 The next item of business is a member's business debate on motion 5086 in the name of Daniel Johnson on mesh treatment clarity. The debate will be concluded without any questions being put. I would invite members who wish to participate to press their request-to-speak buttons now as soon as possible. I call Daniel Johnson to open the debate for around about seven minutes. Thank you very much, Deputy Presiding Officer. Thank you to all of those that have made it possible to bring forward this debate to the chamber this afternoon. I rise very mindful that this is, I think, the first time I've spoken on mesh. What goes before me is, I think, the really tragic situation that many women have had to face over a number of years of debilitating pain and life-changing procedures from which they'll never truly recover. I also am very mindful and pay tribute to those that have gone before me in terms of raising this issue, particularly my former colleague Neil Finlay, whose work on this was truly outstanding, and indeed Jackson Carlaw, who have tirelessly campaigned on this issue. The reason I'm bringing this forward this afternoon is really quite simple. I was approached by a constituent who was having undergone mesh treatment. While grateful that there has been movement and progress, still has questions about the current status and situation. I simply saw a member's debate because it is a means of inviting a minister to the chamber so that we can put those questions and have these updates that are required. The simple reality is that, while there are things that have been put in place, treatment made available, this is an issue that will never truly come to an end for those women that were implanted with mesh. We must not let this issue go quiet and we must continue to endeavour to provide that information and updates. The issues around mesh have been well discussed, but let me just very briefly restate the situation in terms of approximately 40% of women who underwent trans-vaginal mesh treatment faced immediate physical complications. A further 40% had complications within two years. These complications range from leg-growing abdomen back to bowel issues, or to immune disorders, neurological disorders. This chronic pain is difficult to overstate the life-changing and debilitating consequences that it has. It's not just physical pain. TvM has spoken of the impact that TvM has had on her mental health from severe trust issues to post-traumatic stress disorders and panic attacks. There's a real sense of mounting frustration that she and others have about the lack of clarity and information, but it's also the financial impact, the reduction of working hours, giving up paid work, and the financial impact of being able to take up the care and treatment that they required. To that end, I would like to ask a number of questions this afternoon. I hope that other members will as well. I've spoken informally about the tenor and manner that I was attempting to convey through this. To that end, my first question is about support for after-care provision. The Scottish Government fund ran for two years from July 2020 to June 2022 with £1 million set aside for those who suffer from the after-effects of mesh for purchasing self-care items such as incontinence pads and undertaking travel. Can I ask how many women benefited from that fund and how much of that £1 million remains and what will be done to extend any potential funding that women may require? My second question is regarding access to removal surgery. The recent contract to enable NHS patients to visit Dr Veronica in the United States and receive transvaginal mesh removal surgery is welcome, but there are key issues that require clarity. First and foremost is the fact that in order to access this, many women are having to go back to the very facilities and the very physicians that actually perform this procedure on them. It is understandable that that is potentially hugely traumatic and I think that it is very difficult for those women to trust those individuals who carried out those procedures in the first place. Can I ask the Minister first and foremost how many women have actually been able to take up this offer and travel to the United States for surgery from Dr Veronica's? More particularly, does she acknowledge that there is a need to have a more sensitive and prudent approach to both the consultation and assessment for this procedure in terms of having to go back to the places and the physicians that undertook the original treatment? Ultimately, and this was the question that my constituent asked me to ask, how would she feel she had to go back or a family member had to go back to that person? I think that is an understandable question to ask. Question 3 is about the reimbursement fund. Well, there is a £20,000 fund available for those to seek this treatment to get this treatment privately because that is a reimbursement fund. Unless you have that £20,000 available to you, that fund might as well not exist at all. So can I ask again how many women have been able to use this and will the government consider the impacts for those who cannot afford £20,000 and where reimbursement quite simply is inappropriate? I'd also like to ask a question about other medical devices because this is not simply limited to trans-vaginal mesh. Devices such as Isher have also been used, devices which have either subsequently been found to cause debilitating side