Hi everybody. I think I am live. Yeah. So today I am so excited to be here and talk to you about ambient and particularly how we have been as a community making ambience so much simple since the initial launch of ambient which I believe was September 7th. We just had the ambient first birthday recently so very nice to meet you all here virtually. I wish could be in person but let's go. So for folks who don't know me my name is Lensa. I've been a very long time contributor to the Istio project since the very first day. I joined solo about two years ago. Right now I'm the head of the open source as solo working primarily on our open source contribution which the biggest contribution is the Istio project. So I've made a lot of contribution to the Istio project. I'm one of the founding TOC and steering committee member. I'm so fortunate still serving on the Istio TOC and steering at the moment. I wrote two books about Istio. My recent book is with Christian poster about Istio ambient explained. So if you're interested in Istio at ambient at very high level about how to get started what are the business value we're providing do check out that book. A little bit fun fact about me is I actually worked at IBM for a very very long time almost close to 20 years before I joined solo. So at my last day while I was at IBM I was of course super sad to living in such a wonderful workplace and a little fun fact about me is I do a lot of patenting and inventing while I was at IBM. So I went to the corporate directory which we call it blue page back there at one point and then I took a screenshot of how many patents I contribute to IBM. So that was 207 so that means I contribute that many numbers of patents to IBM corporation with me as the co-inventor. So a fantastic experience about writing these patent disclosures. So that's a little bit fun fact about me. Now I want to shift your attention to talk about ambient. So I mentioned September 7 last year we launched ambient as an Istio community. It was an extremely special day for us. We were able to introduce a new data plane mode for Istio without sidecar. So we wrote a great blog which a few of us are the co-author of the blog to introduce to everybody why we introduce ambient. What problem are we solving and what's the new architecture particularly with the layering of architecture of ambient. So if you haven't seen it I highly recommend you after the session check out this blog out there. So I won't spend a minute to talk about challenges with sidecars. Many of you actually already know so raise your hand if you feel like you already know all the challenges of the sidecars in the chat. I love to see that see if you agree with me. So the first is the operation challenging. You have to inject that sidecar. When you first deploy your application you're probably using Kubernetes you don't have that sidecar. So you have to inject that sidecar. And then what we're seeing in the community is you may also already have a sidecar container that's not on wave proxy. You may also have a unique container for your application pod. And we start to see there are sequence issues and most most likely life cycle management issues between your own unit container your own sidecar container that's different than what is your inject for you with the is your innate and is your sidecar proxy that may causing you some problems. And also as your application coming up and down there may be life cycle sequence issue between the is your proxy with your application pod. This is why exist a whole there is a parameter and annotation card hold application until proxy is ready. I remember I was driving for that in the is your community because a lot of our user was asking for it. And then the other thing is there's a lot of CVE comes with envoy proxy. So we tends to release a lot of CVE and ask you to restart your application to pick up the newer version of is your proxy. We don't support Kubernetes jobs. We don't support our server send first protocols. So these are the different challenges related to transparency of the cycle. And the other thing is incremental adoption. Right. Most of our users are actually using is your because they love mutual TLS right. They want to use is your to secure their communication between their applications. They want to rely on is your to manage the the certificates for their application pods in these simple scenarios when you just need is your for mutual TLS.  Right. Because we don't have a simple version of the cycle to allow you just using the layer for function particularly mutual TLS function of the cycle. The third challenging with cycle I would say is the resources challenges. And we try to mediate that challenging with the introduction of cycle resource. You guys probably all see Carl Stonis tweet about when we first introduced cycle resourcing is your how it was helping his company to dramatically reduce CPU and RAM right for for the proxy and for is your day. We've also seen a lot of what we use a complaining about is your proxy cycle resources requirements was overly excessive. We've seen people complaining about remove that before resource limits for the cycle. So these are the different challenges with cycle that some of you. I know most of you are perfectly happy with the cycle. But some of you may you know hold back over adopting is still because of the cycle challenges we have. And that's exactly why we introduce is your ambient service mesh. So in a nutshell what is ambient service mesh. It's the new cyclist data plane mode that we introduced in Istio. What's really cool about it's your ambient is what's left thing the architecture into two layers the layer for layer that focus on providing a zero trust security tunnel for you. And then there's a layer seven layer if you do need a layer seven functionality from our service mesh then you can optionally deploy the waypoint proxy. And what's even exciting since the initial launch is Istio ambient service mesh started as an experimental branch and was merged in master in Istio 1.18 and remaining alpha in 1.19 and we're working really really hard to drive to the next phase which is beta. I can't tell you which release is going to be. If you want to find out more details I'd encourage you to join the ambient developer meeting