 Mae'r next item of business is a committee debate on motion 7487, in the name of Jackson Carlaw on petition PE1865, suspend the surgical mesh and fixation devices to invite members who wish to participate in the debate, to press the request to speak buttons now or as soon as possible, and I invite Jackson Carlaw to speak to and move the motion on behalf of the citizens participation and public petitions committee. Mr Jackson, for around 10 min, please. Thank you, Presiding Officer. Colleagues across the chamber will not be surprised to hear me speak on the subject of mesh or that in this, the 10th anniversary year of this issue, first being raised in a public petition to this Parliament by Elaine Holmes and Olive McIntyre. However, I do so today on behalf of fresh petitioners, Roseanna Clarke and Laura MacDougall, have brought this particular petition to the Parliament's attention and on behalf of all those affected by the issues raised. Members will recognise the similarities in the issues raised in this petition and in our previous debates in this chamber on the subject of transvaginal mesh. I hope that they will appreciate and be patient with the need for plain and uncomfortable discussion of the facts. While our previous discussions focused on the experience of TVT and women's health, Roseanna and Lauren have highlighted significant additional concerns about the wider use of mesh and made clear in their petition that our attention should also be focused on the use of mesh in other surgical procedures, for example hernia repair and the effects that this has had is currently having and will continue to have if the use of mesh continues for men, women and children across Scotland. In raising this issue, Roseanna and Lauren are urging us to be cautious in the use of surgical mesh until more information is gathered and we have a better understanding of the complications and adverse outcomes resulting from these procedures. In their view, there should include investigation of the concerns about our potential cancer risks associated with the use of titanium staples to secure the mesh. In considering the issues raised by the petition, the committee heard from individual members of the public including members of Sling the Mesh campaign. We have been able to explore the experience that they have shared by gathering further information from the Scottish Government and also from clinical specialists familiar with the alternative options for hernia repair, and I will say more on that shortly. The committee is also grateful to colleagues who have joined us at various points in our consideration to offer contributions on behalf of their constituents, and I see several of them in the chamber this afternoon and look forward to hearing further from them. We also heard from the Cabinet Secretary for Health and Sport, who in the Government's initial response to the petition said that he did not believe that there was evidence to justify a pause in the use of relevant diseases, stating that mesh resulted in lower rates of recurrence, fewer serious adverse events and a similar or lower risk of chronic pain. It struck me at our first consideration of the petition back in September 2021 that this was almost exactly the same testimony we had heard in relation to the previous position on transvaginal mesh. In that case, people had been dealing with their issues individually, information on their experience and outcomes was not centrally gathered, held or reviewed, and until people knew that there was a wider issue to speak out about, there was not much information available in the public domain. Since then, the committee has received over 85 written submissions, and the majority of those are personal testimony from individuals detailing the life-changing effects mesh complications have had for them. I am very grateful to Jackson Carlaw for taking my intervention. He mentions the symmetry with the considerations of the committee around this use of mesh and the previous use of mesh around transvaginal therapies. Does he agree that there is also a symmetry there with the fact that risks were not imparted to patients in advance of them undertaking those procedures? Similarly, a stigma around their experience of pain where sometimes they were just not believed. Jackson Carlaw? Yes, I think that that is a very fair summary of the position. It is very redolent of the experience of those who suffered from transvaginal mesh. It was a psychological condition, they were told, and not a real expression of pain and discomfort. Figures from Public Health Scotland and the Scottish Health Technologies Group suggest that there are around 10,500 hernia repairs carried out in Scotland each year. There may be some in the chamber, for all I know. With mesh being used in approximately 62% of those procedures. Official statistics also suggest that there is an average of 32 procedures to remove mesh from previous hernia repairs each year. What is not yet available is data on the reasons why the mesh has been removed. In comparison to the number of hernia repairs being carried out, those numbers may appear small. However, we must keep in mind that behind each of those statistics are individual patients. The committee also heard from the chief medical officer that the complex mesh surgical service only deals with TVM removal and there is no similar service for the removal of other types of mesh. We heard of difficulties in getting mesh removal surgery on the NHS, which were attributed to a lack of knowledge about the issue in primary care. The complex mesh surgical service only accepted gynaecological referrals. Some individuals resorted to going private to get their mesh removed and some travelled abroad to do so. We heard that there is no clear pathway for patients and GPs who are not aware of where to send patients. The testimony that we received details the pain that many individuals who have had mesh implanted during hernia or rectal prolapse repair surgery experienced. The people behind those statistics have told us that their symptoms occurred very quickly after surgery and have worsened over time. They have been left in constant pain. I apologise here. They have nerve damage, sexual pain, issues with their bladder and incontinence. One patient described the pain as feeling like a cheese grater being rubbed against my groin. Another patient told us that the pain feels like they are wearing a tampon dipped in acid. Some people told the committee that they had been told that the hernia or rectal prolapse mesh had eroded into their vaginal wall, bowel and bladder or adhered to their bladder over a fallopian tube or bone. The committee heard that complications had led to mobility issues and had significantly reduced people's mental health and quality of life. Some people reported improvements after mesh removal surgery, but others were told that the mesh was too enmeshed in their body to be removed without causing serious ramifications such as the loss of their rectum or testicles. A Scottish Government commissioned review on hernia mesh stated that most common adverse events following mesh-based hernia repair are pain, infection, hernia recurrence, scar tissue forming between separate surfaces of the body and blockage of the bowel. The complications people are being forced to live with means that they have had to give up working, they have seen their relationships break down and even something as simple as getting out for a meal with their family has become impossible due to the pain that they experience. They have told us of their concerns about informed consent, the point that Mr Cole Hamilton raised, and the challenges faced in having their pain taken seriously. In one case we heard that a patient was not given any other choice of treatment, they were informed that surgery would involve mesh and despite reporting pain in their hips, legs and pelvic area they were met with a dismissive response from the surgeon. Similar stories have emerged throughout the submissions. Over and over people told us that they were either not informed that mesh would be used or if they were, the only risk would be that the mesh might be too tight, an issue that could be solved by snipping it. Unfortunately, the testimony that we have heard clearly and at times graphically demonstrates that it has not been the case. People have told us about developing autoimmune diseases, which they believe to have linked to having mesh inserted into their bodies. Those were all themes that we have explored with the Minister for Public Health over the course of two separate evidence sessions. It was encouraging to hear from the minister and also the chief medical officer about the progress being made on embedded sharing decision making as part of the patient journey. The chief medical officer indicated that a shared decision making approach has been wholeheartedly embraced by the profession and is supported by education delivered by the NHS. He told us that part of this approach includes sending letters to outpatients, encouraging them to engage with the clinical team and to ask questions on the benefits, risks, alternatives and what happens if no action is taken. I am very grateful to the member for giving me a special question because I am not sure that I will be able to speak in the debate. I think that he has very clearly outlined the need that this issue goes much wider than mesh and used in transvaginal circumstances, but also I think in terms of looking at the wording of the motion that is actually the use of polyester and other materials more broadly because I have, others have been contact by women who have had issue devices fitted, who again have had very similar complications. So just wondering if the reassurances that have been hearing from both ministers and medical officials extends to a broader category of devices such as issue devices that have caused similar complications. Mr Johnson raises a very valid point. I would say that the evidence that we have taken has been more directly in relation to the issues raised by the position, but I think that he raises an important consideration and I will be interested to hear whether the Cabinet Secretary for Health and Sport can address that point too. The committee heard that surgical mesh has become the preferred method for hernia repair worldwide, with evidence suggesting that using mesh and hernia repair reduces recurrence. Nonetheless, a small majority of surgeons prefer to use natural tissue repair and will only revert to mesh as a last resort. In that context, during our deliberations, we heard from experts at shoulders hospital in Canada. For those who may not be familiar with this unique hospital, I would highlight that it is the only licensed hospital in the world dedicated to hernia repairs. We are particularly grateful to Dr Fernando Spencer Neto, a surgeon at shoulders, for taking the time to meet with the committee during a vital evidence session last May. Anyone who has viewed the evidence that we heard from shoulders cannot fail to be impressed by the results. Dr Spencer Neto told us that they carry out six to six and a half thousand procedures each year, around 99 per cent of which do not use mesh. The specialist focus on hernia repair and natural tissue repair has resulted in shoulders having one of the lowest rates of hernia recurrence. Indeed, their recurrence rate is around three times lower than hospital with the second lowest rate of recurrence. I can see, Presiding Officer, that I am very close to the time to finish. I will conclude with the words of one of the petitioners. Roseanna Clarkin told us that the Scottish Government has completely ignored us over the past eight years. That is how they feel. We have campaigned alongside the transvaginal mesh women. We always knew that we would have to fight for better healthcare together. This petition is our last chance to get what we feel should already have been in place. I am pleased that the Citizens' Participation and Public Petitions Committee can play a part in ensuring that Roseanna, Lauren and all those who continue to campaign with them will hear their voice heard. With that, Presiding Officer, I move the motion in my name. I thank Jackson Carlaw and the members of the Citizens' Participation and Public Petitions Committee, and most important, I thank the petitioners, Roseanna, Lauren and the other petitioners involved in the petition. I am grateful for the opportunity to speak on behalf of the Government. I am sure that most members of the Parliament are very familiar with issues associated with surgical procedures that involve the use of transvaginal mesh, whether that is from our constituents, from the press, from the campaign that has been running interestingly for ten years, as Jackson Carlaw referenced in his own contribution. We have heard many of the distressing situations that those with complications have experienced. Those have caused us all great concerns, and I am very grateful, genuinely grateful, to all those who have taken the time to open up and to speak very openly about their own experiences. That is not easy at all, given the deeply personal nature of what they have faced. We have heard some of that from Jackson Carlaw in the personal testimonies that he read out just a moment ago. Many of us here, as I say, first heard about mesh and surgery, involving its use through the campaigning of those who had transvaginal mesh implants. I remain very grateful to that particular group of patients for making their voice heard, and it is a group of patients that I continue to engage with. The Government has taken a wide range of action to assist those women who have been affected, and I hope that they have seen some progress, particularly over the course of the last 12 to 18 months. I propose, in my remarks, to focus on those experiences of other types of mesh. It goes without saying, but I will say it to none the less that I am always very sorry to hear of those instances of complications and adverse effects, side effects, in particular on the impact that that has had on individuals as well as the wider families. Alex Cole-Hamilton alluded to this point in his own intervention a moment ago. One of the striking common themes that has come out of engagement with the women affected by transvaginal mesh was that they simply were not believed. I do not want anybody here to think that the testimonies from those who have been affected by hernia mesh or other uses of mesh speak powerfully about the pain that it has caused them. I do not want them to think for one second that the Government does not believe them or does not believe that their pain is real, and, of course, if they have ever felt that a clinician is not believing them, then that