Transvaginal mesh short-life working group minutes: May 2019

Attendees and apologies

Attendees

• Terry O’Kelly, Scottish Government (Chair) 
• Carolyn McKinley, NHS Fife
• Ans Khan, NHS Lanarkshire 
• Chris Hemming, NHS Grampian
• Alan Mathers, NHS Greater Glasgow and Clyde
• Simon Nicholson, NHS Lothian
• Lorna McKee, Chair TVMO Group
• Kelly Macdonald, TVMO Programme Manager 
• Sara Davies, Scottish Government
• David Bishop, Scottish Government
• Corinne Love, Scottish Government 
• Jackie Montgomery, NHS Greater Glasgow and Clyde, Physiotherapy Lead
• Alex Stirling, NHS NSS, ISD
• Anne Lillico, Scottish Government (Secretariat)

Apologies 

• Wael Agur, Scottish Mesh Survivors Representative
• Heather Currie, NHS Dumfries and Galloway
• Klara Ekevall, NHS Forth Valley
• Peter Fowlie, NHS Tayside
• Sham Konname, NHS Ayrshire and Arran  
• Faye Roger, NHS Borders
• Ibrahim Alsharaydeh, NHS Highland
• Brian Chittick, NHS Shetland 
• Angus McKellar, NHS Western Isles
• Martin Roos, NHS Orkney
• Karen Ritchie, Health Improvement Scotland
• Michelle Watts, Scottish Government, Primary Care Clinical Advisor
• Irene Oldfather, Director, Health and Social Care Alliance Scotland 

Items and actions

Welcome, Introductions and Apologies

1. Terry O’Kelly welcomed everyone to the meeting, noted apologies and introductions took place round the table.  He advised that Gregory Hill-O’Connor who had represented The Alliance at the previous meeting had since left The Alliance and Irene Oldfather, Director will be replacing him on this group.  Nicola Steedman, NHS NSS, ISD has moved on to a new position and has been replaced by Alex Stirling. 

Reconfirmation of Declaration of Interests 

2. All those present confirmed that there were no changes to the Declaration of Interest forms previously submitted.

Minutes of Previous Meeting  

3. The minutes of the meeting held on 5 April 2019 had been circulated.  The minutes were approved subject to the addition of a further reference to reinforce the point that Dr Wael Agur will represent the views of the Scottish Mesh Survivors Group (SMS) and not NHS Ayrshire and Arran. As a consequence, Terry O’Kelly’s letter to Dr Agur will be included as an annex to the minute.   

Update on Action from Previous Meeting

Welcome and Introductions

• Terry O’Kelly confirmed that he had issued a letter to Dr Wael Agur (see above).  

Remit and Reporting 

• A revised copy of the remit had been circulated. Terry advised that the primary audience for the Group’s report will be Health Board Chief Executives, but it will also be of interest to the Cabinet Secretary for Health and Sport and MSPs.  
• Alex Stirling asked if “consent” should be considered as part of the Group’s remit. Terry recognised the crucial importance of shared decision making and consent but noted that significant work in this area is already being progressed by the Realistic Medicine team and the GMC. The latter are currently reviewing their guidance on consent and a revised document should be available for publication by the end of 2019.   
• The Group agreed its remit.

Membership 

• Capturing patient and public perspectives - Terry O’Kelly reported that he has been advised by Wael Agur, SMS Representative, that a questionnaire has been circulated to women known to the SMS.  While the information this provides will be helpful, Terry noted that it will be important to look at ways of capturing the experiences of women not identified by or affiliated with SMS.  Lorna McKee advised that the TVMO Group, in partnership with The Alliance, are working on developing methods to gather evidence from this non-SMS population.  Following a discussion members of the Group agreed that it would be a good idea to have a protocol for assessing and recording patient experience.   Action: Lorna McKee agreed to explore what protocol might be acceptable for assessing and recording qualitative patient experience in discussion with HIS and the Alliance. 
• Specimen pathway – NHS Lanarkshire tabled a care pathway on behalf of the West of Scotland Working Group, established and Chaired by Ian Wallace.  This was circulated prior the meeting. It was noted that this is a generic pathway and that most Health Boards currently manage patients in a very similar manner.  There was a discussion on whether the provision of psychological and psychosexual support should be included in the pathway as these are services that that patients may need to access.  Alex Stirling advised that she had previously done some work on this that would be of interest to the Group. 