because everything is changing rapidly with a lot of contributors collaborating on ambient. And then let me quickly summarize the key benefits of ambient right the first benefits which I think it's the most important benefit is simplified operations right ambient enables us to not needing to restart your application part as you enroll into ambient right as you you don't need to restart also for picking up a cve from either layer four or layer seven from ambient service mesh so that's super cool and the other thing is ambient is also designed to save cost for you right we talk about excessive provision resources of the cycle proxy right so that's what ambient is designed for and we have some preliminary numbers which I will share in a little bit about that and last but not least ambient is designed to improve performance for you particularly in the cases if you are only needing ambient for layer seven the zeal trust tunnel primarily for mutual tls and simple authorization policies. You guys are probably all familiar with this diagram and so essentially there are a z tunnel is deployed as a demon sets onto every single node of your kubernetes cluster and it manages the paths enrolled into ambient and it can manage multiple of them which is super cool so ambient mesh provide a shared per node z tunnel to provide a zeal trust tunnel if essentially z tunnel kind of assume the identity of the paths currently running on the same node and one thing I want to point out this is not super obvious to everybody is if you do have layer four policy on your paths that you want to enforce even if your client is in the same node the co-located z tunnel will continue to enforce the layer four policy for you so in this example c3 on the right side is the client and if it's trying to reach out the server one or two even though they are co-located the authorization policy for layer four will continue to be enforced for co-located paths just a little bit dive a little bit deeper into z tunnel architecture by the way this is a picture from the blog john that wrote about z tunnel so do check that out if you're interested in learning a little bit more about z tunnel so when z tunnel comes up z tunnel is serving as a xds client it's also serving as a ca client in this case z tunnel as a xds client would establish secure connection to is your d on 15012 and ask hey can I get my xds configuration and is your d will recognize oh you are a z tunnel instead of a cycle or instead of a waypoint proxy and this is your xds configuration and then and then z tunnel is going to act as a ca client and ask hey can you give me search for this particular application a or application x that i'm i'm managing on co-located on my node and then is your d is going to check oh are you really allowed to represent this particular application is this application a has pod that's co-located on your particular z tunnel's node it is if it's so then let me hand you off you know send you the search and means the search for you so that's uh essentially how the z tunnel architecture works so uh when we first uh designed z tunnel we actually started z tunnel with the pre-programmed envoy proxy and it wasn't the idea I remember back then uh about a year ago there was like three person on the team uh in the community can debugging the z tunnel configuration when z tunnel was written in envoy proxy it was uh super complicated uh with uh with z tunnel handling um configuration for multiple co-located application parts so we started thinking about you know how do we simplify uh the situation right so is your d it generates envoy configuration and sending this huge xds configuration only three people in the community can understand and um and envoy execute the configuration so uh if you guys don't know envoy is not meant for human it's really meant for machine uh this is a famous quote uh from yua one of my favorite co-worker um and also from rob salmon hey he gave a wonderful presentation in two years ago now uh talk about you know what envoy here's uh you know all these wonderful configurations of envoy the truth is uh the z tunnel envoy configuration back then when it was initially launched it's way more complicated than any of the envoy configurations in sci-car because of the fact that needs to have configuration for all the co-located parts so that made the team the community start to you know back to the drawing board about you know is envoy the right configuration for z tunnel you know what if we just send the necessary the absolutely the necessary configuration to the z tunnel without you know render it in the exact format that envoy needs that would allow us to save um a lot of money right because a lot of our user pay uh the network cost between the data plane to the control plane and also potentially um save memory and cpu um by sending way less data down so uh we start to think about as a community what is absolute necessary for the zero trust tunnel right so definitely it needs the co-located workload uh information right the name the parts uh the namespace the service account does it support edgeball you know what's the status what ip does it have or does it even have a waypoint proxy because z tunnel needs to think out where is the next hop it's sending so it's important you know whether it has the waypoint proxy also does it have any layer for policies for the workloads and you know what are the services uh they belong to so these are the it's uh absolute necessary information for z tunnel and that's actually not true well z tunnel needs to know not only the co-located workload it actually needs to have visibility into all the workloads uh regardless whether they are part of the ambient or not this is because uh a client uh here c1 or cq could potentially send in requests to any workloads right whether they are inside of the istio or whether they are inside of ambient uh that's completely reasonable allowed um all right so um so we start to think about you know what configuration z tunnel really needs right and that narrows down to the configuration protocol between z tunnel and the control plane istio d and this is the example rather simplified example of what the workload configuration looks like uh based on what z tunnel really needs and minimum needs and the protocol