is not the trauma-informed, compassionate NHS that I believe in. Jackson Carlaw. I think that politicians across the chamber, including the Government, accept that patients who have suffered in this way need to be believed, but Rona Mackay, a convener of the cross-party for chronic pain, and I and others have heard repeatedly, unfortunately, from individuals who will tell you that that is not always the case on their experience when speaking to clinicians. Of course, and I have heard that too when I have engaged with those either involved, those suffer from chronic pain or other conditions. That is why some of the trauma-informed and compassionate leadership work that we are doing is so important. Equally, if there are instances of particular services where that approach is not taken, I am always open to MSPs, to members of the public, writing to me directly, communicating that with me directly, and I will make sure that that is investigated from the Government to that particular health board or indeed to that particular service. As I say, regardless of how mesh is used, whatever procedure it is used in, let me reiterate on behalf of the Government that those individuals who suffer from side effects from pain, from complication should get the care and the treatment that they need. After hearing the concerns of patients, the Government at the time commissioned the Scottish Health Technologies Group, as has already been referenced, to look into the issue of mesh in hernia repair. That led to the publication of not one but two reports on this subject. Those reports are based on the information from peer reviewed published evidence, much of that from comparative trial data. Both reports support the continued use of mesh in most abdominal wall and groin hernias. We have discussed those findings with professional bodies such as the relevant royal colleges and the British hernia society, and we will continue to work with them on that important issue. It is fair to say that they also support much of what is in the report from the Scottish Health Technologies Group in terms of the continued use of mesh. There is also work on going with regard to establishing registries and encouraging better data collection, which is a common theme from Jackson Carlaw's contribution. It will provide important surveillance and outcome information in years to come. I appreciate that petitioners would like an independent review of all surgical mesh and fixation devices to be undertaken, and that is entirely understandable in light of their experiences. However, given the conclusions of the Scottish Health Technologies Group reports, the action that is being taken by us in response to those reports, which I will touch on in more detail in just a moment, and given the various reviews that were carried out in relation to transvaginal mesh, I do not believe that a further review is warranted. We will remain focused on available evidence, including new information, as it emerges. From that data collection, I spoke about a moment ago, and, of course, we are committed to acting upon it. I am very grateful to the committee for giving me a note. I know what he says about the efficacy of a further review, but I think that there is a growing global sense that the issues surrounding medical devices are a more broad one. I wonder whether he might comment on whether devices that use polyester or other material are cited in motion or, indeed, more broadly, there is a revision in relation to the approach that is taken to medical devices, given the global concern that there is, not just particularly on mesh. What I would say is that the Scottish Health and Technology group looks at global evidence, looks at that evidence that is available internationally, and what I would also say is that it is really important that we, and I think that there is a lot of value in working on a four nations basis in relation to some of those issues. That is why the Baroness Cumberlidge report, for example, on making progress on that, I think is so, so important. So where global evidence emerges on various different devices and the potential complications associated with them, that is why we have the Scottish Health and Technology group to review that particular evidence where it exists. I am happy to take away the specific issue that Daniel Johnson raised and see if there is anything further that we may do in that regard. I am not making as much progress as I would like, but let me try to reiterate a couple of points, if I can, for emphasis. I do understand the reasons for suspension of the use of mesh that has been made by some of the petitioners, particularly this petition. What I would say is that there are some 100,000 hennaw repairs in the UK each year, approximately 11,000 of those in Scotland that was in the year before the pandemic. That includes elective procedures as well as those that are presenting as emergencies, and surgery must be available to all. I think that establishing a special centre, which is again one of the suggestions within the petition, might not be conducive to that, as it would pull resources into potentially one health board area, meaning that patients have to travel. Of course, there will be hennaw repairs that are more complex, and it is for that reason that Chief Medical Officer has asked medical directors to consider the development of local clinical groups and broader clinical networks for the management of more complex cases. We will continue to work with clinical colleagues in this. In the interim, however, there is a patient's right to request a second opinion, if there is any doubt about the treatment that is being offered to them. Lastly, I will turn to address the continued use of mesh in other areas. In comparison to the use of mesh in hernia repair, those procedures are not performed frequently, including the use of mesh in reconstructive surgery and continued use in gynaecology. In those cases, it is recognised that there are currently very few, frankly, any viable alternatives. To suspend the use of mesh in the very wide way that is anticipated by the petitioners, we would, unfortunately, leave quite a wide cohort of people with limited or, indeed, no treatment options, which I am sure is not the reality of what the petitioners would have wanted. I just wanted to end on one of the points that Jackson Carlaw made, that there were a number of recommendations from the reports and from the reviews that the Scottish Health and Technology Group made. They were about ensuring that any procedure is done in conjunction and in a collaborative way with the patient involved, that they are fully appraised of the potential risks that they may be to any surgery, particularly including any surgery-involving mesh, and that alternatives are explored if clinically viable and clinically safe to do so. There is exploration under way on the potential alternatives to mesh, particularly in hernia. In conclusion, the Parliament has quite rightly called on the Government to take steps for those who have been harmed. In some cases, most notably in relation to transvaginal mesh, I think that the Government has responded positively to that, but I also conclude that, in the wider sense sought by the petitioners, a further suspension review, I do not think, is warranted in saying that I completely understand the disappointment that some will feel, but I do hope that the actions that I have said out here and that I will expand on, perhaps in my closing remarks, give some reassurance that we are listening, we are making progress and we are absolutely committed to ensuring that people get the best care that they possibly need. Petitions by members of the public have brought about changes in law, in Government policy, help revised guidelines on an issue or even change a decision. Even just raising awareness of an issue in Parliament can be a success. We recognise the hard work of petitioners and those that are called on to give evidence and members of the Citizens, Participation and Public Petitions Committee. While we often chide the Scottish Government over its lack of transparency or avoidance of scrutiny, which are essential for the functioning of our parliamentary system, we are also well aware that petitioners' process is important for our democracy. Petitioners, Roseanna Clarke and Lauren McDougall have called on Parliament to suspend the use of all surgical mesh and fixation devices, while a full review of all surgical procedures that use polyester, polypropylene or titanium is carried out and guidelines for the surgical use of mesh are established. This petition is not about transvaginal tape, TVT or pelvic mesh implants. Cabinet Secretary, in health committee today we spoke about mesh implants and you intimated there might be a bit of an update that you could give us today and if possible in your closing remarks that would be great. However, this petition is about mesh and other devices and fixations used in surgery elsewhere in the body, particularly in hernia repair. Their petition raised awareness of complications that have arisen from the use of synthetic mesh in surgical repairs. The petitioners also drew attention to concerns associated with titanium protacts that are used with hernia mesh as they carry a cancer warning. Between May 21 and June 22, the committee heard evidence and received written submissions from an awful lot of people, including the chief surgeon of Canada's Sholdice hospital, which is the only hospital in the world that is dedicated to hernia repair, performing up to 6,500 surgeries annually. We heard Jackson Carlaw talk about the complication rate, but it's very important to say the more you do one type of thing, the better you get at it and the less likely you are to have complications. I can't help but wonder how long patients have to wait to be seen at the Sholdice hospital. I'm assuming it's better than NHS Grampian, where the longest recorded wait for diagnostic test in 2022 was 258 weeks. As for surgery, while Sholdice is performing over 6,000 surgeries annually in our own country's largest health board, Greater Glasgow and Clyde, all non-urgent surgeries now pause, likewise in Ayrshire and Arran, the borders, and we understand that NHS Fife is also reducing its elective surgical capacity. As a former registrar in a busy surgical department, I can say that surgery involves risk. The risk increases if the patient's health is compromised, and this includes being overweight or obese. It's important to examine the data from the outcome of many surgeries using a particular technique so as to evaluate any potential risk. If we take hernia repair, a hernia occurs when an internal part of the body pushes through a weakness in the muscle or surrounding wall, and a hernia then develops, and it's usually between chest and hips. An inguinal hernia repair can be carried out as either open surgery, which is essentially just a big cut, or laparoscopic, which is keyhole surgery. Once the anaesthetic has taken effect, the surgeon makes a single cut over the hernia. The incision is about six to eight centimetres long. The surgeon then places the lump of fatty tissue or loop of bowel back into your abdomen, and mesh is then used to staple or exclude into the place of the weakened area of the abdominal wall where the hernia came through, to give it temporary strength while your body heals. There have been reports of issues associated with mesh used in hernia repair such as infection, pain and adhesion. However, the Scottish Health Technologies Group reports that men operated with mesh were less likely to have hernia return compared to those having surgical stitches. Also, the use of mesh meant that men were less likely to suffer urinary retention, injury to nerves, blood vessels or internal organs. They were more likely to develop a build-up of fluid or swelling soon after surgery, which is common. There was no difference of developing chronic pain whether stitches or mesh were used. Only a tiny percentage of hernia repairs involving mesh had to have their mesh removed. Between 2013 and 2018, there were about 70 of those operations in Scotland to remove surgical mesh after hernia repair. That represents about 0.3 per cent of the 25,000 plus patients when mesh was used. In January 2020, the Scottish Health Technologies Group recommended that NHS Scotland used mesh when repairing hernias and adult men. It also stressed the importance of robust data collection, and data on long-term outcomes from hernia repair in Scotland are recorded at a national level to inform further decision making. Emma Harper Thank you for taking the intervention. We are talking about mesh. Do you agree that the properties of mesh, such as the type of filament, tensile strength and porosity, have so much choice in the mesh that is implanted that the data that we get from that might help us to determine which mesh leads to specific complications such as pain? Dr Gohine It's almost like Emma's read the rest of my speech. But yes, I would agree. The National Institute for Health and Care Excellence, which we all know is nice, has found that post-operative complications from mesh surgery were rare. I must say that, in my experience in hospitals, mesh complications were rare. I'm probably the only person here to have actually implanted mesh into hernias. Emma Harper says that she's put them in as well. From a systemic review of literature covering 37 randomised control trials, which total 5,560 participants—and that's quite a lot—10 per cent or less experienced persistent pain from either procedure and 23 per cent or less experienced persistent numbness. Will my colleague take an intervention? Yes. I've now heard Dr Gohine see that he is inserted mesh under into other people. Were he diagnosed with a hernia repair, would his preference be to have mesh inserted into him or a natural tissue repair? Dr Gohine My preference would be what the surgeon deemed to be the most appropriate for me. If that involved the surgeon saying that he thinks or she thinks that mesh would be the correct procedure, then I would wholeheartedly go forward with that, because it depends upon the hernia that I have. But I don't have a problem with having mesh implanted into myself or into my family. Nice guidelines recommend future research into chronic pain and numbness as well as setting up a registry to monitor adverse events and recurrence rates. As for the petitioners, cancer concerns, the US Food and Drugs Administration reviewed early epidemiological studies on implanted hemopoietic cancers and found conflicting evidence, but only two studies suggested an increased risk of lymphoma or leukemia. This is a really important thing to say here. No medical or surgical intervention is without its