effects, pain or indeed withdrawn from use altogether have been used and many people suffer from them. I've been contacted with women who underwent Isher. So can I ask what work the Scottish Government has undertaken in order to identify any other issues such as Isher? What work it's undertaken to reach out to people that have been affected and indeed extend and provide treatment to them? Now there are many other questions that I'm sure other members have. My time is coming to an end, but I do hope this is an opportunity for us to get updates and clarity. I hope and certainly I personally intend to bring forward future emotions or seek other opportunities to get that clarity because I think that's our duty and our responsibility to the women who underwent these procedures and who have suffered I think in a way that I don't really pretend to be able to understand and I think deserve those answers and deserve treatment. Thank you very much, Deputy Presiding Officer. Thank you very much indeed, Mr Johnson. Now I move to the open debate. I call first Rona Mackay to be followed by Jackson Carlaw for around four minutes, Mr Mackay. Thank you, thank you, Presiding Officer. Firstly, let me thank Daniel Johnson for bringing this important debate to the chamber. Indeed it's one of the many in this issue I've spoken over the years in this place. I also thank Jackson Carlaw, former MSPs Alex Neil and Neil Findlay for the immense amount of work they've done long before I came on the scene on the issue of the devastation mesh implants have had in women's lives. Presiding Officer, today we're debating something that will go down in history as one of the greatest medical injustices ever suffered by women. Thankfully, there has been cross-party consensus since the horrendous problems with mesh implants came to light which resulted in a moratorium on the implants in 2014 instigated by the then Health Secretary Alex Neil. Thankfully, now there's a baron implants brought in by former Health Secretary Jean Freeman which was warmly welcomed by campaigners. Award winning journalist Marion Scott and mesh survivors Aileen Holmes and Olive McElroy have blazed a trail on behalf of so many women and after far too long achieved some form of justice. I have to say, I was baffled by the text of Daniel Johnson's motion, Mesh Treatment Clarity and I understand a lot more what the motion means. Of course, he's right when he says in the motion that women experience difficulties and desperation due to their implants, although that is something of an understatement. I'm genuinely sorry to hear of some issues that he's raised today and he asks very important questions and I look forward to the answer to those. This has been a long running, complicated and distressing issue with too many twists and turns to be detailed in a short speech but progress has been made, belatedly I agree, but progress nevertheless. This builds on Baroness Cumberledge's excellent First Do No Harm 2020 report to provide holistic care to women who've suffered with mesh complications. Earlier this year, our current Health Secretary Humza Yousaf introduced legislation to establish a £1 million fund to support women affected by mesh complications who've received implants on the NHS but had to travel abroad to have them removed by an experienced clinician. As we've heard, successful applicants to the fund received a one-off payment of £1,000 to help towards the costs associated with emotional or practical support. Women were entitled to apply if they had at their own expense had to pay for that support and this would include, for example, purchasing self-care items like incontinence pads or undertaking considerable travel as a result of their condition. Presiding Officer, I understand that there's a centre of mesh excellence now in Glasgow with clinicians trained to remove mesh, a procedure which has not been available in Scotland before. But I also understand why many women, as Daniel Johnson has outlined, would not want the same surgeon who inserted the mesh to remove it, the same mesh that has ruined their lives beyond belief. So after everything they've been through, I think it's important that women have a choice of clinician Presiding Officer, it's been a long, hard-fought battle for these women to get justice after the medical establishment was not held accountable for the scandal that affected hundreds of women in Scotland and indeed throughout the world. That battle for justice was fought by strong women who, despite their pain and discomfort, did not want their daughters and granddaughters to experience what they went through. They were not listened to by clinicians, dismissed by an inadequate review they branded as a whitewash and still they kept fighting. So I congratulate them today and hope that they take some comfort that their efforts have ensured this will not happen again and it must never happen again. Too many lives have been ruined already. Thank you. Thank you very much, Ms Mackay. And I call Jackson Carlaw to be followed by Alex Cole-Hamilton for around four minutes, Mr Carlaw. Thank you very much, Presiding Officer. Next year will be the 10th anniversary of the petition which first came to this Parliament identifying what has emerged as one of the great health scandals of our time, the transvaginal mesh. And I want to actually try and continue to approach this and this by-partisan away as possible, paying tribute to Alec Neal to