Transvaginal mesh short-life working group minutes: October 2019

Attendees and apologies

Attendees

• Terry O’Kelly, Scottish Government (Chair) 
• Sham Konamme, NHS Ayrshire and Arran
• Christine Hemming, NHS Grampian
• Klara Ekevall, NHS Forth Valley
• Kate Darlow, NHS Borders
• Alan Mathers, NHS Greater Glasgow and Clyde
• Lorna McKee, Chair, TVMO Group
• Jackie Montgomery, NHS Greater Glasgow and Clyde, Physiotherapy Lead
• Irene Oldfather, The Health and Social Care Alliance
• Margaret McKeith, The Health and Social Care Alliance
• Craig Wheelans, NHS National Services Scotland 
• Sara Twaddle, Report Writer
• David Bishop, Scottish Government 
• Alexandra Rice, Scottish Government 
• Karen Ritchie, NHS Healthcare Improvement Scotland 
• Alex Stirling, NHS National Services Scotland, ISD
• Susanna Mendes, NHS National Services Scotland  (Item 9 only)
• Rosanne Mcdonald, NHS National Services Scotland (Item 9 only)

Apologies

• Peter Fowlie, NHS Tayside
• Heather Currie, NHS Dumfries and Galloway 
• Simon Nicholson, NHS Lothian 
• Ans Khan, NHS Lanarkshire
• Carolyn McKinley, NHS Fife
•  Brian Chittick, NHS Shetland
• Ibrahim Alsharaydeh, NHS Highland 
• Martin Roos, NHS Orkney
• Jacek Rychter, NHS Western Isles
• Kelly Macdonald, TVMO Programme Manager
• Corinne Love, Scottish Government
• Safia Queshi, NHS Healthcare Improvement Scotland
• Wael Agur, Independent
• Michelle Watt, Scottish Government
• Sara Davies, Scottish Government

Items and actions

Welcome and Apologies   

1. The chair welcomed everyone, noted apologies and, introductions took place around the table.

Re-confirmation of Declaration of Interests  

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

3. Kate Darlow 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.  

Action: Secretariat to provide blank declaration form to Kate Darlow for completion. 

Minutes of Previous Meeting  

4. Subject to some minor changes the minutes of the meeting held on 16 August 2019 were approved.

Chairman’s Update

5. The Chair acknowledged various challenges faced by those working in this field, including intense political and media interest.  He thanked members of the Group for their continued support and contribution. The Chair provided an update on a range of issues:

6. Translabial scanning (TLS) – Use of TLS was raised at a recent parliamentary meeting on chronic pain. The Chair reiterated that TLS is not currently available in NHS Scotland and, following review of available evidence,  its use is not supported by either NICE or NIHR.  However, there is an emerging impression (based on anecdotal evidence), amongst clinicians using TLS that it is reassuring for patients, who can view their mesh in the outpatient clinic in “real time”.  This can help to dispel some patient concerns and inform discussion about treatment.  In light of this the Chair proposed holding a clinical/ scientific workshop to consider TLS further, in addition to other emerging modalities such as 3D- transvaginal scanning.

7. Craig Wheelans added support from a NSS perspective and it was agreed that this would be taken forward with input from clinicians, HIS/ SHTG and manufactures. 

Action: Craig Wheelans, Karen Ritchie and Terry O’Kelly to take forward this work. 

8. Visit to USA – The Chair confirmed that the previously agreed visit to USA was going to take place.  The trip would include a visit to a second centre of excellence, before moving onto meet Dr Veronikis.

9. Referrals and interventions – There was a discussion on the volume of referrals from Primary Care of women with SUI and POP.  Anecdote suggests the number has decreased and that there is a burden of morbidity in the community amongst women fearful of voicing their symptoms. Sham Konamme questioned this.  The Group was referred to the Physiotherapy Scoping exercise shared with the Group at an earlier meeting and figures from this report would be shared.  Alex Rice described a scoping exercise planned in NHS Lothian during November to collect information from women attending general gynaecology appointments.   It was suggested that Women’s Health Concern could be asked to do a piece of work and that data from the Menopause Matters survey might also be useful.   It was agreed that an update would be given at the next meeting.

Action:  

Jackie Montgomery to provide data from the Physiotherapy Scoping exercise. 

Chris Hemming to speak to Heather Currie in relation to Menopause Matters.  