side effects. Considering the evidence taken by the Citizens' Participation and Public Petitions Committee, we do not support this petition. Let me explain with another example. Andy Murray won his first round of the Australian Open earlier today, which is quite frankly amazing, given that he has a metal hip. However, he does not have a total hip replacement, he has a hip resurfacing. When I was working in London under Professor Haddad, there was a scandal around hip resurfacing, and there was calls for the procedure to be banned completely, but what we have discovered is that this is a fantastic piece of kit. If it is inserted by the right surgeon on the right patient, Andy Murray shows you the value of the procedure when it is done right. What I am saying is that not all kinds of mesh are the same, not all patient indications are the same, and most evidence points towards hernia mesh being much safer than transvaginal mesh. We do not support calls from the Scottish health technologies group. I think that the Presiding Officer will tell me to wrap up at this point. We do have a support calls from the Scottish health technologies group to strengthen data collection on hernia outcomes and from NICE to monitor adverse effects. I declare my interests as a practicing NHS GP. I apologise to the chamber in advance. With your permission, I will need to leave briefly during the course of the debate to undertake an interview, but I will return and make sure that I catch up with my colleagues' contributions. Let me start by thanking the Public Petitions Committee for its work on this petition and to commend Roseanna Clarke and Lauren McDougall for bringing the petition to the Scottish Parliament. This petition is about suspending the use of mesh of the devices and fixings used in surgery and, in particular, in hernia repairs. Some 11,000 hernia procedures are carried out in the four-year period, five times as many were carried out for pelvic or transvaginal mesh. Problems that have been reported include infection, pain and adhesion to other parts of the body. There are clear similarities in the experiences of people who have had hernia operations with women who have had transvaginal mesh implanted. There are lessons that the Scottish Government must learn from the campaign to suspend the use of transvaginal mesh in 2014 and the unacceptably long time that campaigners have been forced to wait for treatment and for solutions. People who have experienced problems with mesh are often left in crippling pain. They have suffered from multiple organ trauma and extensive nerve damage, despite being told that the mesh causing them this pain was safe. We know that their pain went ignored by some health professionals because they have told us so and dismissed as somehow being all in their minds. Many of the circumstances in the language that was used during the fight about transvaginal mesh is being replicated now in discussions around the use of all surgical mesh and fixation devices. People with lived experience have spoken about the excruciating pain that they are forced to endure and how that has led to depression and sometimes suicidal thoughts. They tell how they have been ignored and shrugged off by doctors when reporting their symptoms or attributing pain to their mesh implants. That pain impacts upon their ability to work or enjoy any quality of life. In the evidence that they gave to the Public Petitions Committee, patients have detailed how the prolapse mesh that they have been fitted with has eroded into the walls of their body or even adhered to their organs. Similar to the experience of the women who are fitted with transvaginal mesh, there are currently few processes in place for addressing and removing surgical mesh that is defective. There is a lack of process around the tracing of the product that makes it hard to retrieve faulty mesh that has been fitted. Whilst I welcome the establishment of a medical device information system, it is genuinely concerning that nearly 10 years after transvaginal mesh survivors brought these issues to the fore, such a system is still not in place. The Scottish Government needs to work to rectify that as a matter of urgency. I give a cautious welcome to the two Scottish health technology reports that make recommendations about the conditions for the continued use of mesh, but I believe that patients must have choice in their treatment and note that in some countries, like Canada, they no longer use mesh at all. Mesh has been banned there since 2019. What do they know that we do not? I also agree with the petitioners that there needs to be a specialist mesh removal service. Currently, the complex mesh surgical service deals only with transvaginal mesh removal. The waiting time to be seen is currently sitting at 42 weeks, and then there is the time to wait for treatment. I have a constituent Maureen, who has faced months of cancelled appointments before finally being scanned at the Glasgow clinic in November 2021. She has been told that there were no issues with her mesh, yet a private scan, which she organised for peace of mind, confirmed that it was twisted and the cause of her pain. Maureen lost her job due to the complications from her mesh surgery. She has been failed by the Government multiple times. The minister cannot tell us how many have been referred to specialists in England or the US or how long that will take. I understand that Dr Varonichus has only treated 10 women and his contract runs out this summer. There appears to be a reluctance to refer to the preferred operations that those women want. I have previously raised the case of Anne, who has been to America for treatment with Dr Varonichus. Ministers are saying that there was no cap on the amount that could be claimed, and Anne's experience is entirely different. Despite the minister saying that there was no cap, Anne is still fighting to be compensated for the full cost of her flights. The service that is established to address the serious problems faced by transvaginal mesh survivors is welcome, but it is not being resourced adequately. If we are to include other types of surgical mesh removal, its operation needs to be urgently reviewed and the scope expanded. We have a duty to get this right for all those who have experienced negative side effects because of surgical mesh. The experiences and stories of those people, heard by the committee, are not isolated. They are widespread and they are real. The Government must learn from this testimony and prevent history from repeating itself. I have raised this several times in connected debates about the use of transvaginal mesh implants in terms of the fact that we needed to expand the debate and the discussion to the use of mesh in other parts of the body. I am very gratified by the work of the petitioners, Roseanna Clarkin, Ann Lauren MacDougall, for the work that they have done to get us to this point. It is a long time coming. Last year, I shared a story of my constituent, Kathy, who is a count echoed by hundreds of other women who were referred to their GPs and a physiotherapist to receive a mesh implant. Kathy was given very little information other than being told that the procedure would alleviate the mild incontinence that she was suffering. What followed was five years of crippling pain with Kathy's mobility, mental health and intimacy with her partner. Her quality of life was devastated. I and my party were proud to back the legislation passed by this Parliament almost a year ago to reimburse the victims of transvaginal mesh implants for the surgery that they would have to undergo to have it removed privately. Although nothing can take away from the trauma that they have had to endure, at least they did not have to bear the hefty financial cost of having the implant removed, and at least their plight and injuries were recognised by this place. However, that legislation was far from a panacea, and it was incomplete. That reimbursement scheme did not include the victims of other mesh implants, for instance those who have suffered complications with hernia mesh. We have heard, somewhat graphically, some of the descriptions of those cases. That is why I was one of the first to raise hernia mesh in the chamber, along with a number of other MSPs, because we have all met constituents—probably all met constituents—to whom this applies. One of my constituents was effectively left crippled by hernia mesh. There are also hurrying accounts of the impact of hernia mesh implants, including a patient who is left with an actual gaping wound in her side in the side of her stomach, which cannot be healed properly, which prevents it from travelling, from going out and visiting her children who live far away. Despite accounts like this, hernia mesh implants are still widely used. Today, we have before us a petition that seeks to address this and to look towards the suspension of the use of surgical mesh and fixation devices, while a review is conducted into their use and all surgical procedures that implant any form of polyester, polypropylene or titanium products. As the member well knows, there are lots of people who are waiting for hernias, and they are not emergencies, but they need to be done. What would we do for them? An anxiety that I have about the approach to the medical profession in some cases is to rush into a decision and to bounce patients into treatment without fully informing of the risks or possible side effects of that intervention. If mesh is not a safe intervention, it is not a solution to the problems that Dr Gilhane outlines. I have met so many survivors of transvaginal and now hernia mesh, and having heard so many tragic and life-changing stories, I have an immediate and visceral problem with this or similar material being implanted into anyone's body. Personally, I would like to see compelling evidence of the safety of any mesh implant before I would ever be comfortable rep commending it to someone that I know or taking it myself. I am aware of the reports of the Scottish health technology groups that support the continued use of mesh in abdominal wall and hernia situations, provided that there is a shared decision making an informed consent process, with an awareness of risk being imparted to the patient. Deputy Presiding Officer, I am not persuaded that that is actually happening, and we have heard it. I intervened on Jackson Carlaw to say, and he agreed with me, that that does not always happen, that informed consent. Giving patients the agency, crediting them with the facts and the risks, is not always happening. If it were to happen, I think that several people may take different decisions and we would see a shift in the balance away from it. I am also mindful of the concern that suspending the use of hernia mesh could leave some people with no or very limited treatment options. That needs to be taken into account, and we have to be cognisant of it, as reflected in the petition. I think that it accredit again the petitioners for the elegant way in which they put it to us. There are some life or death cases where, of course, the use of a mesh or some surgical implant is definitely essential. What many of the cases of transvaginal mesh had in common was the failure of those providing treatment to make those patients fully aware of the potential risks involved in using those implants. Informed consent is one of the key principles and pillars of our health service, or at least it should be. It is right that every patient be given all of the information about what their treatment involves. That is realistic medicine, treating people like grown-ups. That must include the potential risks, as well as the benefits, and whilst patients must always be offered reasonable alternative treatments wherever possible. In this case, 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 that impact the treatment of complex cases are addressed. I also agree with Jackie Belly's excellent point about the urgent and pressing need for mesh removal care pathways to happen in the Scottish NHS. We need to build in the capacity and the expertise to make that happen here in Scotland. I am not a clinician, that is clear. It is of course right that the escrowd student is providing decisions taken by specialists. The first step in that process is hearing the lived experience of those who have suffered from complications. We must remember that many survivors of vaginal mesh implants subscribe not being taken seriously and even being told they were imagining their pain. It is a theme that echoed throughout the space. In fact, Roseanna, one of the people who brought forward today's petition, sadly has a similar story. She even had to deal with her GP suggesting that the pain that she was experiencing was all in her head. It is only by listening to people like her that we will do the due diligence that we need to do around the long-term effects of those materials, what they have on the body, and get a full picture to ensure that nobody else is harmed. Thank you, Mr Cole-Hamilton. We now move to the open debate. I call for Sirona Mackay to be followed by Megan Gallagher for around six minutes, Ms Mackay. Thank you, Presiding Officer. Today we are debating an issue that has been highlighted many times over the years in this chamber. Ten years, as Jackson Carlaw said, and it is one that I have taken a keen interest in. Thankfully, now there is a ban on transvaginal mesh implants brought in by former Health Secretary, Jean Freeman, and it was warmly welcomed by campaigners in the families. Jackson Carlaw, whose motion we are debating today, former MSPs Neil Findlay and Alex Neil were at the forefront of the fight for justice for women and spearheaded the campaign for women victims of mesh. Last year, the Scottish Government passed legislation to establish a £1 million fund to support women affected by mesh complications who have received implants in the NHS, but had to travel abroad to have them removed by an experienced clinician. We thankfully now have a facility in Glasgow with specially trained surgeons where mesh removal can be carried out. The scandal of women in Scotland and indeed globally, whose lives have been ruined by transvaginal mesh, will go down in history as one of the worst medical injustices for decades. However, in all honesty, the debate surrounding petition 1865 has left me a bit confused. I am sympathetic to it. I probably feel more confused now having listened to Jackson Carlaw and then to Sandish Gohani, who clearly do not agree on it, but there are good points made in everybody's speeches that they have made so far. Essentially, the petition calls on the Scottish Parliament to urge the Scottish Government to suspend the use of all surgical mesh and fixation