Jean Freeman and indeed to Humza Yousaf who have all made quantitative and qualitative steps forward in redressing the issue and improving the treatment of many women. What was a bill is now an act and women who went to the United States to have transvaginal mesh removed are now having it reimbursed and I've heard from constituents who've now received the funds that they had to lay out in the first place to undertake what was effectively life's enhancing and saving surgery for themselves receiving the funds back. But I want to say to the minister, and this is a concern, I'm also hearing now though that there is a dead hand, a rather pedantic dead hand, beginning to be applied to those women who are now in the process of seeking to have that money reimbursed. They're being told for the first time that only basic economic flights will be reimbursed, not necessarily the cost of the flight that they undertook. For some of those women whose health has been seriously compromised and who have been physically in a distressed situation, a basic economic flight was not the most appropriate way for them to travel to the United States. We've got to be very careful we don't start trying to treat these women as if they're going in some holiday excursion. They are going to the United States to enhance their quality of life and when we say we are going to reimbursed the costs that they have incurred, we should be prepared to reimburse all the reasonable costs that they have incurred in undertaking that. Secondly, I am slightly concerned that Dr Veronikis has removed transvaginal mesh from women that is now being reimbursed but yes has been given a contract by the NHS to remove transvaginal mesh from other women but I understand not a single patient not one. In addition his contract is just for a year and I understand even if women are referred to him there's a cap been placed on a number of women that can go to him because there is still a prejudice not within this parliament but within our medical establishment that they know better than Dr Veronikis and they want women to go through a process that involves them. So yes we have the Glasgow Centre for Mesh Excellence that's been referred to there's currently a 46 week waiting time for anybody to be seen at it. 46 weeks if you've been waiting all these years for a mesh implant which has actually compromised your living is not really an acceptable delay whatsoever. Secondly many of them are being sent to a doctor in Bristol who is actually one of the doctors who was telling women that they'd had a full mesh removal who then saw Dr Veronikis who pulled out acres of additional centimetres of mesh from within them so it's no wonder they don't have confidence in this process. So I say to the minister yes we are making superb progress but I think we have to be mindful that in the practice there are still some very serious and significant issues that need to be addressed and we've got to ensure that we are listening to women the women affected and doing right by them not just saying we're doing right by them in this chamber so my concern is with some of the medical establishment and we need a strong hand in responding and dealing with that. It's one that we come back to on a number of occasions and Daniel Johnson made reference to it in relation to the MHRA. There is cross-party consensus in this Parliament for us as a Parliament to approach the UK Government in respect of what we have seen as the shortcomings of the MHRA and to try and find a solution which would allow Scotland and I say this as a unionist Scotland to approach these issues from a health perspective unique to Scotland for whatever reason the Scottish Government hasn't wanted to take advantage of that cross-party consensus that exists within the chamber I really implore them to consider doing so we don't want to see future avoidable surgical implant health crises that we could if we applied ourselves more directly and appropriately avoid. Thank you Mr Carlaw and I call Alex Cole-Hamilton to be followed by Siobhan Brown again around four minutes Mr Carlaw. Thank you very much Deputy Presiding Officer it's always a tall order to follow Jackson Carlaw in a debate of this nature and I wish to put on record my thanks and appreciation of the work that he has done over the years alongside the likes of Neil Finlay working with the campaigners particularly Elaine and Olive who we've heard described already my thanks also to Daniel Johnson for bringing this debate to the chamber today we're still distanced to travel in this issue and I will come on to some aspects of the challenge still before us I think to the women that still suffer physical and mental trauma due to mesh procedures but have come forward with their own deeply personal stories and we've heard all of them your bravery is awe inspiring but it should never have been necessary and you should never have had to drag this issue this far yourselves Presiding Officer let's talk about Cathy I have talked about Cathy before in this context but I think her story bears repeating like thousands of others Cathy underwent mesh procedure she's a constituent of mine for West Edinburgh because she was referred to it and recommended it for the treatment she was assured that the procedure was safe that would treat her mild incontinence with very little risk of complication in that she could get on with the rest of her life that could not have been further