Transvaginal mesh short-life working group minutes:August 2019

Attendees and apologies

Attendees

• Terry O’Kelly, Scottish Government (Chair)
• Ans Khan, NHS Lanarkshire
• Sham Konamme, NHS Ayrshire and Arran 
• Carolyn McKinley, NHS Fife
• Klara Ekevall, NHS Forth Valley
• Christine Hemming, NHS Grampian 
• Alan Mathers, NHS Greater Glasgow and Clyde
• Jackie Montgomery, NHS Greater Glasgow and Clyde, Physiotherapy Lead
• Simon Nicholson, NHS Lothian 
• Karen Ritchie, NHS Healthcare Improvement Scotland 
• Nicola Steedman, NHS National Services Scotland
• Margaret McKeith, The Health and Social Care Alliance
• Irene Oldfather, The Health and Social Care Alliance
• Sara Twaddle, Report Writer
• Michelle Watts, Scottish Government, Primary Care Clinical Advisor (by phone)
• Alexandra Rice, Scottish Government
• David Bishop, Scottish Government (note)

Apologies

• Heather Currie, NHS Dumfries and Galloway 
• Ibrahim Alsharaydeh, NHS Highland 
• Martin Roos, NHS Orkney 
• Brian Chittick, NHS Shetland 
• Peter Fowlie, NHS Tayside 
• Angus McKellar, NHS Western Isles
• Alex Stirling, NHS National Services Scotland ISD
• Craig Wheelans, NHS National Service Scotland
• Wael Agur, Scottish Mesh Survivors Representative
• Lorna McKee, Chair, TVMO Group
•  Kelly Macdonald, TVMO Programme Manager
• Sara Davies, Scottish Government 
• Corinne Love, Scottish Government 
• Anne Lillico, Scottish Government

Items and actions

Welcome and Apologies  

1. The Chair welcomed everyone to the meeting, noted apologies and, introductions took place around the table. 

2. The Chair briefly spoke about recent coverage of mesh issues in the Scottish press, noting that this level of interest is likely to continue up to and beyond both Parliament’s return from recess and publication of Baroness Cumberlege’s report.  The Chair stressed that the Group must continue to focus on its declared purpose, ensuring that women have access to the best possible services for mesh complications, benchmarking our services against those available across the UK and elsewhere.

 Re-confirmation of Declaration of Interests 

3. The Chair again reminded Group members of the importance of maintaining accurate, thorough, up-to-date declarations, and encouraged those present to view information on declarations provided on the Baroness Cumberlege review website. 

4. Irene Oldfather noted that, as this was her first meeting as a member of the Group, she would need to file a declaration for publication on the Group’s website.

5. Sara Twaddle confirmed that she would need to file a revised declaration given her change in role. 

Action: Secretariat to provide blank declaration forms to Irene Oldfather and Sara Twaddle for completion

Minutes of Previous Meeting  

6. Subject to some minor changes to spelling, the minutes of the meeting held on 14 June 2019 were approved. 

Capturing Patient experience  

7. Irene Oldfather and Margaret McKeith gave an update on the Alliance’s engagement work with patients.  To date, focus groups have been held in Aberdeen and Dumfries, with further sessions planned for Glasgow, Edinburgh and Inverness.  Aiming for as wide a reach as possible, face-to-face interviews are being held, with additional telephone interviews scheduled.   

8. There was a discussion around emerging themes. Those engaged have indicated that they are grateful for having been given the opportunity to tell their stories. 

9. The Alliance’s activities in this area have been promoted via MSPs, Health Board Chief Executives, IJBs, and social media. 

Action: Irene Oldfather and Margaret McKeith to produce a report, outlining the Alliance’s findings, ahead of the next meeting.  

10. The Group briefly returned to the report produced by Dr Agur on behalf of Scottish Mesh Survivors (SMS), and presented at the previous meeting.  In particular, concerns were again raised about use of the term “recommendations” in that report.  It was agreed they are the views of SMS, rather than the Short Life Working Group and this must be made clear.  The Short Life Working Group will, however, give consideration to them when making its own recommendations. 