devices, whether a view of all the surgical procedures was used polyester, polypropylene or titanium is carried out, and guidelines for the surgical use of mesh are established. Acknowledges that mesh must be used in life or death situations, but adds the caveats that mesh is only used when essential. Patients have alternatives to mesh, and mesh has to be used with the fully informed consent of the patient. The petitioners want the use of mesh devices and stitches to be suspended, while a review of all surgical procedures, which implant any form of the materials that I just mentioned—for example, hernia mesh, recto mesh, mesh use and hysterectomies—is carried out and guidelines for the use of surgical mesh are established. They are calling for the suspension of the use of titanium protaxe and claim these carry a cancer warning. Crucially, the petition also recognises and supports women with TBT or pelvic mesh implants and acknowledges that what we are talking about is not the same. I am not a clinician and neither are the majority of us in this chamber with notable exceptions. My opposition to the use of women receiving mesh implants was based on hundreds of testimonies from women who suffered life-changing injuries. However, with regard to the type of mesh that is used, which is the subject of this petition, as I have said, even the petitioners acknowledge that it is different from TBT. The fact is that many people have had mesh for hernia inserted and successfully. I do not know the data for those who have reported LFX, and I think that data is absolutely key to this issue. I would hope to learn more about that. The obvious statement to me is that a review would cause delay for patients getting treatment at a time when, as we all know, delays are prevalent due to the intense and unprecedented pressure on the NHS. A review would take time to set up and to come to a conclusion, and that would surely leave medics and patients in limbo. The petitioners ask that mesh is only used when essential. Surely a surgeon would not use it unless he deemed it essential. They ask that patients have alternatives to mesh, and I am unclear how many of us know what options are available to surgeons to treat hernias and other conditions. They ask that mesh is only used with the fully informed consent of the patient. One of the stipulations since the scandal of TBT mesh is that patients do have fully informed choice, and that should be the norm for any surgical procedure that has been undertaken. I take on board what Alex Colehamann has said. The petitioners also acknowledge that mesh must be used in a life-or-death situation. I would suggest that only clinicians know the severity of any situation, and they would make the correct choice to keep the patient alive. The mesh scandal, where many hundreds of women in Scotland and many more throughout the world has been a long and very difficult journey for those affected by the devastating symptoms and side effects that have been life changing. We have come a long way in 10 years, admittedly at a much slower pace than it should have taken to stop women being affected in this way, and that has been acknowledged by the medical profession. The bottom line for me is that my issue with this petition, which is undoubtedly well-intentioned in heartfelt, is that I simply do not know if there is justification for it. I am not sure that the majority of us do. I am just saying that there is uncertainty here, which could have unintended consequences, but I agree with the previous speakers that we must listen to the petitioners and what they have been experiencing. My concern is that many patients would face delayed treatment, or less effective treatment, where the petition to be upheld. I begin by recognising the many women and men who have come forward to discuss deeply personal accounts of their life changing and lifelong consequences that mesh surgery can cause. Reliving this trauma must be difficult, but it gives MSPs the opportunity to pause, reflect and review treatments offered to people across Scotland. Also to those who have campaigned vigorously to ensure that any procedure involving mesh is low risk and appropriate. In all of our considerations today, when mentioning the use of such devices, it is people's health, safety and wellbeing that must be our first concern. The petition that we are debating today, if approved by this Parliament, would suspend all surgical mesh and fixation devices. I have some sympathy towards those who have submitted the petition to the Petitions Committee, given the serious implications transvaginal mesh had had on many women globally. Mesh was previously used to treat stress-urine incontinence and pelvic organ prolapse in women. However, in 2014, a petition was submitted on behalf of the Scottish mesh survivors here, our voice campaign. We have all heard the harrowing stories, some this afternoon, from women who have bravely told their stories, how they were told that they were just experiencing women's problems and that there was nothing seriously wrong. Taking the time to read some of their accounts helped me to understand the distrust that women felt towards the Government and our NHS for not being believed. It was right that the Scottish transvaginal mesh implants independent review from 2017 recommended stopping this surgery after concerns were raised by women who suffered from debilitating severe and painful consequences. Thankfully, there are now specialised services in Scotland for women who have experienced complications from mesh implant surgery. The Scottish Government officially signed a contract that allows women to have painful mesh implants removed by specialist surgeons in the United States free of charge. The deal allows NHS patients in Scotland to travel to Dr Foronicus Clinic in Missouri for transvaginal mesh removal surgery, and another waspire healthcare where Professor Hashim operates was also agreed earlier this year, giving women the option to go to Bristol for this surgery, although the points that Jackie Baillie raised during her contribution is concerning. I do not think that I will be the only MSP in the chamber today who wishes that the Government acted sooner and more efficiently to support women who had this type of surgery. One take away from the whole debacle was that MSPs from across the political chamber rallied together to ensure that mesh survivors not only had a clear route of treatment but were also compensated if they had spent thousands of pounds of their own money to have the implant removed. As my colleague Dr Sandesh Galhany and others have articulated, there is more than one type of surgical mesh. There appears to be some kind of evidence that points to similar issues to transvaginal mesh and other kinds such as hernia. Potential complications include chronic pain, bowel obstruction, hernia reoccurrence and infection. As the concerns have been raised, the need for data and evidence is essential when investigating the link between cause and treatment. For example, only a tiny percentage of hernia repairs involving people have had to have their mesh removed. The National Institute for Health and Care Excellence found that post-operative complications from mesh were rare, so I do believe that we need to be careful when looking at mesh and any side effects of having that kind of surgery. Does the member agree that anyone who is experiencing complications of ingonal hernia repair or any mesh implant should be looked after by cadent, compassionate and kind and competent multidisciplinary team? That is something that we really need to make sure that we move forward and consider. I think that anyone who is experiencing any kind of pain should be treated with utmost care, respect and dignity. That is something that any patient who approaches any service within the NHS should expect. I do agree with Emma Harper that we should always look at the scenarios and make sure that we are moving in a positive and forward thinking direction. Moving on to the petition itself, the foundation behind this campaign is that petitioners believe that surgical mesh can lead to cancer. It also calls for mesh to only be used in life and death circumstances and for a full review into how surgical mesh is used. That is why, in others, I have outlined the importance of evidence-based arguments because, as my colleague Sandesh Calhani mentioned earlier, official sources such as the US Food and Drug Administration said that they are sceptical of mesh leading to cancer. Therefore, more evidence would need to be supplied in order to look at the petition further. However, that being said, I will not speak against any individual's own personal experience of mesh implications, but I do believe that all avenues must be investigated should they experience any of the issues outlined by transvagino and hernia mesh victims. If I may, before I finish today's contribution, I want to bring up hospital waiting lists as they will undoubtedly impact people who are experiencing any symptoms that could come with mesh surgery. At present, many people cannot see a GP being seen at A&E within four hours or get through to the phone on NHS 24. That combined with budget cuts in NHS staff shortages is deepening the crisis that has emerged in our healthcare service. If the Government does not get to grips with hospital waiting times, people will continue to suffer unnecessarily due to the pressures on our NHS and the lack of action from the Government. We on this side of the chamber will continue to hold to the SNP-Green Government to account to ensure that improvements are made to our healthcare service. Emma Harper will be followed by Katie Clark for around six minutes. I am speaking in this debate today as there are two points that I want to make and I have got some additional info as well now after hearing everybody else. First, as a former operating room nurse here in Scotland, England and in California, I have experience of hernia or angonal hernia repairs and other hernia surgery using surgical mesh. I have seen the amazing results achieved with repair of anatomical defects fixed using mesh. Surgical mesh is a crucial tool for surgery. Secondly, I completely understand the chronic and serious and total distress that complications have occurred for some women and they have experienced that as a result of transvaginal mesh. I was a health committee member in the last session when the legislation was taken forward in order that we deal with the transvaginal approach. The testimony that we heard from the women that had complications was extremely powerful, as were the campaign and efforts of the survivors. I again put my thanks on the record for them. Anyone experiencing mesh complications must be listened to with kindness, compassion and caring. They need to have a great team of health professionals, and it actually distresses me to hear that some folk have had their pain ignored. I welcome the steps that the Scottish Government has put in place to allow women to take whichever course of action is most suitable to them for their mesh complications so that they can be rectified. I look forward to updates from the cabinet secretary on how the complex mesh surgical service is progressing. Our recent studies, including from the Royal College of Surgeons, suggest that the risk of chronic pain following an angonal hernia repair is similar regardless of whether mesh is used. Prior to the use of mesh and hernia surgery, recurrence rates of hernia orphe were extremely high, 10% to 20% in some studies, and there is little doubt that mesh use has dramatically improved statistics and outcomes for patients. According to the Royal College of Surgeons, most of the negative coverage of surgical mesh has focused on post-operative pain issues, and they say that there is a danger that the coverage may be taken out of context. We know that original reports of mesh complications featured gynaecology surgery, which is entirely different to patients having a groin or other abdominal hernia repair. In the report published by the Scottish Health Technologies Group, there are a number of recommendations for the NHS Scotland to take forward, which are underpinned by evidence. The clinical evidence supports the continued use of surgical mesh as a choice and an option for elective repair of primary ventral hernias, incisional hernias and primary angonal hernias in adults in Scotland. While patient preference may be for a non-mesh or suture-only repair, access to alternative hernia management options should be available, obviously that depends on the patient, the size of the defect, even the size of the patient, the assessment, the diagnosis, the specific surgical or non-surgical recommendations that need to be made. The report makes clear that all elective hernia repairs should be preceded by a detailed discussion between the patient and the surgeon as part of an informed consent process. I agree with Alec Cole-Hamilton on that. It is important to ensure that the discussions include the benefits and risks of surgical and non-surgical approaches to hernia management, including the fact that neither mesh or non-mesh repairs such as suture are risk-free procedures. We also need to make sure that the risk of developing chronic pain following a hernia repair, especially for patients with pain as their main presenting symptom, is also put forward to the patient. The communication is absolutely crucial in enabling patients to make informed consent decisions on their treatment options, and the decision to use laparoscopic or open mesh repair should be based on the patient's medical history, the characteristics of hernia and the surgeon's expertise as well. In addition, it is worth making sure that I turn the right page. In addition, we need to make sure that it is crucial to monitor the effectiveness of surgical mesh data. Data on long-term outcomes from hernia repair in Scotland must be recorded at a national level to inform future decision-making. It must be aligned with the UK's medical device information system and should include collection of patient-reported outcomes. I welcome an update from the cabinet secretary on whether that data will be collected or is it being collected, and how it will be reported. In addition, it is worth noting that the NICE guidelines also recommend laparoscopic surgery as one of the treatment options for the repair of ingonal hernia. Again, it depends on whether it is unilateral or bilateral. Again, it is about assessment and diagnosis of the patient. Section 1.2 of the NICE guidance states that, to enable patients to choose between open and laparoscopic surgery, either by the trans-abdominal pre-peritoneal or totally extra-peritoneal procedure—that is my favourite, by