from the truth she was agonising pain and made various desperate attempts to contact the doctors and nurses that administered her treatment those calls went and answered in some cases literally the phone rang out and she never received a response it is crucial that we realise that that Cathy's is not an isolated incident and rather a problem within the medical profession and our society it's no coincidence that this is a problem which is overwhelmingly experienced by women because we know are much less likely to have their pain taken seriously and their symptoms diagnosed in fact a study completed by the UK Government last year found that 85% of women had experienced a time in which they were not listened to by their healthcare professionals that has devastating consequences and as such is in part how we've got to this position consequences like that have been unjustly thrust on to people like Cathy instead of being treated she has experienced years of crippling and chronic pain and changes to her lifestyle but we've heard about these life changing injuries and they are physical and mental effects of that still affect her to this day Presiding Officer there are 20,000 more women up and down Scotland that have suffered this problem in one form or another and it is my profound hope that the bill we passed in January by that conversation but I'd like to associate myself with Jackson Carlaw's remarks that we can't be cheap about this we need to recognise that there are additional costs incurred when you are moving somebody across continents who has mobility issues caused by the implants we are trying to reverse and it's not enough to stop there either and it is still I think deeply regrettable that the bill was not extended to survivors of other mesh implants such as hernia mesh MSPs across the parties such as myself and of course Sue Webber from the Conservatives and whilst there may be fewer victims of hernia mesh implants their plight has been just as horrific and yet they've not received any real recognition or indeed compensation furthermore whilst women have undergone this procedure will now receive that compensation it barely scratches the surface of their ordeals that's on the vaginal side of things ordeals caused by experiencing such crippling pain are you unable to go to work in a lot of cases do things that you love or even think about anything else it becomes all-consuming not only does this leave significant physical scars but mental ones too and it is vital that the government now provide these women the victims of hernia mesh implants with that mental health support Presiding officer to boil this down at its simplest this case is one of thousands of women being egregiously let down by the state as such it is our duty it is incumbent on all of us to do everything we can to rectify it and the government must do everything that they can to provide the support for those in need thank you thank you very much indeed Mr Cole-Hamilton I now call Siobhan Brown to be followed by Jackie Baillie for around four minutes thank you Deputy Presiding Officer and thank you to Daniel Johnson for bringing this important debate to the chamber and I think so far from all the contributions have been very valid and read some really valid questions as well first last year a constituent of mine from Presswick got in touch to ask me to help speed up her mesh removal after what she'd called 12 years of living in a nightmare despite having surgery here my constituent was unable to have all the mesh removed and she decided to navigate herself through the process and as such was not under the care of any consultant she was naturally worried that she'd slipped through the cracks and all she really wanted to know was to pay for her to travel to the US for groundbreaking surgery with Dr Veronica until that point I'd only really watched and read the news reports about women speaking about the horrors of mesh and it wasn't until I actually spoke to her that I realised the reality of living with it my constituent received the mesh implant in the hope that it would improve the quality of her life after the birth of her second child the mesh which had been around for several years before that was hailed at the time a revolutionary treatment for women suffering from stress incontinence or a prolapse and six surgeries later and hysterectomy still did not correct the damage or take away any of the chronic pain bladder complications and sadly the original problem which was bladder prolapse the pain was so great she had to call the end of her 30 year career in education and this story is not unique more than 20,000 people across Scotland were raised by mesh implant and women just like my constituent who deserved to be helped and in January this year as we know the Scottish Parliament unanimously passed the transvaginal mesh removal cost reimbursement bill to compensate women who paid for the removal surgery any woman who wanted the mesh removal either here or in the UK was urged to contact their clinician for referrals to the Bristol centre or the one in the USA and on the 6th of June this year mesh removal cost opened and women who had paid for the surgery and who decided to have the surgery could be reimbursed news that I welcomed fast forward to now and just this week I've been speaking to my constituent who has returned from the US after four hours of surgery she is thankfully now mesh free and this is great