indicates whether it's tcp or edge ball so in the moment you add your workload uh through uh label namespace the istio io data plane ambience we are going to the control plane is going to flip the protocol into edge ball and send the updated configuration to z tunnel and if you have any policy particularly layer for policy apply to your workload istio d is going to associate your policy with that particular workload and also send the updated configuration uh down to z tunnel so with that this is uh results much simplified workload xds configuration that's so much simple to read and debug if you agree uh raise your hand in the chat somehow let me know you know the workload configuration compare with the on-way configuration you had to read in the past it's like 100x simplified in my opinion and it's so much less resource from istio d to generate the xds configuration for z tunnel and reduce the network cost right because some of you might pay for that between z tunnel and istio d all right um so the next question we start to ask in the community is uh what about z tunnel implementation now that we have a configuration protocol defined right so uh i believe john did a lot of work on this uh he had a prototype of a z tunnel written in goland and he also did the initial prototype of z tunnel written in rust and as a community we finally decided on rust due to its high performance low resource utilization and a very battle tested library and it can support work stealing in fact john actually did a uh a test a scale test recently where he set up ambient on very large scale hypothetically in a sense but with a large scale on that particular note z tunnel coming with just 500 megabit of ram so it's unbelievable so hopefully you see at this point you see how we really simplify z tunnel from implementation and also the configuration perspective right so now we're going to ship to talk about waypoint simplification a little bit right um so when we initially introduce waypoint uh waypoint was only on a service account sculpt so that's great um but um what if you your tenant scope is really namespace right i know a lot of users they are you know you desire tenant space is namespace instead of service account so we made a lot of simplification to waypoint also so that not only we support service account but also support namespace scope for waypoint so it depends on whichever you feel comfortable as a tenant scope for layer seven processing you can choose to use either waypoint sculpt for service account or namespace in order to deploy a waypoint proxy it's you can deploy it's really simple you use the experimental command to generate your kubernetes gateway resource or you can just create the resource yourself i would recommend you use the command to have an example and then tweak it as needed if if so so for example in this example it's super important to point out the gateway class name is it's your waypoint so so that's to let the gateway controller for the waypoint controller to know to deploy a waypoint instead of a deploy is your gateway right and then the listener is 15008 because that's support for edgebone so so the example here is deploy a waypoint that's namespace scope and if you want to have a service account sculpt waypoint you just add a simple annotation to tell us what the service account is for so one change we made is waypoint actually has its own service account now so it's super important to let us know what service account this is for just to help you a little bit more understanding waypoint architecture so this is a diagram from john and myself published your blog on waypoint so i do check out that blog if you're interested to know a little bit more about waypoint so in a nutshell when you create the gateway resource to deploy your waypoints using kubectl apply command it's your d is going to serve as the waypoint controller and then sees the gateway resource with the is your waypoint as the gateway class name and then it would automatically deploy the waypoint proxy for you based on the gateway resource and then your waypoint it's going to be very similar as the cycle except it's not running as a psychology application pod right it's it's going to have its own ca client it's going to have its own xds client it's going to have needing xds config from it's your d so it's going to first establish a secure connection to it's your d and ask hey can i get my certificate signed right because the waypoint as we mentioned it's going to have its own identity and and history is going to you know check the token and sign the search for waypoint and then the waypoint can begin to ask for xds configuration from is your control plane so that's a nutshell of how waypoint works now i want to start you telling you guys the story how we decided to why we started to looking at simplify the waypoint right so we started looking at how can we simplify waypoint configuration again back to the story there was maybe five person can understand waypoint config when we initially launched waypoint because it was super hard with i think there was like two internal listeners super complex config so we started looking into how we can simplify the waypoint config by should we apply export to annotation and cycle resource like cycle does right because you know every single waypoint they're not going to need reach out to every single other services and workloads in the cluster so maybe we could look into these configuration from user to give us a hint so just to get you familiar with the cycle configuration so typically you apply export to configuration right as a result from service producer you're going to reduce some of the configuration you'll see in this case you know the purple cycle and blue cycle from namespace two and then as a service consumer you typically apply the cycle resource which specify you know what are the egress connections you can reach out to in doing so you effectively reduce your configuration further right so if you apply that to namespace one and two essentially what you are essentially seeing is a simplified configuration where within your namespace waypoint you can only see what's deployed in your namespace for example in this case namespace one only sees the red and yellow so we start to think about you know do we ask user