Transvaginal mesh short-life working group minutes: February 2020

Attendees and apologies

Present: 

• Terry O’Kelly, Scottish Government (Chair) 
• Ans Khan, NHS Lanarkshire
• Sara Twaddle, Report Writer
• Klara Ekeval, NHS Forth Valley
• Christine Hemming, NHS Grampian
• Alan Mathers, NHS Greater Glasgow and Clyde
• Heather Currie, NHS Dumfries and Galloway
• Jackie Montgomery, NHS Greater Glasgow and Clyde
• Sham Konamme, NHS Ayrshire and Arran
• Karen Ritchie, NHS Healthcare Improvement Scotland
• Erin Fyfe, Scottish Government
• David Bishop, Scottish Government (note)

Apologies:

• Simon Nicholson, NHS Lothian 
• Peter Fowlie, NHS Tayside 
• Ros Jamieson, NHS Greater Glasgow and Clyde
• Carolyn McKinlay, NHS Fife
• Lorna McKee, Chair, TVMO
• Kelly Macdonald, TVMO Programme Manager
• Craig Wheelans, NHS National Services Scotland 
• Susanna Mendes, NHS National Services Scotland 
• 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
• Mary Hucker, Scottish Government
• Irene Oldfather, The Health and Social Care Alliance
   

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 a blank declaration form to Erin Fyfe

Minutes of previous meeting 

The minutes of the meeting held on 13 December 2019 were approved. 

Chairman’s update

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

Hardship fund – in the 2020 budget the Scottish Government announced a £1 million fund to help mesh-injured women. Officials are now considering how this fund should be allocated and will work with the Health and Social Care Alliance Scotland in doing so.

Action:

• David Bishop and Terry O’Kelly to discuss further with the Health and Social Care Alliance 

Dr Veronikis – the Chief Medical Officer and Scottish clinicians visited Dr Veronikis in November. The intention is that a reciprocal visit take place in order that professional relationships can be developed. The significance of Dr Veronikis amongst patients and politicians is appreciated, but there is a need to uphold GMC regulatory and NHS governance processes and this has been stressed, and integration into the NHS GG+C team is desired with teaching/ training/ mentoring and support as appropriate.

Establishing a “Dr Veronikis” service in isolation would not be welcomed and, even in private sector, would likely attract both regulatory and governance challenge as well as professional criticism. 

The option of utilising a BSUG governance team to support NHS GG+C has been discussed. This has apparently already been looked at as part of a Board “benchmarking” exercise, but this could be extended to mesh removal surgery (previously suggested by SG and could involve other UK complication centres as part of service and network development in UK). 

Case note review – The First Minister has given her assurance to those who attended her meetings in November that they will be offered a case note review. Any such review will need to have the confidence of the women involved, and both RCOG and the Health and Social Care Alliance have therefore been engaged in order to help identify clinicians and to co-design the format of the review respectively. More details will be provided in due course.

Accountable Officers accepted the need for the review and appreciate its intent. Accountable Officers acknowledged they will have a role within Boards, for example in helping with access to patient notes.

Short Life Working Group report 

Sara Twaddle presented a draft version of the Group’s final report. This is in a late stage of preparation, and Health Board Chief Executives are expected to consider it as an agenda item at their meeting on 10 March 2020. Group members agreed that the report addressed the Group’s remit, with appropriate outcomes and recommendations. These indicate the need for some further development but this should be achievable (e.g. elimination of unnecessary pathway variation; standardisation of MDT process, information and patient decision aides; communication training).

Action:

• Sara Twaddle to continue to work with SLWG members in order to finalise the report by week commencing 24 February
• David Bishop and Terry O’Kelly to liaise with Sara Twaddle to ensure report is with Chief Executives ahead of their 10 March meeting

Translabial ultrasound

The Scottish Health Technologies Group (SHTG) were asked to consider translabial scanning after persistent calls from patients and campaigners for its routine use. In response the SHTG provided a ‘rapid response document’ which again confirmed that there is no published comparative evidence to support the use of this modality. Nonetheless, the new Complex Pelvic Mesh Removal Service will give consideration to its use. It was acknowledged that is would be useful to share this report with the IMMDS review.

Action:

• David Bishop and Terry O’Kelly to forward SHTG report to IMMDS

Ownership of mesh section of NHS 24 website

A memorandum of understanding between Accountable Officers and NHS 24 was presented. It sets out roles and responsibilities concerning the provision of information on the NHS 24 website. Group members agreed it was appropriate that the Chair sign the document.

Action:

• Terry O’Kelly to sign the memorandum of understanding and return it to NHS 24

Specialist centre update 

The phase 3 application for the Complex Pelvic Mesh Removal Service was considered by public representatives on NPPPRG, and will now progress to the final stage of the NPPPRG and NSSC process in March.  

The need to finance the new centre has been accepted by the Scottish Government and funds should be forthcoming (with planning approval) for commissioning to start at the beginning of April. Some development is required in NHS GG+C (job- planning, recruitment etc.), but need for timely delivery is accepted.

AOCB

None.

Date of next meeting 

To be confirmed.

February 2020