news and very welcome my constituent is in the process of completing her reimbursement form and it's not appropriate for me to go into all the details of the challenges that my constituent is currently facing in the process but I have written to the cabinet secretary in regard to the issues regarding the reimbursement process and I look forward to a response for my constituent even after all the forms are filled in and the money is paid I'm aware this is not the end of the process for my constituent or any of the other women the pain and the damage may still be there and rehabilitation may take a long time many women have suffered an unimaginal amount of pain due to the complications as a result of transvaginal mesh implants and it's absolutely right that the Scottish Government act as it did there are rightly concerns around women who may seek removal in the future if symptoms develop and I'm pleased that the Scottish Government provided assurance that the specialist national service is available within the NHS in Scotland hosted by NHS Greater Glasgow and Clyde the complex pelvic mesh removal service story does not end here and we must be mindful of that there are women who may need help for years to come and we must be ready and willing to act accordingly as a Government I remember my constituent saying to me that because of the ongoing pain and the complications her youngest child didn't really know her we can't give her that time back but we can give her a future by doing everything in our power to enhance the lives of the women who are involved of time thank you thank you very much Ms Brown and I call Jackie Baillie to be followed by Sue Webber for around 4 minutes thank you Presiding Officer I would also like to begin by congratulating my colleague Daniel Johnson for securing this important debate scores of women across Scotland are being left in limbo as they continue to face prolonged waits for treatment that will reverse the damage inflicted by transvaginal mesh implant surgery for around 20,000 women in communities up and down the country this surgery was life altering and caused unthinkable hardship they had to fight to be heard with clinicians telling them that the mesh wasn't the cause of their pain so let me also pay tribute to Jackson Carlaw Neil Findlay, Alex Neil and the women affected for their work and their campaign which resulted in the Scottish Government making a promise of paid for mesh removal and open reimbursement schemes that you had already paid that was indeed particularly welcome and now things appear to have stalled just a little despite government promises patients have been made to wait months to see a specialist and there's been little progress on this to date earlier this summer I asked a written question to the Cabinet Secretary for Health and Social Care and I asked what the average and longest waiting time is for mesh surgery the Cabinet Secretary's answer unfortunately did not provide any clarity so either the Government doesn't know the answer or they simply just don't count this at the health committee less than a year ago I asked how long women will have to wait I was told that the pressure on the service is easing so we hope that it will not be long before we're able to get back to a full service delays currently are of 11 months just yesterday in the chamber we discussed waiting times in NHS Scotland it appears to me that mesh surgery has fallen victim to similar delays last month I heard from Maureen Care a mesh survivor who had to endure months and months of cancelled appointments before finally being scanned at the complex pelvic mesh removal service in Glasgow last November Maureen was reassured that her mesh was flat and in place following a five minute scan for her own peace of mind she decided to pay for a private appointment which confirmed that her mesh was in fact twisted the continued failing of these women is unforgivable Maureen told me I've lost my job because of this the Scottish Government are just paying lip service to me I have no idea how long this is going to take a lot of people are being sent back to people they don't trust consultants who've told them all along that it isn't the mesh that is the problem she went on to say is yet another fight meanwhile the pain is still there and you don't know how fast things will progress and if they will get any worse Presiding Officer women are in chronic pain they're still being left to suffer whilst waiting for this surgery they continue to be failed let me turn to the cost those affected were promised flexibility but they're now being told that £4,000 on reimbursement and travel for treatment this is contrary to the financial memorandum which said the estimated cost would be £4,000 there is no appeal system in place and their costs will not be covered by the Government as promised so the Government needs to do in my view three things one, get on top of waiting times to be seen by the complex pelvic mesh removal service because these women have waited long enough two, ensure that women who want their mesh removed out with Scotland can get this done without further barriers being erected in their way and Jackson Carlaw is absolutely right because I understand there has not been one referral directly from NHS Scotland to Dr Veronica's and number three, ensure that women are actually reimbursed for the cost of their travel and accommodation I don't think any of us can begin to imagine