to add these configurations right but the reality is most of the user actually don't like you add these configurations right and creating cycle resources that's a hustle for user to learn so we decided you know what if we just introduce a destination only waypoint from a waypoint perspective it needs to only to know the end point the paths the workloads it's managed by that particular waypoint whether it's namespace or service account scope right so by introducing destination waypoint we are really able to simplify the waypoint configuration to focus on only the relevant paths and workloads that are relevant to the waypoint and what's the benefit to bring to our user is we eliminate the need for cycle and export to for waypoint right so you no longer needs to worry about those configurations I hope you like that give us a thumbs up in the chat if you do like that waypoint simplification so we also did a little bit calculation of a simple example of using cycle resource was using waypoint right the configuration what's coming down is waypoint has less than one percent of the configuration comparing with cycle using the same 25 deployments with 10 paths in the example so that's how much configuration we were able to reduce through this destination only waypoint the other thing about waypoint I want to highlight is policy enforcement for longest time Istio has server side source side policy and also destination side policies it's super confusing to our user and then they have to check out the logs on the source on the destination side to find out you know what's going wrong and they have to check the configuration also so with destination only waypoint we're having all the policy enforced on the destination regardless whether it's route policy or regardless whether it's authorization policy so it's so much easy for our user to understand read the logs and looking at the configuration just in one place it's also super important in a mixed environment whether you are running your client outside of the mesh or inside of the mesh when the policy is always on the server side so you are guaranteed to have the policy enforced which before when some of the policy on the client side that you'll be surprised why are they not working so this is the power of the destination only waypoint egress waypoint it's under construction so join us in the ambient dev channel and the ambient weekly meeting to learn a little bit more as we develop egress waypoint lots of not the least I want to quickly go over some of the resource savings study we've done with small scale with three deployments we've noticed 90% saving on layer four and 75% saving on layer four and layer seven we also increased the scale to a little bit more to 150 parts and we're seeing consistent savings so we do want to do more tests on thousands of parts and the even larger scale stay tuned for that you might be wondering what about cycle so cycle will continue to be support you can interrupt between cycle to pause in ambient so so there are maybe certain scenario you will continue to use cycle for now so I do want to show these scenarios to you I think I'm running out of time so I'm going to wrap up just the key takeaway for my talk is the ambient is the new data plane introduced in istio and zetano and waypoint we have been drastically simplified both of them since the initial launch and they are designed to scale with very minimal configuration with that I'm going to stop sharing and I will be taking questions if you have on the note on the on the chat box so do let me know if you enjoy my session or if you have any questions I will be there thank you all so much and try the ambient and give us feedback


I'm here, really, to do a brief warm-up for one of the men who inspired me and I think should inspire all of you. Back in 1993, when the World Wide Web was in its infancy, Carl Malamud helped put the SEC, Edgar Database online, put the Patent Office online from the outside, actually ran some of the first big government websites as a non-government person and then actually donated them to the federal government as a way of bootstrapping the federal government web presence. I mean, this is a guy who's incredibly prescient at his urging and with his help and actually I was, I should say, he convened with my help an incredible meeting about open data which really kicked off my thinking about this area. He is really the father, I think, of open government in America and he's now working to free the law, which he says is America's operating system. Please give a very, very warm welcome and a very big debt of gratitude to my good friend Carl Malamud. Good afternoon. Thank you, Tim. In September of last year, I stood before you at the Government 2.0 Summit and spoke about primary legal materials, the statutes, opinions, regulations and other rules that govern our daily lives as a society. If code is law, then the law is America's operating system and in my talk, I laid out the history of how this common good has been subdivided and fenced off. Our democracy is based on the rule of law and access to justice. But how can we be a nation of laws, not a nation of men? How can we have due process under the law? How can we have equal protection under the law when the law has been locked up behind a cash register, stamped with an unwarranted copyright assertion and then shrink-wrapped in a click-through license agreement creating private parcels from the public domain? My talk was in the morning and the Government 2.0 Summit ended with a keynote discussion later that day between Tim O'Reilly and Andrew McLaughlin, the Deputy Chief Technology Officer of the United States. Tim asked Andrew what his takeaways from the summit were and Andrew said one of his takeaways was Carl.gov, which he explained meant that there were some things that were clearly obvious that the Federal Government should be doing and that the idea that things that have the force of law are not freely available to everybody in the country is appalling and that the White House should be using its moral authority and convening power and perhaps even more direct measures to get data out into the open. While the prospect of Carl.gov was certainly intriguing, I called up the White House and suggested that a way cooler domain name