Dr Veronikis 

11. Alan Mathers and the Chair reported that efforts continue to enable US Surgeon, Dr Veronikis, to visit Scotland.  He requires GMC registration, and has been encouraged to gather the evidence necessary.   

12. A contract of employment in the UK is a key requirement for GMC registration It is anticipated this will be offered by NHS Greater Glasgow and Clyde but only with agreement and after a process of due diligence. 

13. A key step in this process will be a visit by key clinicians to Dr Veronikis at his hospital in the US.  This is presently being arranged and will take place as soon as is practicable.  A visit to a further recognised mesh complication centre will also be undertaken as part of the same trip. 

14. The Group noted that an educational visit by Scottish clinicians to peers in the US is entirely appropriate and is consistent with contemporary practice whereby skills and experiences are shared. Scottish clinicians having themselves hosted visiting clinicians from Scandinavia and elsewhere in recent months.

15. The precise detail of a return visit by Dr Veronikis to Scotland will be considered during the Scottish clinicians’ US trip.  This will include, for example, discussion around whether Dr Veronikis will perform surgery himself or if his role will be that of an assistant and mentor to others.

16. Some Health Boards have been receiving requests from patients for referral to Dr Veronikis.  Alan Mathers confirmed that NHS Greater Glasgow and Clyde have replied to a number of these requests, and agreed to share the wording of their responses with other Health Boards. 

Action: Alan Mathers to share a form of words used by NHS Greater Glasgow and Clyde in response to requests for referral to Dr Veronikis. 

Health Board Care Pathway for managing complications  

17. Sara Twaddle confirmed that Health Boards have provided examples of their care pathways. 

18. Michelle Watts confirmed that, within Primary Care, means of follow-up are being reviewed, including the possibility of using teleconferencing, etc.  In addition, prescribing, access to psychology, and other issues, are being considered, including whether there are opportunities for a more standardised approach.

19. Christine Hemming confirmed that NHS Grampian is also looking at issues in this area, including the need, or otherwise, for physical follow-up, standardisation of questionnaires used, access to psychology etc.

Action: Christine Hemming to provide a short note on the work being undertaken by NHS Grampian ahead of the next meeting. 

NICE (123) April 2019 and comparison with current care available in each Health Board in Scotland.   

20. Sara Twaddle confirmed that all Health Boards except NHS Orkney have now carried out an exercise to benchmark the care pathways they offer against NICE guidance published in April 2019.  The responses received indicate that some aspects of care pathways require further consideration, including: 

• decision aids
• registry access 
• post-operative care
• six month follow-up

Action: Sara Twaddle to provide a short note on this ahead of the next meeting. 

Tertiary Centres

21. Nicola Steedman confirmed that a Stage 2 proposal is now in draft form, but requires more work, including financial calculations which are still to be finalised.  The aim is that the proposal will be complete in time for submission to the next NPPRG and NSSC meetings, due in November and December respectively.

22. The NPPRG and NSSC meetings provide a key opportunity for Health Boards to review and comment on proposals.  At the end of that stage of the process, a full business case will be drawn up, the proposal will be submitted to Health Board Chief Executives, and will go to the Scottish Government for sign-off.

23. Alan Mathers confirmed that NHS Greater Glasgow and Clyde is presently undertaking due diligence on the proposal. 

Action: Nicola Steedman will speak to colleagues within NHS Greater Glasgow and Clyde to query whether there is any scope to have a draft proposal ready in time to be shared at the Group’s next meeting.   

Configuration of workforce and training needs

24. Carolyn McKinley reported that, contrary to her previous repost, Health Boards currently suggest they have satisfactory arrangements for performing nonmesh procedures, and that there is no apparent un-met requirement for additional training. It was reported that those wishing to refresh or improve their skills are doing so through local arrangements at Health Board level.

25. The Group also discussed requirements around the minimum number of procedures that any individual clinician should carry out yearly in order to maintain and demonstrate competence.

Action: Sham Konamme to share West of Scotland document on number of procedures and competence.

Action: Secretariat to share Chief Medical Officer’s letter to Health Boards on number of procedures and competence.

AOCB 

None  
Date of next meeting - Now 25 October 2019 following a change from 27 September 2019.