the way—patients should be fully informed of all the risks. We know that international guidelines for growing hernia management, developed by the hernia surge group, show that they conducted a thorough review of hernia repairs, leading to 136 statements and 88 recommendations for the best practice approach to hernia repair, and it is worth exploring their evidence and guidelines. Last Thursday, I spoke with Dr David Saunders, consultant upper GI surgeon in Devon hospital in Barstable. He is the president of the British Hernia Society, and he gave me lots of info to take forward. I would be interested in whether, at closing from the deputy convener of the committee, he will seek input from the British Hernia Society as we move forward, because one of his members is right on our doorstep here in Edinburgh. In closing, I thank the petitioners for bringing this issue to Parliament, but I repeat that any decisions that we take forward must be based on best available clinical data and evidence. I thank the petitioners, Roseanna Clarkin, who is a mesh-injured woman who has suffered chronic debilitating pain and life-altering injury after a procedure for hernia, and Lauren McDougall, whose mother, Michelle McDougall, suffered 18 years of pain as a result of a surgical mesh procedure before dying of a rare cancer. Neither, Roseanna nor Michelle had given to mesh being used. Having met both Roseanna and Lauren, I know the pain and damage that mesh has caused in their lives and how they are seeking the support that they deserve from the Scottish Government. Roseanna and Lauren have met a number of politicians, but they have not met the cabinet secretary, and I would ask that he consider meeting with them to hear of their experiences first hand. I asked Roseanna Clarkin what her top ask would be for the debate today, and she said that it was patient pathways to be provided for all who are mesh-injured, rather than each individual having to fight for medical support. The petition that they have put before this Parliament is backed by powerful testimonies from over 70 mesh patients and their families. It is clear on what action they are asking from the Scottish Government. We need to accept that people are still having mesh implanted in Scotland, and I would argue that the Scottish Government must suspend the use of all surgical mesh and fixation devices, while an independent review takes place. Mesh is a cheaper option, but there are other options available, such as skin and pig skits that the petitioners believed would have been used in their procedures. The Scottish Government must provide greater healthcare support for patients who are mesh-injured. It must increase access to specialist care, including mesh removal surgery and alternative treatments. Katie Clark agrees that it might be worth exploring what she is doing with the one-stop-shop clinic in Barnstable at Devon, because she has the whole pathway sorted for one-stop-shop clinic for chronic management of pain for mesh repairs. I am very grateful for that helpful intervention. We should look at what is happening there, and indeed we should look at what is happening around the world. Jathy Bailey has already pointed to the decision in Canada to suspend the use of mesh, but I believe that the Scottish Government must apologise for its failure to act to date on the concerns of mesh patients and establish a compensation scheme to support those individuals as they attempt to overcome the pain and damage that mesh has caused them. Many of the campaigners on the issue are now living with life-changing conditions, which are directly linked to the mesh procedures that they underwent. Although transvaginal mesh and its complications affected the lives of so many women, as we have heard, the use of other mesh products to treat conditions like hernias affects women, men and sometimes children, too. Despite the testimonies that the Public Petitions Committee received from patients affected by the use of mesh, the true extent of the damage caused by those products remains unclear. Indeed, there have been a number of calls in this debate already for more data and for evidence to be obtained. In our evidence to the Public Petitions Committee back in June, the Minister admitted that it was not easy to trace what products had been used in all procedures and which were causing harm. However, despite the lack of regulation on its use, NHS Scotland continues to use mesh in surgical procedures. From 2016 to 2020, 62 per cent of all hernia repairs carried out by NHS Scotland used mesh. That is why I joined campaigners in their call for an independent review of mesh and fixation devices. We cannot establish the true scale of the damage that those mesh products have caused in the lives of so many patients across Scotland until we get the data and until we get the evidence. Until that review is completed, the Scottish Government must order health boards to suspend the use of surgical mesh and fixation devices and use other procedures. We need to put protections in place for patients, and there needs to be clear guidelines to be sent out governing the surgical use of mesh. I believe that we need to suspend the use of mesh, but there may well be situations where it is essential and there are no other alternatives available. However, that must only happen when patients have given informed consent to its use. It is disturbing that so many petitioners did not give that consent. I am very grateful to the Petitions Committee for giving us the time to explore those issues today. I hope that the cabinet secretary will agree to meet the petitioners to take forward the issues that are being raised in this debate. I have mentioned in this chamber numerous times the experience of one of my constituents who received a transvaginal mesh implant. She shared with me her story, which she described as a 12-year nightmare of excruciating pain. Her continual pain had a knock-on effect in all aspects of her life, including her career and her family. I note that this petition that we are considering today is not explicitly about transvaginal mesh, but mesh used in surgery elsewhere. The reason I mentioned this experience of my constituent is because, as I was reading the story of Rosanna Clarkin, one of the petitioners echoed what my constituent went through—that all encompassing pain can really have a devastating effect on your life. I would like to thank Rosanna and Lauren McDougall for bringing this petition to members. It is given us a chance to speak about this really important issue and hear other people's stories. It is clear that the Minister for Public Health and the Cabinet Secretary for Health is taking this issue seriously and listening to concerns as well as the evidence. I do believe that, given the statements issued by the Scottish Government and the scientific research available, it would not be wise to call for a suspension of such surgical mesh in other parts of the body. As we have heard, mesh is routinely used in hernia surgery and around five times as many hernia mesh procedures have been carried out as pelvic mesh or TVT implants in Scotland. Further to this, hernia repairs are one of the most common surgeries carried out globally. As with any surgery, that carries risks and side effects and the Scottish Government commission researched into the use of mesh in a commonly performed hernia repair. That resulted in the publication of the Scottish Health Technologies Group report on the use of mesh in primary hernia repair in adult males. The report concluded that, compared to non-mesh procedures, using mesh resulted in lower rates of recurrence, fewer serious adverse events and similar of lower risk of chronic pain. A further report by the group found that evidence supports the continued option of using surgical mesh in hernia repair, and as the minister has previously stated, the use of mesh in operations is long established and in situations there are very few, if any, viable alternatives. Therefore, the suspension of mesh treatments would leave people at this stage with no other options. There is also a very important point that has been raised by the petitioners and the Government and the research bodies, and that is of informed consent. It has been reported in the media that Rosanna was not told that her reparation would involve the use of mesh, and she did not find out until much later that mesh was actually used. I obviously cannot comment on specifics of this case of what happened, but it is unthinkable that something like that could actually happen. I agree with the minister and the healthcare professionals that, with the exception of emergency procedures, the use of mesh should only be carried out with the fully informed consent of the patient who understands the potential risks and the other options that are available to them. The chief medical officer wrote to health board directors in 2018 to highlight the importance of informed consent. If I could ask the cabinet secretary in his closing speech to confirm that informed consent is still being highlighted across the health boards in relation to mesh surgery. Let me draw my conclusions to an end, and I completely understand that some of the members of the public who signed this petition will be disappointed that mesh surgeries are going ahead. I trust that the communications from the Scottish Government and healthcare professionals will give reassurance and the reasons behind this. Fundamentally, it is crucial that we listen to the people who have suffered from mesh surgery complications. My constituent was not listened to. Rosanna was dismissed at first and told her pain was in her head. I am sure that there will be many others with this experience. Only by continuing to listen to people with lived experience can we ensure that we start the important process of supporting any person that needs this type of surgery and get the best possible care in place for the future. I welcome the opportunity to speak in this debate today. The mesh issue has been in the Petitions Committee agenda since my arrival in this place, and it is fair to say that it has delivered some of the most harrowing of evidence sessions that I have been involved in with my time here. It certainly focused my mind on the fact that what we do in this place, amid all the other white noise of political discourse, has a profound effect on the lives of people in Scotland. In the case of this debate today, a topic that has had a far wider reach and implications than just within our borders. I also wanted to say in particular evidence session at the site of the cabinet secretary and the chief medical officer being cross-examined in committee room 1 by committee members and former members, with so many women affected by this procedure sat behind them, many in wheelchairs. It is a vivid one, and every time I step into committee room 1, I always remember that picture. The fact that the then committee was drawn by the now convener, Jackson Carlaw, Alex Neil and Neil Findlay, highlights the cross-party support for this campaign. I would like to put on record that the undaunting pursuit of this issue by my colleagues, Jackson Carlaw and previous colleagues, Alex Neil and Neil Findlay, was so important in arriving at a solution for the petition of such a harrowing issue. Without their determination and effort, it is unlikely that we would get to where we are now, and considering the time that it took to get there, Deputy Presiding Officer, remembering that I have been involved for nearly seven years and that is way short of my other colleagues, for such an acute issue that it seems ridiculous to me that, firstly, it took so long to make the Government move on this and accept that there was a major problem, and secondly, here we are again discussing similar issues and trying to ensure that similar outcomes that we require are realised. Having said that, and given the recent political discourse, it does restore a bit of my faith in this Parliament that we can affect change for the good of the country if we do come together across this chamber. I would also like to add my again sincere gratitude to the Scottish Mesh Survivors campaign for their unrelenting and resolute campaigning to try to ensure that what they have had to endure was spoken in a public forum and that their desire that no one else needs to have their lives devastated by potential repercussions of the use of mesh. This campaign also highlights the national and international impact that a public campaign can have through the Petitions Committee vehicle. Back then, there were questions to be answered. Firstly, how a former health secretary, Alex Neil, can take the robust action of imposing a moratorium on the use of transvaginal mesh only for certain health boards to continue to use the procedure to treat stress newly incontinence. I think that there were some 400 women undergoing this procedure since that moratorium. Who was ensuring the moratorium was adhered to? Who was responsible? Rules cannot be set if there is no system of enforcement. It was news to me and many other MSPs apparently as well as the campaigners that a moratorium called for by the Government is not binding. This has to be an area of concern and something I think the Parliament is still to address. Had that moratorium held, I don't think we'd be in the position we found ourselves in. I also want to say that the involvement of the MHRA was absolutely shocking. A body in whom we place a great deal of trust and responsibility has been exposed as inadequate and incapable of applying any degree of logical care. In fact, claiming that the sufferer's pain could be psychosomatic, no duty of care and candour. It was painful watching the chair of the review squirm in the chair under questioning during the evidence session. Her answers causing gasps from the women seated behind her. A lack of empathy and understanding was all too evident. Given the language used at the time from certain conditions around, it is all in your head as highlighted by Jackson Carlaw on behalf of the committee. The way in which that kind of language really slowed up the process of getting to that moratorium in the first place and the subsequent positive results for the transvaginal mesh petitioners, it is a worry to hear that that kind of language is creeping back into similar concerns from the men who have had or are considering mesh implants for herny repair. As we know, men are not so good at talking about health issues and certainly more reticent to organise themselves the way women mesh survivors did and to push for justice in the way that they did. We would all want to avoid a similar situation down the line where we are taking evidence from a group of men suffering