the pain these women have suffered and are still suffering and it is incumbent on us to ensure that the welcome provision made by the Government is actually effective thank you I call Sue Weber to be followed by Katie Clark four minutes thank you and like everyone else around the chamber so far I'd like to thank Daniel Johnson for raising this important issue this afternoon I have suffered and in many cases continue to suffer a huge amount of stress and anguish I've raised questions about trans-vaginal mesh mesh in this chamber before written articles in support of women affected and I welcome the chance to speak in the debate two years ago the Scottish Government announced the service to help women suffering from complications after receiving the vaginal mesh implants sadly hundreds of sufferers are still waiting for their ordeal to end bat by 1.3 million of Government money the NHS national services division was tasked with establishing the new service in NHS Greater Glasgow in Clyde and the official announcement said it would be introduced gradually from August 2020 no one knew just how gradual it would be but for some the sufferers the effect has been catastrophic a constituent of mine has been in touch to tell me she's been in constant pain since her operation 17 years ago the plan unveiled in July 2020 gave her hope but she is living proof that the promise has not been fully honoured or fulfilled she said I find it impossible to trust the NHS to care for me with mesh issues a life with mesh is painful humiliating and soul destroying and my existence has already has destroyed so much of our lives one of women affected by this scandal has been in touch regarding her experience with the trans-vaginal mesh removal reimbursement scheme and we've heard some detail of that from Jackson Carlaw she understood that there was to be flexibility on the reimbursement criteria but she now says it appears that the ceiling is £3,000 for flights to America and this has been introduced by national services Scotland in some situations the cost of economy flights exceeds the £3,000 limit there is nothing in all the supporting documents to the bill stating that there will be a ceiling on cost of flights and furthermore as I'm sure we can all appreciate flight prices depend very much on the time of year and how far in advance you book them and when you're planning surgery you don't have that foresight, that long-term planning under the guidelines made by the Scottish Government there is no appeal system on the mesh reimbursement application where is the flexibility and the due consideration that was to be given to each application is nonexistent several women's claims are in excess of £3,000 and all should be given equal consideration in 2019 the First Minister, Nicola Sturgeon promised that she was absolutely committed to and determined that we will do everything possible to get these women the treatment and the care that they need I do not believe and nor do the women who have contacted me believe that enough is being done by the Scottish Government to engage with the mesh survivors or help with their heartbreaking plight the current health secretary, Humza Yousaf must be honest with Samantha and hundreds of other victims still waiting for help and justice and explain to them why the system is still failing tell them exactly what will be done to give them the treatment that they were led to expect as my constituent said we do not want mesh to wreck the time that we have left the Scottish Government appears to have washed their hands of these women as soon as the bill was passed and this is unacceptable I congratulate my colleague Daniel Johnson for securing this debate today because it is very clear from those campaigning on this issue that they feel they are still not being listened to I am going to focus in the short time that I have available today on the concerns of hernia and other mesh survivors who do not seem currently to be able to say that they do not seem to be covered in the scope of the scheme which is being discussed many of those have suffered life-altering conditions and in particular I would like to pay tribute to Rosanna Clarken and Lauren McDougall who are petitioning this Parliament and asking that there should be a suspension of all surgical mesh and fixation devices being used in Scotland it is very much the case that mesh is still being used I have spoken with both women and men who have been affected by this procedure for example a 50-year-old man who had mesh implanted into his right side groin in 2013 who is still suffering extreme pain and debilitating conditions as a result of that procedure well as physical conditions which mean that he is not able to carry on normal living in the way that most of us would expect he hardly sleeps can't really get medication which alleviates the symptoms and says that he is suffering from depression my constituent Rosanna Clarken was aware of mesh before her procedure she indeed had been a campaigner and she did not give consent to mesh being used on her her understanding was that it would be tissue that would be used for the procedure a hernia procedure that was carried out on her and she is not the only example unfortunately of the medical profession not getting informed consent from patients so I believe that there are still many issues that this Parliament needs to discuss in relation to the use of mesh in Scotland and I hope that