would be law.gov, a distributed, authenticated registry and repository of all primary legal materials in the United States, reliable bulk access to the raw materials of our democracy from the August pronouncements of the Supreme Court across all three branches of government, across all 50 states, down to the counties and cities, the water districts and school districts. Sometimes the most difficult things to communicate are those most obvious, principles like access to the law so we may have access to justice. Abraham Lincoln was the master of that most difficult feat of rhetoric, showing us the obvious when the obvious has been clouded by a fog that gradually accumulates until we all forget where we started and what we stand for. In his second inaugural address, a mere 702 words delivered in less than seven minutes, Lincoln reminded America that there are no winners on the battlefield, that we all faced the blame for the tragedy that was the Civil War, there was no victorious North, there was no vanquished South, there was only the United States of America, and that all citizens must bind up the nation's wounds, working together with malice towards none, with charity for all, with firmness in the right. 27 years earlier, in Lincoln's first major speech, his 1838 address to the Young Man's Lyceum of Springfield, he spoke on the topic of the perpetuation of our political institutions, saying that our government would only last if we adhered to a reverence for the Constitution and laws, saying that upon these let the proud fabric of freedom rest as the rock for its basis. Lincoln understood the importance of the law as something to be breathed by every American mother to the lifting babe that rattles on her lap, let it be taught in schools, in seminaries, and in colleges, let it be written in primers, spelling books, and almanacs. Adam Gopnik, in his book Angels and Ages, teaches us that the genius of Lincoln was having seen something large and having found the right words to say it's small, using small facts to build a big truth. To make the idea of law.gov real, we have started with small facts and many questions, a national conversation in the form of a series of workshops that began in January at the Stanford Law School, continuing on to a dozen top law schools around the country, and ending in June next month at the Center for American Progress and then Harvard. We have learned much from this national conversation. At Stanford, Jonathan Zittrain explained how grassroots efforts can reach a tipping point and then change the world. At Columbia Law School, we saw the chief architect of Lexus Nexus and Beth Novak, the deputy CTO of the United States, sitting side by side discussing how to make the law available to all. At Colorado Law School, we learned about Western law from the Colorado Secretary of State, the chair of their Judiciary Committee, and a justice of their Supreme Court. At the University of California workshop, we heard California Secretary of State Deborah Bowen tell us we can really change the way people own their country if they know how it works. In addition to these 15 workshops, we have seen the spontaneous formation of grassroots working groups, such as the creation by law librarians of a national inventory of legal materials, an effort to document the state of our code. What these librarians have found are many small facts that perhaps might be a big surprise. It was a surprise to learn that the states of Colorado, Georgia, Idaho, Mississippi and Wyoming to list just a few examples all prominently warn that their state statutes may not be copied without written permission. As librarian Sarah Glassmeyer tweeted, I've bought fireworks with less warnings and disclaimers than the one some state legislatures slap on their online law offerings. The librarians have found that 21 states assert copyright over state regulations. They have found that in California, to access the official reports of the courts, you have to accept a click through license agreement where you agree not to share the materials with a specific prohibition against public and nonprofit use. With these many small facts, we hope to present this fall in the form of a report and recommendations, the case that the infrastructure for our legal system must change, that America's operating system can and must become open source. The United States Senate has already requested a copy of the law docket of report as has the Federal Trade Commission. The House of Representatives hosted a bipartisan law docket event two days ago and the Ninth Circuit of the Court of Appeals of the United States has requested a briefing. This conversation, while many years in the making, really began to take off at the government 2.0 summit last September when we traded Andrew McLaughlin's Carl.gov for a shot at law.gov. There is no more valuable piece of furniture than a well-made soapbox and the best carpenter in the public domain has to be Tim O'Reilly, who has created many platforms we can all share, places to meet with our peers, combine our voices to make big things from small pieces to work on things that matter. Just as the open source convention brings together the programmers of Pearl and Python, just as the Maker Fair has inspired a generation of what President Obama in his first inaugural address so aptly called the risk takers, the doers, the makers of things, the government 2.0 expos and summits are becoming a place where we can all work on ways to make our government reflect who we are as a people, to make government reflect the better angels of our nature, a government where the rule of law is breathed by every American and access to justice becomes part of the proud fabric of freedom. Thank you.