from the misuse of a similar procedure. One of the key elements for me that came out of the initial petition was the lack of discussion around options available for treatment and the possible repercussions. I think furthermore the subsequent way the international community has communicated and delivered better medical solutions must be applauded and further cognisanced given to the co-operative working continuing as we develop the right solutions. Now, I listened with interest to my colleague Sandesh Gulhally who obviously has massive more experience than I have and he talked about the right procedure conducted by the right surgeon and I think that Deputy Sprengh's officer brings us to the crux of the matter. I would ask, as the committee are considering, for a pause to ensure that the pathway of treatment reflected that desire to have the best treatment by the best surgeon. I once again would like to thank the petitions for their courage and persistence and I would like to assure them that they will be heard through the committee. I would also urge the cabinet secretary to learn from the mistakes made in dealing with transvaginal mesh. It is entirely reasonable to note that the petitions committee are considering less the use of surgical mesh and potentially a moratorium until such times. There is a full review of all those surgical procedures and that more comprehensive information detailing all treatments are available. We must avoid at all costs another session in committee as I previously highlighted when it was too late to prevent such painful complications. I look forward to further deliberations by the petitions committee, Deputy Presiding Officer. Thank you, Mr Whittle. I now call Emma Roddick, who will be the last speaker before we move to closing speeches. Around six minutes please, Ms Roddick. Thank you, Presiding Officer. I want to start by saying that I enjoyed hearing from Jackson Carlaw earlier about the history of campaigning in this place around the use of mesh. I was very interested to read back on his committee's work over the last few years on this petition. My reliable source of pre-2021 parliamentary gossip has had to pop out for the moment, but Christine Grahame tells me that he has been a stalwart on this very much cross-party issue. I am pleased with the progress that was made last year on transvaginal mesh ensuring that mesh injured women can access treatment in Scotland or elsewhere with an independent provider if that is what they want to do. I want to repeat something that I said back then and encourage any of my constituents in the Highlands and Islands who would like a referral to any of those services to make their wishes known to their clinical team, and then they should be able to access the best possible treatment for them as quickly as possible. One strong theme during that debate last year and reflected in what I just said was the importance of choice for patients—the choice to see the specialist that they want and not have a particular pathway prescribed by the Scottish Government in exchange for supporting necessary removal of mesh. That is my concern and probably my only concern about this petition. There has to be choice for patients. Informed choice, and I am certain that despite the great steps forward taken in realistic medicine in Scotland, there is work to be done there in making sure that patients feel empowered to understand their treatment, ask questions and even request alternatives, even through what is undoubtedly a power imbalance between them and their doctor. We have all heard people who have been laughed off for consulting Dr Google, but patients should be encouraged to find out more about their own needs and their own treatment. Mesh is still considered suitable in some situations and it would not be reasonable to remove that choice from patients here and now when medical guidance is still that it can be the most effective treatment in some circumstances. That would be particularly concerning where there is no obvious alternative and certainly no risk-free alternative. I understand that the Minister for Public Health told the committee last year that the chief medical officer had written to health boards to encourage them to consider the availability of non-mesh alternatives and address any skill gaps. To me, that certainly needs to happen alongside, if not before, efforts to cease the use of mesh altogether. If the Medicines and Healthcare Products Regulatory Agency were to come out and say that mesh is not suitable, then this petition's ask would absolutely be the right move. At the moment, the guidance is that it is still suitable in some situations and I think that we have heard that echoed quite clearly from others in the chamber with medical backgrounds. In the meantime, it is right that the NHS is particularly vigilant with procedures where mesh is still used and I understand that protocols are in place to ensure that. We all have a responsibility here to make sure that lived experience is heard and mesh is not being used inappropriately or carelessly. I am glad that the issue is still being given deserved attention. It is right that the Scottish Government keeps an eye on on-going work and forthcoming research, as well as any emerging patterns in complaints from patients who have experience of mesh. I am sure that many members across the chamber will ensure that their eyes are not taken off the ball here. I also want to finish by thanking those who lodged the petition and contributed to the debate surrounding it. I share their concerns and I completely sympathise with their position. I have read submissions to the committee and it is always devastating to hear that people and usually women feel dismissed by doctors when they experience complications or negative symptoms. There is no doubt that mesh has previously been used when it shouldn't have and women have not been listened to when they should have. As a young woman with a chronic illness myself, I completely understand that feeling and I am all too aware of the possibility that seeking medical help can mean facing condescension or even being ignored and then suffering further harm as a result. My heartfelt empathy goes out to all those who are brave and passionate enough to use their stories to influence us and to help others. I hope that regardless of whether and for how long mesh is used to go forward, the petitioners know that they have contributed very strongly to the discourse around mesh, the need for specialist mesh removal services and the wider issue of informed consent. I think that we have heard some very considered contributions today and I hope that the impact that the petitioners have had on all of us is clear to them. It would be very helpful to hear from the Scottish Government how monitoring of the use of mesh will happen going forward. Before moving to closing speeches, I would just express some disappointment that we seem to have two members who have not shown the courtesy—oh, we have one member who has not shown the courtesy of being here for closing speeches and presumably that message can be communicated in the apology to the Presiding Officer given. We will now move to closing speeches. I call on Paul Sweeney to wind up on behalf of Scottish Labour around six minutes, please, Mr Sweeney. I am grateful for the opportunity to speak in this afternoon's debate on the suspension of surgical mesh, both as a member representing survivors of mesh repair and as a member of the Petitions Committee, which is considered this extremely important matter in various forms over the course of some 10 years, ably convened by the member for eastwood and has done so with great diligence and great sympathy and empathy for the people who have been affected by this. I think that it has been the Parliament at its best. It really has been impressive as a new member to this institution to see how accessible and effective it is at addressing serious concerns of marginalised groups in society, and for that I commend the committee's work. I would like to begin by extending my gratitude, as mentioned by Katie Clark to Roseanna Clark and Lauren McDougall in particular, for their tireless work in keeping this issue on the parliamentary agenda, by sharing their harrowing experiences of mesh repair, as described in quite stark detail by Mr Carlaw earlier, with parliamentarians and the public alike in committee. The constant reliving and sharing of that trauma is not easy, and it is not easy to listen to and it must be even harder to talk about, and so for that I would like to commend their courage in sharing their stories to the committee and in serving the public interests so well. I hope that the cabinet secretary has heard those remarks today, and he will consider that very reasonable request for these women to meet the cabinet secretary personally to describe that in detail and how they would like to seek the address, not just merely through the committee, but also through the machinery of government, and I think that that is a very reasonable request. Transvaginal mesh is an issue that has been raised in parliament on a number of occasions, but this petition crucially focuses on the use of surgical mesh and fixation devices elsewhere in the body, and that is a crucial distinction, particularly in relation to hernia repair, which has continued to cause pain and discomfort for survivors. The petitioners have rightly raised the complex problems that mesh can cause, including infection, pain and adhesion. A lack of specialist services for survivors to explore treatment and removal is an issue that we have seen with transvaginal mesh, and unfortunately the lack of treatment options is a key issue for survivors of hernia mesh repair too. There are some mesh specialists scattered throughout Scotland, but it is scarcely enough, and many survivors' referrals to these professionals are rejected, especially if their mesh repair was used for hernia treatment and was not transvaginal. So, Deputy Presiding Officer, medical professionals are trying their best to be of support to mesh survivors, but the simple reality that we have heard through committee in evidence is that there is not a clear pathway for referral and treatment for their patients who are left feeling alone, isolated and reliant on emotional support from other survivors and their families in the absence of specialist medical treatment. This is not sustainable or acceptable to deprive mesh hernia repair survivors of options to treat or remove mesh, forcing them to live in chronic pain, and that is why I was dismayed by the Conservative spokesperson's citation that they would oppose this agenda today, this petition. I think that that is deeply harmful to these women, often women who have said that they have suffered acute pain, and I think that everyone is cited. I'm happy to give it away. It would be the suspension that we would be against, but as you heard in my speech, I would very much be in favour of data gathering and further finding out. I thank the Conservative spokesperson for that clarification. I think that suspension in this instance was about addressing real harms experienced here, and I think that that is something that should be considered in the shadow minister makes the point about evidence gathering, but the issue is that he described the low rate of defects, for example, the low rate of having to do repairs, but the reality is how can the evidence be valid or reliable when so many women are denied agency in the healthcare system? That was the very issue that this petition was seeking to address, Deputy Presiding Officer. It was the fact that we're in a kind of logical circular issue. We're short-circuiting the issue. We're not actually addressing the reality of the evidence. It isn't picking up the lived experience of these individuals. That's what this committee was seeking to serve as a remedy for, and I would hope that the shadow minister might consider that, although there is a necessary need, and hopefully the minister will also consider this, we need to gather more evidence. Those witnesses' voices have not been heard thus far, and that is simply not acceptable. What are we going to do as a Parliament to address that? What is the Government going to do to address that? Of course, Canada stands as a stand-out example of what can be done with national specialist centres for surgical repair for mesh and fixation devices. Survivors have expressed that they would like to see that delivered in Scotland. The shoulder hospital is specifically devoted to hernia repair. The centre holds the largest single database of hernia patients in the world. Each surgeon performs 600 to 700 hernia surgeries per year. The shoulder repair technique has a lowest rate of recurrence, as was described by Mr Carlaw. It's clearly a model that, while in the short time we should be looking to enhance services that already exist in Scotland to better treat and remove mesh, the long-term goal should be to establish a similar national specialist treatment centre where survivors can access the support and treatment that they need from specialist medical professionals. The shoulder clinic has caveats such as weight loss, stopping smoking, stopping alcohol, and they are very selective in the patients that they take for their non-mesh repair. It's difficult to compare that with the patient population that we have in Scotland. Would you agree with that? I think that you heard that in evidence. That's certainly an important clarification and useful to have on the record for sure that they are important caveats. Nonetheless, it was very explicit and clearly expressed in evidence that having that concentration of medical professionalism skill was critical to achieving low recurrence rates, and that doing high volumes in a nationally focused centre was absolutely important. As was mentioned by the shadow minister in his remarks about having the need for evidence, let's look at how the structure of the medical service provision and the treatment pathways are provided. I think that concentration in a national centre is something that was compelling in evidence. As Labour shadow minister in this area and the minister previously put to committee, it's important that the model is supported. We should look at delivering it, even though if the Government doesn't think that it's workable, it's something that merits further investigation. If the issue of people living in chronic pain and illness due to mesh repair anywhere in the body is to be tackled, we need ambition, not abdigation. Those people deserve much better. I now call on Alexander Stewart to wind up on behalf of the Scottish Conservatives around seven minutes. I'm grateful for the opportunity to close the debate