Transvaginal mesh short-life working group minutes: December 2019

Attendees and apologies

Present:  

• Terry O’Kelly, Scottish Government (Chair)  
• Simon Nicholson, NHS Lothian  
• Christine Hemming, NHS Grampian  
• Klara Ekeval, NHS Forth Valley  
• Peter Fowlie, NHS Tayside  
• Ros Jamieson, NHS Greater Glasgow and Clyde Sham Konamme, NHS Ayrshire and Arran  
• Carolyn McKinlay, NHS Fife Lorna McKee, Chair, TVMO 
• Kelly Macdonald, TVMO Programme Manager 
• Jackie Montgomery, NHS Greater Glasgow and Clyde  
• Karen Ritchie, NHS Healthcare Improvement Scotland 
• Craig Wheelans, NHS National Services Scotland  
• Susanna Mendes, NHS National Services Scotland  
• Mary Hucker, Scottish Government 
• Anne Lillico, Scottish Government (Secretariat)   

Apologies:  

• Sara Twaddle, report writer 
• Alan Mathers, NHS Greater Glasgow and Clyde 
• Alexandra Rice, NHS Lothian  
• Brian Chittick, NHS Shetland 
• Margaret McKeith, Health and Social Care Alliance  
• Safia Qureshi, NHS Healthcare Improvement Scotland   
• Ibrahim Alsharaydeh, NHS Highland 
• Wael Agur, Independent  
• Alexandra Stirling, National Services Scotland, ISD 
• Kate Darlow, NHS Borders  
• Sara Davies, Scottish Government 
• David Bishop, Scottish Government  
• Irene Oldfather, the Health and Social Care Alliance 
• Heather Currie, NHS Dumfries and Galloway  

Items and actions

Welcome and apologies  

The Chair welcomed everyone, noted apologies and introductions took place around the table. Members of the group were reminded that papers for all meetings are not for onward circulation until approved and agreed.  

Declarations of interest  

The Chair reminded group members of the importance of maintaining accurate, thorough and up-to-date declarations.  

Action:

• Secretariat to provide blank declaration forms to Susanna Mendes and Rosanne Mcdonald 

Minutes of previous meeting  

The minutes of the meeting held on 25 October 2019 were approved.  

Chairman’s update and draft report  

The Chair provided an update to the group on a range of issues:  

First Minister meetings – the First Minister held two meetings with women experiencing complications following vaginal mesh surgery on 25th and 26th November 2019. The First Minister committed to ensuring that each issue raised will be followed through to improve the current service. The first of the meetings coincided with the publication of the Health and Social Care report, “My Life, My Experience”. This provides further evidence regarding patient experience. For a group of women this is clearly poor and purposeful interventions are needed to facilitate quality improvement. Work by the Realistic Medicine team concerning communication and shared decision making was discussed and will be explored further with colleagues. 

Action:

• Mary Hucker to liaise with Ros Jamieson   

Patient Decision Aid (PDA) – a PDA prepared by Wael Agur had been circulated to the Group prior to the meeting. The Chair welcomed this as an important contribution but advised that other such aids are either currently available or are in preparation. The aim should be to have one PDA for used across the UK and this must be as helpful and accessible as possible for women.

Action:

• Chair to liaise with Wael Agur and then national groups (BSUG, BAIUS and NICE). PDA to be reviewed from a language and literacy perspective

Visit to USA – the Chair confirmed that CMO and a number of clinicians had visited both Dr Goldman in Cleveland and Dr Veronikis in St Louis as part of an information sharing and benchmarking exercise. This proved to be very constructive. The service in Scotland in general and surgical treatment in particular, were held in high regard by colleagues in both American centres. It is intended that a reciprocal meeting will take place in spring 2020. The group agreed that this is an important initiative and wish to have patient representatives involved.  

Case Note Review – There was a wide ranging and frank discussion on the need to establish of a case note review for a group of women who have undergone mesh removal and who have concerns about aspect of their treatment.  Issues considered included the remit, structure and process, and the timescale of the review. The group agreed it was important to take account of the needs of both patients and clinicians. A process that includes co-design and co-production will be explored with the purpose of better ensuring confidence and value. 

Action:

• Chair to liaise with professional colleagues (RCOG) as well as the Health and Social Care Alliance.  

SLWG draft report – A copy of the draft report was circulated prior to the meeting. The Chair invited members to review the report and submit comments to Mary Hucker by the end of January 2020.  

Action:

• all group members to review the draft report and feedback 

Referrals and activity  

A paper from Alex Stirling was circulated. As Alex was not present to speak to the paper, it was agreed that this would be carried over until the next meeting. The group considered a graph circulated by Sham Konamme, demonstrating the number of referrals to NHS Ayrshire and Arran Continence Service from October 2010 to November 2019. Referrals are noted to increase but the rate of increase is slowing latterly. The cause and significance of this is not clear. 

Jackie Montgomery advised on a recent report concerning the demand for and availability of physiotherapy services in Scotland. Variation in service provision and access times is evident.   

Action:

• Jackie Montgomery to provide a copy of the review and, if necessary a commentary, for inclusion in the final report

Patient Pathways 

The West of Scotland Pathway for Management of Patients with Suspected Pelvic Mesh Complications was circulated prior to the meeting. It was agreed that the West of Scotland pathway and the pathway circulated as part of the proposal for the specialist centre should be compared. The need to remove unnecessary variation was agreed.

Action:

• Susanne Mendes/ NSS to review pathways as part of the commissioning process
• Secretariat to circulate all pathways for review and comment

Patient information and shared decision making  

A summary of the DISCERN findings was circulated prior to the meeting. DISCERN is a robust questionnaire based tool, used by the TVMO to assess the quality of written information provided for patients. The summary report provided for the group contained a number of approved information sources and in particular, a document from NHS Lothian on mesh complications. It was agreed this should be reviewed by the group.  

Action:

• Simon Nicholson to circulate the NHS Lothian document 

Education and training   

A summary of the governance arrangements in each health board for training in non-mesh surgery, and how they compare with the BSUG scheme, was shared with the group. Mary Hucker advised that in general, responses indicate compliance but in some instances this is inferred rather than being explicit. Where required, Mary will contact individual Health Boards to advise on changes required to ensure clarity.  

Action:

• Mary Hucker to contact Health Boards. Action: Simon Nicholson confirm the arrangements in place in NHS Lothian   

Specialist centre update

Craig Wheelans provided an update on the current position regarding the proposed Specialist Centre. He hoped that stage 3 of the process would be reach by February/March 2020 and if the appropriate level of funding was made available the service could be commissioned by April 2020. Craig and colleagues will provide a written update on progress in early January 2020 with an outline of potential cost. The group encouraged NSS to be forward looking and holistic in their approach, reflecting the views of the group that patients should be at the centre of planning and that they have the support built in the service for the care they need. The importance of “wrap around care” and pathway “navigation” was stressed. Work with NHS England to establish a national (UK) database will be included as will assessment and commissioning of radiological imaging. Finally, a proposal to hold a meeting in Glasgow to bring together representatives from the UK designated centres was discussed. The suggestion that this might occur prior to the start of commissioning was strongly supported.

Action:

• NSS to provide written update 

AOCB

No issues

Date of next meeting  

14 February 2020

January 2020