First item is to welcome to the health, social care and sport committee. First item is to decide whether to take items 3, 4, 5 and 6 in private. Are members agreed? The second item today is an evidence session with the Scottish Government on the Transvaginal Mesh Removal Costry and Burstence My bronchol locals, ond we have our officials from the bill team who are participating remotely. They are Greg Tramers, the head of chief medical officer's policy division. Sorry, I'm just hearing some feedback, I'm not quite sure why. I apologise everyone, that's better. David Bishop, the mesh team leader. Terry O' Kelly, the Senior Medical Advisor. Bill Cigarland's and Kate Walker's lists from the Scottish Government and I would invite members to ask questions just by, I've got a note of the kind of questions that you want to ask, but I'm going to ask the bill team initially some questions about the specialist mesh removal services. I would like to get an idea of just where we are with that at the moment. We've obviously reached out to mesh survivors around this, and that's a question that they have around the mesh removal services as they stand. I'm not quite sure who I would go to. Would it be Mr Chalmers? Good morning, convener. Perhaps on that question, I might defer it to my medical advisor, Terry O'Kelly. I'm always being closely involved in the service. Good morning, convener, and rest of the committee. Welcome from a very rainy Aberdeen. The specialist mesh service in Scotland was established following work undertaken by a short-life working group consisting of council officers and representative parties. It is funded for the first three years by additional money from the Scottish Government. The centre is housed within NHS Greater Glasgow and Clyde and has been operational now for over a year. You will appreciate that the work of the unit has been inhibited to an extent by the Covid pandemic, but considerable progress has been made. Not only in establishing a fully functioning multidisciplinary team with recruitment of new clinicians—those are both medical and non-medical clinicians—we are now able to offer a truly holistic service for women with mesh-related complications. At the moment, the work is on going. We have a service review next month, and we are looking for updates on patient experience and early outcomes. That is going to be important. There is a service level agreement in place, which we have had a lot of input into. Across the United Kingdom, other centres are being established in England, designated centres in Wales and in Northern Ireland, and centres are being established in Wales. The Scottish Centre is seen as leading. It is leading because of the clinical expertise that is on offer. It is leading because of the public and patient engagement. We are grateful not only for colleagues in Glasgow but for working with the Scottish Health and Social Care Alliance, who are taking that forward. We appreciate—I think that everyone does—the sensitivities involved in the care that the women who have suffered need to have confidence re-established, and we are working towards that. We are working towards not only providing good experience, good outcomes and what we are looking for, but also ensuring that the skills of our surgeon are prudentialed. That is a process that is being established through the Royal College of Obstructions, Royal College of Surgeons and the General Medical Council, and we have been actively engaged in promoting that and ensuring that it moves forward as quickly as possible. Finally, one of the issues that was a major problem previously was information and shared decision making. With the background of realistic medicine, we have been intimately involved in developing the new guidance, GMC guidance on consent, and also engaging with services across the United Kingdom to make sure that we have information, we have patient decision aids and that those are seen to be and are acceptable for patients. Over the years, since the mesh survivors group has been petitioning, there will be a lot of testimony as to what happened to them and where that trust dissolved in the people who had been removing the mesh. How has that informed how the services are going forward? We are talking about the clinicians involved and the surgeons involved and the work that you are doing and the expertise that you have. What learning has come from the mistakes of the past or the practices that the past has led to the point that we are with this bill? We have drawn on the experience of patients very much. That is not only has it been used to craft and mould the service, but it will continue to do so going forward. We heard the voices in Scotland of the women. One has to accept and recognise that the bravery of the women to come forward to keep pressing their points, often when their views and their pleas for help will not listen to. I think that there was that perception. Given the numbers of patients that were involved, there must have been a lot of reality in that. That was born not only here in Scotland, but also by Baroness Cumberlatch and the experience of her committee in Westminster Parliament. We have heard those voices. We recognise that there are lessons to be learned. If we look across the policy areas that are being developed with regard to mesh, those lessons have been learned and what learning is being applied. I am interested in issues around total mesh removal versus partial, but some of the procedures are quite complicated. There might be subsequent surgeries that would be required. Does the bill cover additional, wider requirements for women that need concomitial surgeries? I might start on the bill and then I will defer it to Terry in terms of the clinical aspects of your question. In relation to the point about whether the bill provides for reimbursement when there has been more than one surgery, it does. I think that, apart from that point, in the explanatory notes, we are aware that, as the member has said, the successful surgery can require more than one surgery. We have covered that in paragraph 10 of the explanatory notes. Forgive me, Terry, but you might want to comment on the surgical aspect of that. For some women, the issues that are related to mesh and complications and care going forward are very complex. I am speaking to you as a clinical surgeon here in Aberdeen, Scotland. Those are not really the domain of private practice and private hospitals. Those are the domain of major NHS centres with all the infrastructure and services that can be offered for women. That was the point that we raised through the Accountable Officer and the Short Life Working Group, and it was echoed by Baroness Cumberlatch. This women is dependent on a multidisciplinary team, and we have to be able to offer them holistic care. The bill really covers the primary assessment and