on behalf of the Scottish Conservatives, and I strongly welcome the opportunity of Parliament to have this debate here today. As a member of the Petitions Committee myself, I would like to commend our committee convener, Jackson Callow, and my fellow members of the committee for the way that they have conducted themselves during the sole process. To have a committee debate here today is an extreme example of what can be achieved, and I really hope that the petitioners will see and take forward many of the views that have been expressed today. A common theme throughout the scrutiny of the petition has been that campaigners feel that their views are not being heard and they have not been listened to. Following on many of the passionate contributions that we have heard this afternoon, I hope that things come out from this debate will be that campaigners feel that the issue that has been affected is being looked at and is being realised by this Parliament. The issues around the use of transvisional mesh have been also documented extremely well, and many speakers have talked about the opportunities that have taken place during that time and the flexibility that has taken place. The whole idea of mesh and the fixation and devices that have been dealt with are much less scrutinised than have been done in the transvisional mesh. I thank the petitioners for their courage in bringing forward this petition and giving us the opportunity to debate it here today. Many of those who have encountered the concerns has been widely recognised that there is a long-running debate around transvisional mesh. As many individuals have talked about today, the work of Jackson Carlaw, Alex Neil and Neil Findlay in the previous Parliament and bringing forward and making sure that that was listened to showed once again how this Parliament can, when working together, achieve great things for the people who they represent. We have seen and we have heard distressing accounts from individuals whose lives have been turned upside down by mesh complications. Some of those wrote to us and they undertook that in good faith because they were not necessarily aware of many of the risks. It is much to their credit that, through their pain and procedures, they have decided to talk publicly about that process. It is also widely taken up that many individuals suffered extremely and continue to suffer. We have a role to play to ensure that that is recognised here within this Parliament. We are their voice and we will give them the chance. As I said today, it has shown how that can be achieved. I would like to talk about what people have said today, because what has been said by many people about this whole process is vitally important. We have heard about the Scottish Health Technology Group continuing to support the use of mesh and hernia. We have also heard about many of the mesh-related complications that have taken place. As I said, many speakers have spoken about their constituents and individuals whom they have had personal contact with about how that takes place. It is an opportunity for us to ensure that there is greater clarity when it comes to certain types of devices and the uses of their procedures. With that being said, our experience of dealing with this issue, especially when it came to transventional mesh and the technology that was going with it, many people experience problems, and that has been talked about. It is also important to consider alternative treatments and pathways to mesh. That has been discussed today. The evidence that we took as a committee from Canada when it came to Dr Fernando Special Nito at the shoulders hospital in Canada, he talked about it and gave evidence to us and suggested it. It has been useful to hear comments from others today about what has been happening at that hospital. Scotland has a different healthcare system than Canada and has some different population diagrams when it comes to managing all that. Nevertheless, the Government is taking seriously the consideration and learning lessons from what is happening in Canada. As expected, today's debate has seen a number of important and passionate contributions, and I would like to dwell on them for a moment or two. Our convener, Jackson Carlaw, as I have said, talked about the life-changing effects and also talked about data. The way that the Scottish health technology group suggested that there were 10,500 annual repairs that took place in Scotland and 62 per cent of those procedures were dealt with with mesh and that 32 procedures were removed, but there was not enough data about to find out the real aspects of that. The cabinet secretary himself, in his opening statement, talked about the distress to patients and acknowledged that distress, and that is vitally important. The adverse effects that those individuals have suffered. He also talked about data collection and the issues regarding that, and then moved on to local clinical groups, rather than to the national centre that has been suggested by the petitioners. My colleague Dr Sanders Gilhane, who has expert knowledge and experience in many of this, talked about the need to have petitions like that so that there can be the opportunity to debate and discuss. He spoke about the issues that are happening on Canada and the risks that come in place with patient size, with complications, with infection, chronic pain and numbness. All of that is vitally important to ensure that the best is given to them all. Jackie Baillie gave a very strong and passionate speech, as she always does on health topics, and I enjoyed it greatly. The Scottish Government must learn lessons, she talked about, and it is important that the Scottish Government learn lessons. Lived experience was talked about from Jackie Baillie, and pathways were needed. Those are vitally important, and 10 years have taken and nothing has happened, Jackie, and all of the comments that you have made, I do hope that the cabinet secretary takes on board. Alex Cole-Hamilton also spoke about the risks, side effects and tragic stories that we have all had to deal with. That, in itself, is the crux of the story, because we have all heard and seen and got the lived experiences from constituents. Meghan Gallacher once again spoke about data and the evidence-based approach, but she also talked about waiting times that everyone is experiencing at present, and how that knock-on effect could have a real impact on their way forward. Emma Harper, our nurse, spoke about the crucial and critical tool that mesh is, and that people should be treated with kindness and compassion and respect. We would hope that that would be the case in all individuals, but we have seen and we have heard that many people found that not to be the case. Brian Whittle spoke about the effects that he had and what he saw when he saw the transnational mesh situation. In conclusion, we have had the real opportunity to see first hand, and I hope that the cloud of all our warning signals that have taken place is about ensuring that we do not see and we do not have the same mistakes that have been made in the past. Everyone who has suffered due to mesh in the past or anyone who might in the future risks and the skill that takes forward. We owe it to them to ensure that we do all we can to ensure that they are listened to, understood and respected for the report. As I say, I commend the petitioners for what they have done so far. I now call on Cabinet Secretary Humza Yousaf to wind up on behalf of the Scottish Government around eight minutes, please, cabinet secretary. Thank you very much, Deputy Presiding Officer. I thank all the members from across the chamber for their contributions. It has been a very good debate. There have been very common themes that have been raised right throughout from members again across the chamber. There are also very diverging opinions on what the next steps should be. That has not diminished at all from the debate. Sometimes we can only assume that the best debates are consensual. That is not always the case. There is consensus on a number of points, and maybe I should start at that place first. There is absolute consensus that those petitioners who are raising those issues that we all have gratitude to them for sharing their stories and sharing the stories of their loved ones, but their pain that they are describing, be it on their own behalf or on behalf of a loved one, is very real. There is nobody here who is doubting that. As I said, I would already be greatly upset and quite frankly angry and annoyed if stories are brought to my attention where issues around pain and chronic pain are being dismissed by clinicians. I do not think that that would be the experience of the majority of people, but I accept in some testimonies that we have heard that that has been the experience of some. As I said, I am very open to members of the public or members in this chamber writing to me directly in relation to some of those concerns. Where else do we have consensus? I think that we have consensus in the act that Government, mainly, should be learning from some of the journey that we went on in relation to the women who were affected by transvaginal issues. I do not take away from what was said from critics when they argue that it should not have taken 10 years to get to the place where we eventually ended up. I think that that is fair. It is imperative that Government learn from that, and I am absolutely committed to doing that. On the points of some difference, the difference centres on what happens next. There are some members who are very passionately arguing for a complete suspension of the use of mesh and hernia mesh. There are others who are saying that that would not be the right approach. The majority of contributions to that is probably not the right approach at this stage, but one to be continually kept under review. All that being said, for those who have called for a suspension of mesh, I hope that they will be at least in part—because they will be disappointed—but in part reassured by the fact that we are aiming to improve data collection, which is another common theme. What does that look like? There has been some work that has been done already and undertaken by the British Hernia Society, which a number of members will be very aware of. On our own working on data collection, what we are aiming to do is that the NHS Scotland Scan for Safety programme will effectively improve patient safety. It will provide electronic traceability and link patients to implantable devices in acute care, so that we can get real-time data electronically in relation to any issues that might be cropping up. As I said, that is in addition to the work that has been done by the British Hernia Society. It has made progress in establishing its own registry, which it will begin piloting shortly, and we will be watching that closely and working with the British Hernia Society very much where appropriate. I wanted to address some of the other issues that were raised by a number of members across the chamber. I thought that Senator Gohani's contribution—and more so, if he does not mind me saying his exchange with Jackson Carlaw was very interesting to watch, because Dr Gohani made it very clear in his response to Jackson Carlaw that, first of all, the clinical advice that is provided is one that people should listen to. Equally, we all agreed that that should be a discussion between patient and clinician, but, equally, he also said that he had no issue with a mesh implant either in himself or indeed within another family member. We can see from a clinical perspective that there continues to be a high level of confidence, because what Dr Gohani expressed is being expressed by many clinicians right across the country, up and down the country. We saw that from the Scottish Health and Technology Group 2. There is a high degree of clinical confidence in the continued use of mesh. Now, where alternatives can be explored, they should be explored if that is what the patient wishes, and it should be made very clear, as with any surgery, of course, the potential complications or risks that are inherent with the use of mesh. Informed consent—this was an issue that was raised by many members and Siobhan Brown to ask specific questions about informed consent. Let me give her and other members an absolute guarantee that informed consent is not just an issue that I take very seriously, it is an issue that I have discussed with our chief medical officer, and he takes very seriously too. I am very encouraged to hear from patient groups that informed consent processes have improved quite significantly. The importance of shared decision making and informed consent is the very centrepiece of realistic medicine. Government often talks about it, but it is something that is very close to the heart of the chief medical officer. We want people to be fully involved in the decisions about their care. That is why we are encouraging people to ask their healthcare professionals questions to help them to make those informed choices and equally for clinicians to ask questions when they are in discussions with their patients. What are the benefits? I will shortly. What are the benefits? What are the risks? What are the alternatives? What if I do nothing? Those are the questions that we expect clinicians and patients to be asking each other. Briefly, would the cabinet secretary agree with me that 10 years ago it would have been impossible, five years ago it would have been unlikely, but this afternoon we have had a substantive informed debate with contributions from all across the chamber on the subject of mesh, and is that not actually the perfect tribute to all those campaigners who, over the last 10 years, have worked so hard to ensure that this Parliament understands the issues under pinning mesh, as well as they now do? Not for the first time in this debate, I agree wholeheartedly with Jackson Carlaw. I am beginning to doubt myself in the amount of times I have agreed with Jackson Carlaw and this afternoon I have to say, but he has, and I say that only in jest, because he knows that he has my admiration, as well as the admiration of the Government in relation to the excellent work that he has done on the issue of mesh, both transvaginal mesh and indeed the wider issues on mesh. I have been in front of his committee that he convenes and he takes, I know how seriously he and other committee members take these issues. I also hope that the testimonies and the stories and the bravery that has been shown by the women that have been affected by transvaginal mesh does give confidence for others to come up and speak about their own complications and their own health in relation to their own health, whether that is mesh