we will have further debates in this Parliament because many are calling for the suspension of use of all surgical procedures and that is a believer debate that this Parliament needs to continue to have they are asking for an independent review of all mesh and fixation devices to the substantial damages that are being awarded particularly in the USA for those who have had mesh implanted they are asking for improved patient pathways which would include specialist surgeons who are aware of the complications who know how to properly insert mesh and to remove it when needed and they want to see a choice of surgeries available with natural tissue repair first and believe that mesh should not be used until that work is done they would like to see a specialist mesh centre with more surgeons trained in natural tissue repair and in particular they are calling for an apology and recognition from the Scottish Government and indeed compensation to those affected I believe that these are all matters that this Parliament should be debating I first welcome the debate that Daniel Johnson has brought today and I very much welcome the landmark legislation I fear however that there are more issues that we need to look at and I hope that the time will be available to do that and that the minister will respond to that in the summing up Thank you very much indeed Ms Clark and I call Marie Todd to respond to the debate minister for around seven minutes please Thank you very much for the opportunity to close this debate on behalf of Government and I'm grateful to Daniel Johnson for tabling his motion We've quite rightly discussed mesh here in Parliament on a number of occasions women across Scotland have been so severely affected and I know that we are all determined to do the best that we can do now to help them I'm going to try to respond to all of the points raised but let me be absolutely clear and reiterate my door is always open to hear of concerns if I haven't responded to your concerns right to me For our part the Government's absolutely committed to ensuring that women can access the care that they need and the care clearly needs to be care which they have confidence in and that they can access that care as quickly as possible As members know we've established a specialist service in the NHS Greater Glasgow and Cread and that carries out both full partial mesh removal surgery and offers high quality dedicated facilities Fully holistic care is provided giving patients access to pain management physio and mental health support so far around 50 surgeries have been carried out and 150 outpatients seen and I think it's only right that we acknowledge the effort that the NHS has made to establish and maintain a new service during the height of a pandemic their dedication and commitment is abundantly clear it's reflected in the positive feedback they've had from patients and I look forward to visiting that service in the near future to further demonstrate my support for what they have done that said we know that patients want choice the Parliament agreed in its last session that that was absolutely vital and the Government and NHS have worked together to deliver it so patients who are referred to the Glasgow centre can choose to have their removal surgery there or they can have surgery in an NHS England centre or from one of two independent providers one in Bristol and one in Missouri in the USA patients have been understandably frustrated at the length of time it's taken to put all these arrangements in place but I'm sure members acknowledge the importance of agreeing that systems that ensure referrals can be made safely and to ensure proper integration of care provided in Scotland there are really strong patient safety reasons for women to access care from private providers via the NHS in this situation those arrangements have now been agreed they weren't imposed by the NHS they were agreed by the private providers and the NHS along with those for patient seeking treatment in Glasgow members will be pleased to know that we expect patients to begin to travel to the independent providers from October next month and I can assure colleagues that there is no cap on the numbers who can go to Dr Varonicus once the clinical decision is made to remove mesh the choice of where that surgery happens lies with the patient members will also recall that we unanimously agreed legislation earlier this year to allow women who had previously made their own private arrangements for mesh removal surgery to apply for reimbursement the scheme opened earlier this year 648 applications being made received and in many cases payments already being made the fund was extended for a year to enable more women to apply for further and it's not the case that there's a cap on the value that can be reimbursed but what the Government and NHS national services need is to ensure that the costs being reimbursed are reasonable and that the scheme is applied equitably to all applicants and in the event that costs are more than the NHS expect there will be a requirement for women to provide supporting documentation to show that those costs were necessary. There it is to be clear an appeals mechanism in the reimbursement scheme and there is explicit provision for payments above the normal rates. Presiding Officer, the measures that we've put in place have arisen because we have listened to the women affected and because their experiences were related