removal of mesh. It may be that women will come forward having had further care following that, but I think that the principal aim of the bill is to reimburse women who have had mesh removal, and that act rather than on-going management. With the referral possibilities for care out with the NHS that is being established, that will predominantly involve the physical removal of mesh rather than any reconstructive or additional procedures or clinical interventions that are required, such as chronic pain management or psychosexual, counsellor, etc. Those are the domains of the multidisciplinary team, and they are the domain of major NHS centres. Elsa Garland wants to come in before I go back to Emma Harper. I just wondered if I could just add to what Greg and Terry have said, just to clarify that the bill gives power to ministers to make a scheme. As I set out in the bill itself, the cost of being reimbursed will include the cost of the removal surgery itself, but ministers will have power to cover other costs, including if there was more than one surgery needed to remove mesh. We have quite a broad power within the bill to have those things in the scheme, and those are things that can be considered as the scheme is drafted. We heard earlier about a person who needed additional time because of a pre-existing condition that needed to be managed with constrained anti-thrombolosis-thrombolising therapy. If somebody required additional time because of additional health conditions, would that be included as well? I will come back to Elsa Garland. Thank you, convener. Again, this is something that we can consider in the scheme itself, as to what other costs could be included in addition to the main mesh removal surgery. I do not know if the additional time is perhaps a longer period of time in accommodation while treatments are being carried out, but those are things that could be considered as we look at the shape of the scheme itself. We have heard from many women that they have all said that there should be a degree of flexibility because every single person's case, when they have gone for the surgery, whether it has been in Bristol or in the States, has been different. There have been different circumstances, as Emma has mentioned. There may have been different health complications. They want to see that recognised and flexibility. If you do not fit into a particular box but you still have incurred a lot of cost, there is that flexibility. Do you believe that the bill as it stands allows for that? If I may, convener, the bill does allow for flexibility in setting up the scheme. I do not know whether there has possibly been a slight misunderstanding in terms of the costs that were set out in the financial memorandum, which were estimated costs that were used to estimate the cost overall of the bill. I do not think that the intention is that there would be a specific cap for things such as the mesh removal surgery that would be covered in full, and we would look maybe to more to set out what would be considered reasonable in terms of accommodation and travel costs, etc. However, there is that degree of flexibility in the bill, so it is not that, for example, the 20,000 estimate for surgery was just really in order to get an idea of what the total cost of the bill would be, rather than saying that the scheme might say what we are only going to cover up to that 20,000 limit. We might dig into that later. Some members have some questions on the financial memorandum in particular, so that is good to have that to dig into later. I very much welcome Terry O'Kelly's comment on us moving towards a holistic approach. How will you assess success here of the specialist service and how will patients' reported outcomes be collected and reported? We can look at how patients are managed through a process management in an episode, say hospital admission or some other practice of care. You could measure that, set up a pathway and then measure against it. That would be reasonable for things like pain management, and I am sure that that could be done. Similarly, with psychological inputs, etc. However, when it comes down to it, it will be patient experience. When patients engage with a centre, what are the expectations that start? How were those expectations addressed? What was their final opinion? I think that that is really important. We should be able to measure that relatively early. With regard to outcomes, again, there are early outcomes. Those could be patient orientated, but there will be later outcomes. What is the legacy of the care going forward? That is being looked at and addressed across the United Kingdom by an oversight group setting up a database that morphs into a registry over time. That is being led by NHS Digital. We are engaged with that. We have pilots running here in Scotland. Prom is an issue. There are some established problems that are validated. The mesh survivors would not unsurprisingly like one bespoke for mesh and mesh complications. One of the difficulties is that these problems take some time to establish. They take longer time to validate. It is important that, as we go forward, we have an eye on that, something that might be bespoke, but we also try to apply something that is present and exists at the moment so that we can get an early handle on patient-reported outcomes to know and be sure that what we are doing is correct and is addressing what women, not only what they want, but also what they need. That is pretty vital. We have heard a lot from some of the witnesses this morning about the challenges that they have had with the logistics in managing that private sector experience, whether it be in the US or in England. However, the challenges that they have with gaining that trust with the NHS service and an NHS-based service will be much better at managing the anticipated and unplanned outcomes of the complex surgery. What are we doing to reassure and benchmark that we are going to have some of the best mesh removal specialist services in Scotland again? I think that this is something that is very much in the forefront of my mind and actions. We want to change the narrative, but to do that, we cannot just say to women and mesh survivors that we have a great service, etc. What we actually have to do is demonstrate