Alex Stirling to look whether SPIRE could provide material.  

Kate Darlow and Sham Konamme to look at their respective Health Boards and review referral numbers.  

Corinne Love, Senior Medical Officer, to be invited to provide an update on the Women’s Health Agenda. 

10. TVMO Group (TVMO) – The Chair explained that the work of the TVMO was drawing to a close and decisions were required on future planning.  Lorna McKee explained that the TVMO was intended as a short life working group and, as all aspects of its remit have been completed, it had served its purpose. However, there is still a need to ensure that assurance and improvement activity continues and she was looking to pass on this responsibility.  The Group agreed that they would take over from the TVMO.

11. Patient Representation – The Chair advised that although Scottish Mesh Survivors no longer wished to be represented on the Group, their “representative”, Dr Wael Agur has been invited to remain on the Group by the Cabinet Secretary.  The Group heard about a range of different approaches to patient involvement and agreed that patient engagement is important.    

12. Discussions in Parliament  - The Chair provided a resume of recent discussions in the Scottish Parliament. He invited the Group to consider how to address accusations that have been made regarding complete mesh removal, what is recorded in case records and what patients have been told.  It was agreed that a case review exercise is required but a number of issues need to be clarified, including how to identify cases and who, or which group, has the authority and credibility to undertake this task.   It was agreed that a methodology would be developed and circulated to the Group for consideration. 

Action: Alan Mathers to produce a methodology for a case review.

Capturing Patient Experience 

13. Irene Oldfather and Margaret McKeith took the Group through the report “My Life, My Experience” which has been produced by the Health and Social Care Alliance (the Alliance) in response to the Group’s request to engage with women who have experienced complications following transvaginal mesh surgery.  The purpose of the report was to build on previous engagement and reports, explore the effects of surgery and determine the type of impact it has had on the lives of the women concerned.

14. The Alliance spoke to 46 women from across Scotland who shared their experience of living with complications following transvaginal mesh surgery and many of those interviewed were talking about this for the first time. The overarching themes identified from the consultation exercise are:  

• Impact on physical health 
• Impact on mental health 
• Impact on relationships
• Impact on finances 
• Impact on confidence in healthcare system

15. The report will be published in due course.

Health Board care pathways for managing complications 

16. Sara Twaddle advised that the West of Scotland pathway has still to be signed off.

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

17. A report from Sara Twaddle concerning application of this guidance across NHS Scotland was considered.   The report summarises the position for each NHS Health Board on the management of complications following vaginal mesh insertion in terms of current practice and the resources required to fully implement the recommendations in NICE (123).

18. In light of the findings the Group were invited to consider several issues and responses will help frame recommendations in the final report: 

1. What recommendation are required regarding local MDTs? There is variation across NHS Scotland. Christine Hemming agreed to share NHS Grampian’s terms of reference for referral to MDT.  Additional requirements would be brought to the next meeting. 
2. Given the ongoing work on pathways of care for women experiencing mesh complications, is any additional comment required about regional MDTs? It was agreed that the recommendation would be that Boards should consider whether to establish Local or Regional MDTs. 
3. A UK wide registry is planned. Are any further recommendations needed regarding data collection? It was agreed that as UK wide regulation is planned, no further recommendation is required. 
4. Should national work be undertaken on decision aids and provision of information? It was agreed that national work should be taken forward. 
5. Should there be consistency of follow up? It was agreed that all women should be offered review following surgery and must have information regarding access (contacts etc.) if problems occur.  In line with current practice however, timed review (6 weeks/ 6 months) at a physical clinic might not suit all and a range of options with choice should be available, including virtual clinics and review by phone etc).

Training and Education  

19. The Chair had previously written to the Accountable Officers asking them to review their arrangements for training in non-mesh surgery and to determine how these compare with recent RCOG/ BSUG guidance.  He asked those who had still to reply to do so to Sara Twaddle so that the information can be included in the Group’s report.     

Specialist Centre managing complications in Scotland

20. Craig Wheellans provided a brief update on the current position regarding the proposed Specialist Centre.  He advised that he had had discussions with representatives from NHS Greater Glasgow and Clyde regarding the governance process and clinical input.  He agreed to circulate a paper to the Group and provide a further update at the next meeting.

Date of Next Meeting - Friday 13 December 2019