with such power by a number of members of this Parliament, some of whom have since required and I want to reassure the Parliament that we continue to listen that I and my ministerial colleagues have heard directly from those affected by mesh complications and that the Cabinet Secretary will meet a group of mesh patients in the coming weeks. Our colleagues in the health and social care alliance have done absolutely sterling work carrying out focus groups and other engagement work and I'm really grateful for what they've done and what they continue to do to work with these women who have been affected by this. Importantly NHS Greater Glasgow and Clyde too have engaged directly with patients passing through their new service in Glasgow and will continue to do so. The feedback. Jackson Carlaw. I'm very grateful to the minister for everything she said but I just want to try and tie two pieces of this together. I'm pleased to hear that women will be able to travel to independent providers presumably that being Dr Veronica's from October but Jackie Baillie and I have both made reference to the current extended waiting time that there is for women to actually go through a process or a conclusion as to what they then wanted to do and if the contract with Dr Veronica's is only for one year there is a very obvious danger that there will be a significant number of women who will not be in a position to make a judgment until we're almost at the end of the period where there is a contract for them to take advantage of the independent provider that's been approved. Will the minister keep an eye on that and commit to potentially extending that contract to ensure that all women irrespective of when they come to a decision to elect for that independent option? Minister and I can give you the time back for that. So certainly we're absolutely aware and regret that patients are experiencing longer than normal delays in accessing NHS care including at the mesh removal service in Glasgow as the NHS seeks to recover from Covid-19 the Covid-19 pandemic. Patients are however being seen surgeries are being carried out and I can absolutely reassure the chamber that concerted efforts are being made within the service to continue to reduce waiting times. I will certainly consider the particular point that Jackson Carlaw has raised there about the one year contract and whether women may time out of that particular system. That is certainly not something having put so much effort into ensuring that this can happen seamlessly and that women can access that care seamlessly. We certainly don't want them to time out simply because of the challenges that we are all facing relating to the pandemic. So I'm more than happy to look at that question should arise in future. Certainly. I welcome the point she's just made and her openness to look at things again. Could she look at the ceiling of reimbursement costs because I have an email from a constituent who is saying and I repeat a ceiling of £3,000 for flights to America has been introduced by NSS. So if she would take that away I would happily provide her with the information to conduct such a review. Minister. I'm more than happy to look at that. I can assure Jackie Baillie and her constituent that there is no cap on the reimbursement. There is simply a requirement to provide evidence that is public money so there is a requirement to provide extra evidence but there is absolutely no ceiling so I'm more than happy to look at that in future. If I go back to the health and social care involvement they have done amazing work in ensuring that the voice of lived experience is absolutely at the heart of the service that's been developed in Glasgow and the feedback that they receive absolutely helps us to refine and further improve what is still a very new service and indeed actions already being taken as a result of the help that we have had from their patients for which they and we are truly grateful. In terms of the issue implant, I have personally met with women who are affected by the issue implant. We have agreed steps to highlight the issues related to it and of course I think relevant to everyone with an interest in this area the Scottish Government has accepted all the recommendations of the Cumberlage report and we are bringing forward legislation in this year for a patient safety commissioner. Now that post of patient safety commissioner, our aim is to prevent tragedies of this scale happening in future and the women who have been impacted by the implants have absolutely made a tangible difference for those who come after them and that post is evidence of it. The Government will of course reflect on the discussion that has taken place today. We remain absolutely committed to ensuring that patients can access treatment that they have confidence in and to that end I want to commend the service in Glasgow and I hope that all members will acknowledge the effort of our NHS colleagues that they have made in establishing a new service in such difficult circumstances. We are going to ensure that engagement with patients continues so that their experience is further influenced and refined the services we offer. We will continue to offer patients choice over who provides their treatment and the NHS will continue to communicate and discuss all of these options with patients. Thank you. Minister that concludes the debate on how to suspend this meeting of Parliament until 2.30.