Transvaginal Mesh Case Record Review

Contents of the Report

Each chapter discusses key areas integral to a Review of this nature. As befits a pilot study, we have been critical, analytical, and reflective. We have provided recommendations for the establishment, management and support of potential, larger scale future Case Record Review.

Chapter 1 introduces key information about the composition of the Transvaginal Case Record Review Group and our methodology. It outlines the remit and terms of reference of the Review and our shared understanding of them. Finally, it describes the principles and essential characteristics that we agreed would form the work of our Review.

Chapter 2 considers the advance planning that we undertook prior to the Review’s launch by the Cabinet Secretary for Health & Sport in February 2021. Once the Panel had been appointed, there was an expected 4-6 months before the Cabinet secretary formally launched the Review. We used this time to undertake advance planning and preparations. The starting point was how we were going to design a workable process which was both understandable and effective for women who chose to engage with the Review. We knew that we would be working with a number of women where trust, or more accurately, a lack of trust, about their healthcare and the relationships within it, was a significant issue. It was vital to understand this and what was important to them. Where possible, it was hoped that we may be able to restore some elements of that breakdown in trust within patient and healthcare relationships.

Chapter 3 describes the documentation and templates that were designed to assist both the Panel and the participants to navigate their way through the process. We recognised the need for these to be clear, concise and informative. We started to examine how we were going to store and transfer substantial amounts of sensitive information. Chapter 4 considers the engagement with Health Boards, GP surgeries and other agencies in case record retrieval, while Chapter 5 examines how the Panel went about reviewing the case records and how we relayed our findings back to the participants. Part l of the report concludes with Chapter 6 reflecting on some international perspectives; the experiences and work undertaken in other countries, namely Australia and New Zealand.

Part ll starts with Chapter 7, and describes the characteristics of the women who shared their - often described as - lived experiences with us. This chapter considers how the women themselves perceive the challenges they have encountered in their daily lives, both with regard to their health and their well-being. An important aspect of this is to consider not only their lived experience to date, but their perceptions on where they are currently and what the future may hold for them.

Chapter 8 provides that the use of clearly understood language and meaningful dialogue should be at the heart of any decision-making and consent processes. It reflects on the current legal and clinical frameworks for decision-making and their practical application throughout all aspects of a patient’s engagement with their healthcare professionals, whilst Chapter 9 looks to the future and reflects on ways to manage women’s care, recognising the legacy of treatment and the impact that this has had on women’s faith and trust in their healthcare. The future role of the complex mesh surgical service in Scotland and how it integrates with local services will also be addressed. The importance of data capture is recognised. Not only is this an essential requirement to inform the allocation and provision of resources but to ensure that aftercare and follow up is available for those who have received treatment, both within and out with Scotland. Pathways for treatment and referral need to be clearly articulated and publicly available.

Whilst the responsibly for the contents and writing of this report is mine, the reflection contained in the following chapters is the result of the collaborative work and unanimous views of the Panel.