women in my constituency. Daniel Johnson. I'm very grateful to the minister for giving way. Just for clarity sake, perhaps I overemphasise that the progress they're of, but I think just reflecting on what the minister just said, while we have that centre in Glasgow, do we not need to, most importantly, make sure that women who have been referred have clarity and information about where they sit in terms of that treatment process, starting from the point of initial referral and if there's a secondary referral where they're at status is and when they might likely be treated because I think that lack of information, that lack of clarity is one of the biggest fundamental barriers still faced by women that are facing this daily hardship and pain caused by mention. I thank Daniel Johnson for that further comment. I recognise what you've just said. It's something that I am taking a note of. I have my officials at the back of the chamber. They will also have taken a note of this, and I know that the service will be watching this debate as well. Decision making between clinicians and patients should be about shared understanding of benefits, risks and alternatives. That ethos has been the focus for some years of the new chief medical officers' realistic medicine initiative. This work between the Government, NHS professionals and the public has helped to consolidate a changed culture that has informed consent at its core, but the report of the review underlines that our focus and ambition has to be sustained and both the CMO and I accept that responsibility. As I have just highlighted, a number of members also drew attention to the services that are available to women. Members expressed quite loudly their frustration about waiting times for a first appointment in the Glasgow service, but that can remain too long. That is a concern that is fully appreciated by myself and also by NHS Greater Glasgow and Clyde. I regret that patients are experiencing delays in the mesh removal service in Glasgow. As I have said, waiting times for the first appointments are too long. The service is increasing outpatient capacity, including by employing an additional translabial scanner. That will allow more patients to be seen. I should say that waiting times have actually got a wee bit to get through and probably won't get through it anyway, but waiting times from decision to treatment to surgery are now generally within 12-week treatment time guaranteed, but we will continue to work with the NHS National Services Scotland and NHS Greater Glasgow and Clyde to bring those waiting times down. I think that I should also just point out, because it is important that the service in Glasgow is looked upon across the UK as a model of clinical expertise and service development. Since its inception, it has sought out patient views and made positive improvements to their services based on feedback received and they remain committed to further improvement. I note that that other members— I am grateful to the minister. Does that mean that they will consider now urgently a follow-up after-care service? That leads me on to patients who have had removal surgery carried out by independent providers receive two follow-up telephone or video calls from their surgeon or specialist nurse post operation. Any further after-care will be provided by the patients local health board. That is a normal process for surgery after-care and means that the patient is treated as close to home as possible. I can see you are not shaking your head, so I will go back and speak to my officials about that. I think that there was also points made about the Scottish pelvic floor register, which will allow clinicians to record details of pelvic floor procedures undertaken on individual patients. In time, that could allow for product recall in the event of a safety concern and also comparisons of outcomes associated with different types of procedure. I think that it is clear that better data collection is important for the NHS and for patients. Better data allows for comparisons of outcomes, more efficient recall of trends and many other benefits. I think that Jackie Baillie made points with regard to redress. Others have commented on the fact of the mesh fund, the reimbursement fund and options for surgery outside the NHS. Baroness Cumberlidge, in her review, talked about a redress system. The Scottish Government accepted the recommendations made by Baroness Cumberlidge, which were in Scottish powers. We also committed to supporting and working with the UK Government on others, including the redress agency. However, the UK Government did not accept that recommendation, so I am aware of that process. We also talked a bit about the accountability of clinicians, and clinicians are subject to independent regulation, including through the GMC. The Government has no sight, as I have said before, of any records involved in the review, which is aware that the panel did not refer any individual to professional regulatory bodies. That was a matter for the panel's professional judgment, which the Government of course respects. There was discussion today about the number of ways in which the Scottish Government has sought to assist women affected by mesh. I want to confirm two further actions. First, I can confirm that the NHS contracts that are in place with independent sector providers of mesh removal surgery have been extended for a further year into 2024. I know that in earlier debates there has been concern that the agreements that allow for those contracts might expire. I want to be clear that that is not the case. Moreover, the Government plans to offer further contract extensions after 2024, while there remain women to be seen by the Glasgow Service who wish to exercise their choice to have mesh removed by other surgeons. Secondly, I want to inform Parliament that my officials were shortly lay a new mesh reimbursement scheme under the 2022 act. That new scheme will extend the closing date for new applications from the original closing date of 6 December this year to 31 March 2024. Members will recall that the mesh reimbursement scheme was put in place to reimburse the small number of women who had entered into arrangements to pay privately for mesh removal surgery before the independent provider contracts were in place. Let me end by repeating my thanks to all members who contributed to today's debate. The Government and I know that Parliament will not lose sight of the work that must continue to be done to offer respectful and dignified care to women who have suffered such enduring harm. Those are courageous women. I am committed to maintaining all of the Government's efforts to that end, and I hope that I will continue to have the Parliament's support. Thank you very much. That concludes the debate on transvaginal mesh. It is now time to move on to the next item of business. There will be a brief pause to allow the front bench to change.