or otherwise. That should be seen as a good thing, although there may be disagreements between us in relation to the way forward. People speaking about their health openly, raising issues about complications or harmful impacts of any procedure, it is important that the Government knows about that. It is important that the health service knows that, of course, I give way to that as well. I thank the cabinet secretary for giving way, but would he agree, though, that in encouraging people to speak up it is really important that they are listened to and that what happened previously with the transvaginal mesh, that their comments are keen to hear what they have to say. I agree wholeheartedly with that, and that was a common theme from the women who were affected by transvaginal mesh. I continue to try to make progress in terms of some of the other issues that were raised. I think that a couple of members have asked if I will meet with the petitioners. I do not know if I have had a request to meet, if I will double-check that, but I will give absolute full and due consideration. I am not necessarily convinced that it will change my opinion, given the Scottish health and technologies group reviews and reports, but there is nothing to be lost from meeting with petitioners, with members of the public, about their experience and their family's experience, so I will give that consideration when a letter or correspondence comes to me to that effect. I think that it is important that Jackie Baillie and a couple of other members mentioned Canada and other international examples that we should look to. I think that it is a very fair comment that we should look to other jurisdictions and other countries across the world. I am not sure, maybe I have the wrong information, but I am not sure that Canada has suspended or halted mesh in its entirety. I think that they have for transvaginal mesh, but whether they have done that for all mesh procedures, I am not entirely sure, but I will double-check that, and if that is the case, of course, we should be linking in with our health colleagues in Canada. Brief intervention and brief response, Paul Sweeney. I thank the minister for giving me that point. We addressed the issue of the structure, the specialist surgical centre. That was a key aspect of the evidence from the Canadians. Would he consider that replication in Scotland? We have considered it. The points that were made by Marie Torr in front of the committee when she was asked about that very point remain. We were talking about two very different health systems. I referenced them in my opening comments as well. If we were to have, for example, a specialist centre for the number of hernia operations that are done, that might involve people having to travel to one particular centre where they could be seen closer to home. However, let us not dismiss the issues that are raised about pathways and specialist centres. I know that I am running vastly over time already. Let me reflect. I recall one of the debates when we were taking forward the Transvaginal Mesh Removal Cross-Reimbursment Act and I commented that our work on mesh had really shown this Parliament at its very best. I really just end on the point that Jackson Carlaw made in his intervention. I hope that we can continue to work in this spirit when considering what more can be done to the patients, although they may be disappointed in the fact that the Government is not suspending the use of mesh and hernia operations. I am listening. We are listening and we are committed to ensuring that people get the care that they need. I now call on David Torrance to wind up the debate on behalf of the Citizens, Participation and Public Petitions Committee. Around nine minutes, please, Mr Torrance. I am pleased to be closing the extremely important debate on behalf of the Citizens, Participation and Public Petitions Committee. I thank my fellow committee members and, of course, committee clerks who support hard work and guidance to elected members is vital and very much appreciated by the committee. I also thank my colleagues who have contributed to today's debate. As a convener set out earlier, the Cabinet Secretary, Alex Cole-Hamill, and many of my colleagues have mentioned throughout, we can be left in little doubt about the devastating impact surgical mesh had on some patients across Scotland and their fight to be believed about their condition. In our consideration of this position, the Citizens, Participation and Public Petitions Committee has gathered a wide range of evidence to assist our understanding of the use of surgical mesh and its impact. I also like to put on record my thanks to petitioners Roseanna Clarkin and Laura McDougall and all those who have shared their experiences of this issue with committee over a course of the past 20 months. This is not the first time we have debated the effects of mesh treatment. As a Parliament, we have been speaking about surgical mesh in one way or another for almost 10 years now. Jax and I were both members of the Petitions Committee when the issue of transvenginal mesh was introduced and I am honoured to be standing here today with Jax and his convener and I, his vice convener, of the committee as we debate this petition. Why we have made welcome progress for those suffering from complications from the use of transvenginal mesh, the issues of Roseanna and Lauren have raised in the petition remain to be resolved. It is for that reason that I want to focus my remarks this afternoon on the finding solution to concerns that have been raised. Since the petition was submitted to Parliament for our consideration, the Scottish Health Technologies Group has published two reports on the use of mesh in hernia repair. First of these reports provide an assessment of the use of surgical mesh for repair in hernia in male patients. Dr Gahane mentioned this earlier on in the findings that the use of a mesh meant that men were less likely to have their hernia return. The report also found that use of mesh meant that men were less likely to suffer urinary retention, injury to nerves, blood vessels or internal organs, but it reported that patients were more likely to develop a build-up of fluid or swelling soon after surgery. The SHTG has recommended that all elective in girl hernia repairs should be proceeded by detailed discussion with patients to help manage their post-surgery expectation. As we have heard from patients, it is vital that these discussions do take place ahead of any surgery to ensure that it can reach a fully informed decision about their health. We have heard how the recommendations were further developed in the second SHTG report, which explored the use of surgical mesh in repairs of the lung and groin herniers and adults, not just male patients. Although both reports have concluded that evidence appears to support the continued use of surgical mesh in hernia repair, it is worth highlighting the recommendations that patients preference for non-mesh repair and access to alternative hernia management options should be available. The report also mentions that patients should be provided with detailed information on hernia repair in a variety of accessible formats. Anyone who has been in hospital appointment to discuss treatment options will know how challenging it is to absorb all the relevant information and feel confident that they are making a fully informed decision. Therefore, making this information available in other formats, written and verbal, would certainly be a positive development. A committee heard that the chief medical officer wrote to all health boards in December 2021 highlighting the SHTG report asking them to consider the availability of non-mesh surgery. We also heard from one of the Scottish Government's senior medical advisers, Terry O'Kelly, who stated during our evidence session in June 2022 that it is critical that, when appropriate, patients have access to non-mesh surgery, which might be provided by her health board or by another health board elsewhere in Scotland. As raised by Paul Sweeney this afternoon, the committee also heard from patients that this is critical when ensuring that there are patient pathways for those who have been made aware of risk and want to pursue an option of non-mesh treatment. Emma Harper I thank David as deputy convener David Torrance for taking an intervention. We have talked about mesh this afternoon but we have not really talked about the titanium fixation devices, which is also part of Roseanna Clarke and Lauren McDougall's petition. Would he agree that further discussion might be necessary, further evidence might need to be taken and that also we have biodegradable fixation devices now and they are being used more often? I thank the member for her intervention. The committee is still taking evidence around what is raised in the petition so I think there is a scope there for us to look at what has been suggested by Emma Harper. As a key aspect of ensuring patients have access to I forgot where I was at but as a key aspect of ensuring that patients have access to those alternatives will be identifying any skills or training gaps and as the convener has mentioned already this afternoon we look forward to hearing the findings of the Scottish Association of Medical Director's report on the availability of non-mesh surgery in health boards across Scotland. It may feel like a long time coming but we welcome steps to support patients in making informed decisions before any surgery takes place. Getting things right at the beginning of a patients journey is important. We have heard a lot throughout the committee's deliberations and indeed this afternoon about the complications that arise when mesh doesn't work as patients and clinicians have hoped. There is a small minority of surgeons who prefer to use natural tissue repair and only use mesh as a last resort. As a committee we are interested to hear about more of approach as a convener touched on early at the beginning of the debate and Alexander Stewart and several other members have mentioned we took evidence from the shoulders hernia hospital in Canada. Shoulders is the only licensed hospital in the world dedicated to hernia repairs and has been a steadfast supporter of natural tissue hernia repair for over 76 years performing over 400,000 abdominal wall hernia repairs. To date we use mesh in less than 2 per cent so mesh is still used in Canada in all other cases and the surgical outcomes remain the gold standard in a abdominal wall hernia repair. A committee held a virtual evidence session with Dr Fenner Spencer Nettle, the chief surgeon at shoulders hospital to discuss the work of the hospital during this session and were given his views towards the use of mesh. When asked Dr Nettle would a ban in the use of mesh in hernia repairs be a good thing, his response was, in some situations there is no possibility ever to close the opening with mesh. Sometimes the herniers improve, the surgeon's knowledge of how to treat herniers also improves, the stats from today are probably very difficult from the stats on patients who were operated on five to ten years ago. In relation to hernia repairs it is not possible for her to be a ban because in some situations using mesh is the only way to do a good repair. Given the success of the shoulders hospital with natural tissue repair, which has resulted in lower reoccurrence of herniers, it is extremely helpful to speak with the surgeon as experience of Dr Nettle. Nothing less, while there is undoubtedly much that can be learned with regards to skill, training and techniques that are used in the shoulders hospital, it is important that these successes and achievements must be taken into context of our own healthcare system and culture. Pre-offensive preparation and post-operative care for hernia repair surgery in Scotland and patients treated at the shoulders differs greatly in terms of application and strict criteria selection. A hospital applies selection criteria such as weight loss before emitting patients to shoulders hospital. We also do not take patients who might have more complex medical news such as those who might need a backup from cardiology or intensive care units. Dr Nettle told us, if a patient in question is to choose and wants to undergo weight loss, that is okay. Sometimes there are patients who need to lose, say, £50. Indeed, there have been patients who have to lose £100 or more before they have had their operation. Sometimes we also change the estimated ideal weight a little bit. One of the suitable criteria for patients' medical decision is if they have chronic conditions, it needs to be stable before they can have operation. With obesity, though, it is questionable whether we can do tissue repair, because operation is a lot more difficult when decisions has to be bigger, wound can be infected, there can be more hematomas and frequently one complication will lead to another. That is why we always try to patients to get to a correct weight. Unless there are some very specific things that happen, most of them will reach a correct weight or at least get very close to it and they have operation. I am 100% sure that that makes a difference to a final result of individual patients. That raises an important question regarding the restriction of access to treatment, because of personal criteria and whether such criteria could be brought into play here and would be acceptable to the members of the public. For some patients, the use of surgical mesh may be the most appropriate option available to them. It is important to know that a petitioner has not called for a permanent ban on the use of mesh, but rather a suspension of it is used until we can understand the complications better and ensure robust guidelines for it to be established. The evidence of our committee has gathered indicates that there is still work to be done to track outcomes of the use of surgical mesh. As the minister has mentioned in the evidence, there are challenges in tracing what products have been used and in which of these are causing harm. By recognising the regulation of a medical device as a reserve matter, the committee has also noted cross-party support in this Parliament for a Scottish Government's effort to make progress on the issue around the regulation of these devices. In conclusion, our committee has a powerful testimony from individuals living in constant pain following the use of mesh. We have heard from experts on alternatives that could be used and we have heard about the need to improve patients pathways and embed a culture of informed consent. What has been clear as we have heard all this evidence is that we cannot wait another 10 years for the solutions to be developed and implemented.