In March 2019, the Cabinet Secretary for Health and Sport asked that a short life working group (SLWG) be established to examine the course of care for women who experience mesh complications.
The SLWG consisted of Accountable Officers from each territorial NHS Board, a clinician identified by the Scottish Mesh Survivors Group to represent their views, plus representatives from the Scottish Government, the Transvaginal Mesh Oversight Group, the Health and Social Care Alliance Scotland and national NHS boards. The SLWG met on seven occasions. The SLWG's remit covered five areas:
1. The physical and psychological needs of women who experience complications
The SLWG received reports from the Scottish Mesh Survivors Group and the Health and Social Care Alliance Scotland and noted the similarity of findings across both reports. The SLWG agreed that cognisance must be taken of the findings when planning and delivering services for women affected by mesh complications and consideration should be given to how the system can be provided with assurance that this is happening.
2. Sharing experience, techniques and learning
To support learning from colleagues in the United States, the SLWG recommended a study visit be undertaken to the USA. This took place in November 2019. A reciprocal visit is intended for Spring 2020, with the aim of further sharing and comparison of surgical experience of mesh removal, to build professional relationships and to identify how the Scottish service can be complemented by US experience.
3. Organisation of care for patients suffering complications in Scotland
The SLWG considered mesh complications pathways in place; implementation of recommendations pertaining to management of mesh complications from the 2019 NICE guideline; and waiting times and staffing levels for specialist physiotherapy services across NHSScotland. The SLWG noted variation in each of these areas and made a number of recommendations for work to be undertaken to reduce the variation in care for patients suffering complications.
4. Education and training requirements to ensure a sustainable and resilient high quality service
The SLWG has reviewed arrangements for training in non-mesh surgery in NHSScotland and noted that all NHS Boards undertaking such surgery have local arrangements equivalent to BSUG guidance. The SLWG recognised the need for ongoing training in effective communication and empathetic behaviours and recommended that all urogynaecology services review and provide training in these areas for all clinical staff.
5. Resource implications
The SLWG has supported the development of the proposal for a pelvic mesh removal service sited within NHS Greater Glasgow and Clyde with a view to ensuring equitable access to healthcare, long term follow up and the potential to improve outcomes and meet the needs of patients. The SLWG also identified the likely resource implications of its other recommendations.
The SLWG will continue to exist until the pelvic mesh removal service has been established. Thereafter, a new group should be established with appropriate representation, from both clinicians and those with lived experience, and authority to provide oversight of the delivery of improvements in services.