 Action: Accountable Officers to review the generic West of Scotland pathway and provide “bespoke” care pathways for their own Health Boards for the next meeting.  

 Action: Alex Stirling to circulate her report on psychological/psychosexual services.

• Specimen pathway – NHS Lanarkshire tabled a care pathway on behalf of the West of Scotland Working Group, established and Chaired by Ian Wallace.  This was circulated prior the meeting. It was noted that this is a generic pathway and that most Health Boards currently manage patients in a very similar manner.  There was a discussion on whether the provision of psychological and psychosexual support should be included in the pathway as these are services that that patients may need to access.  Alex Stirling advised that she had previously done some work on this that would be of interest to the Group. 

 Action: Accountable Officers to review the generic West of Scotland pathway and provide “bespoke” care pathways for their own Health Boards for the next meeting.  

 Action: Alex Stirling to circulate her report on psychological/psychosexual services.

• Feedback on Northern Ireland complication pathway – Caroline McKinley advised that due to the current political situation in Northern Ireland (NI) it is difficult to obtain information about the NI pathway.  She has however, identified that it does include provision of 3D scanning.   Terry commented that translabial 3D scanning is not currently available in NHS Scotland or NHS England.  He added that opinion from the National Institute for Healthcare Research, following an application for a Health Technology Assessment, is that there is insufficient evidence of additional benefit in the diagnosis of complications relative to currently available imaging techniques.  The Group agreed that there is no objective evidence to support offering translabial 3D scanning at present.

Action: Carolyn McKinley to keep the NI position under review. 

• Declaration of Interests – Sara Davies confirmed that she is content with the approach the Group has taken to recording declaration of interests. 
• NICE (123) April 2019 - NHS Lanarkshire has undertaken a comparison between NICE guidelines and its present care pathway.  It found that there are only minor differences between current practices and those that NICE recommends.  Lorna McKee commented that this finding is similar to the responses to the Self-Evaluation Tool provided by Health Boards. She added that the “gap” analysis model used by NHS Lanarkshire is helpful, particularly in relation to Multi-Disciplinary Teams (MDT). The TVMO Group can provide further data on MDT, but to do this they need agreement from the Accountable Officers to share the data.  This agreement was secured.

 Action: For the next meeting Health Boards to undertake a similar comparison between their care pathway and NICE guidelines, using the template supplied by NHS Lanarkshire. 

 Action: Each Health Board was asked to feedback on their own care pathway to the AO Group. The TVMO Self Evacuation exercise will report its findings separately to Boards as part of overall feedback at a later date.

• Sharing Experience – review the current specialist service for complications in Scotland -   The Group considered the information from BAUS and BSUG on those regarded as (international) experts for managing mesh complications. The Group agreed that mesh complication services provided in Scotland are of a very high quality, but accepted that arrangements for referring women elsewhere need to be clarified. The Group did not believe that bringing Dr Veronikis to Scotland was appropriate at present.  Following a discussion it was agreed that there will be benefit in a small group of clinicians visiting centres out with Scotland in order to view, compare and contrast contemporary practice. This should take in Dr Veronikis at his hospital.  It was agreed that the visiting group should include surgeons undertaking mesh removal, a laparoscopic surgeon, and other relevant senior clinicians such as a specialist nurse and physiotherapist.  It was noted that this observational training visit merits a positive communication.  
•  Complex education and training needs –This work is ongoing but not finished. It will be carried forward to the next meeting.  

Any Other Competent Business 

4. Physiotherapy – Jackie Montgomery introduced the scoping exercise she has undertaken on behalf of the TMVO Group.  This looked at the specialist physiotherapy services available to women.  She explained that Health Boards have physiotherapy in their care pathway but there is variation in capacity, demand and waiting times. Further work is being undertaken and Jackie agreed to join the Group.

Action: Jackie Montgomery to map the need of physiotherapy services. 

5. Restorative Justice – Terry reported on a recent conversation he had with colleagues within government in New Zealand who are exploring a form of restorative justice in order to bring together clinicians and patients to talk about adverse outcomes. This has some similarity to the NHS Lothian framework “Being Open” which addresses adverse events associated with childbirth.  The purpose is to foster greater understanding of events and issues and if possible, to enable those affected achieve resolution. The Group thought this was a novel idea and not without risk.   Following discussion it was agreed that the Group requires more information and a better understanding of the process before engaging further.    

 
Date of next meetings: 

• 14 June 2019 
• 16 August 2019  
• 27 September 2019