through evidence that we have a centre that is as good as any in the world and that we hope is world leading. To do that, we need credentialing and that we need that as soon as possible. We need the skills of our surgeons to be accredited and we need evidence—hard, really robust evidence—of excellent patient experience and outcomes. At the start of the centre of those experiences, I think that we can look at very early. The outcomes are going to be based on initial measures rather than the long-term legacy, but it is through providing women with hard evidence that we are going to be able to change the narrative and lead them to want to use our centres in Scotland. I absolutely appreciate the lack of trust and the issues with confidence. What we have to do with the service here in Scotland and across the United Kingdom is to restore that. It is not something that is within my gift. What we have to do is provide the information and it will be for women to judge and to value the experiences of their peers who have gone through that service, but the initial measurements experience are extremely encouraging. I encourage women to look at those and speak to our clinical teams and to open their eyes to what is available here in Scotland before they decide to go anywhere else. Thank you. You spoke in one of your earlier statements that you had some new staff coming on board. Where are we recruiting the staff from? What areas of expertise do we have that were not in the team perhaps before in terms of that multidisciplinary element? There are some surgeons who were here in Scotland and working Glasgow, but they have been augmented by colleagues from the rest of the United Kingdom. We are now up to complement with removal surgeons. If a woman chose not to have clinical contact with one of the surgeons who perhaps has been responsible for care in the past, she could state that an elect has been managed by another colleague. With regard to the others, we have pain management, nurse specialists and those are really important additions to the clinical team. I am really interested in how we can support these women's mental health in particular, and whether any consideration within the bill was given to reimbursing maybe private medical costs. A lot of what we heard from mesh survivors earlier this morning was that some have lost confidence in the centre in Glasgow itself and some will probably have lost confidence in the Scottish NHS as a whole and may want to be seen privately for what has been a traumatising event for many of them. I just want to see if there has been consideration given to paying for or reimbursing, for example, private counselling and other things that may be outside just the mesh removal itself but may actually help those women recover. I might start on that and then other colleagues might want to contribute. The bill at the moment in section 1 on the scheme that Ilsa referred to is a concern in the first place with mesh removal surgery. I will be clear to the committee members. As Ilsa has said, we have a scope to refer to other costs in the scheme. At the moment, our intention would be that the main focus is on the surgery, on the necessary preparatory steps towards the surgery and the accommodation arrangements around the surgery. The reason for that focus comes back to the primary intention behind the bill, which is that the Government has decided, as members know, to commence arrangements, to procure surgery in the independent sector. The purpose of the bill is to reimburse people who entered into private costs, essentially not knowing and having no reason to know that the Government was about to do that. That is the primary focus of the bill and that is the reasoning around it. I suppose that acknowledging what the member has asked, it is the case that services of the type that she has referred to in terms of mental health support and other important matters have and have been and will continue to be available as normal through the NHS, whereas, in the past, the mesh removal surgery was not available through the independent sector. There is scope for matters that are connected to the surgery to be included in the scheme, but the general is not the intention of the Government that the whole scope of a person's health needs might be covered by the scheme, even though the way things are connected to the surgery are helpful. What is proposed in terms of the options and making it clear to women to present what the options might be? The bill allows for patient choice that they can opt to have their surgery in Scotland or in other parts of the UK or they can opt to have it privately. How is that going to be made clear to women what the options are and how much is it going to be patient-centred and their choices are respected? I would really like to hear how that is going to be communicated, not just to the patient but also to their GPs. One of the things that we have heard from women is maybe sometimes a lack of understanding about mesh and the complications of mesh at the GP level. I am happy to hear that. Your question can be used for the highlights on what is covered in the bill and what is not. The bill is focused on surgery that has taken place in the past and things that have happened. It is only about reimbursement of moneys already spent. The bill does not cover what you have described correctly as the range of service and surgery options now available to patients in the future. As Terry has already explained, one of the primary parts of those options is the mesh removal centre in Glasgow. There is also now the option developing of surgery in NHS England and potentially the other part of the UK. The work under way now is to make arrangements for the independent sector. Those three options in the present are separate from the bill. Obviously, these issues of course are connected, but the bill is very much focused on the past to ensure that people who have entered the post. The reason that we are asking is that we also want to know about the specialist mesh services. That is why we are asking quite a few questions around that as well as the reimbursement. No, I completely understood, convener. I think that that is a convenient moment for me to ask Terry to talk about the sorts of conversations that you are asking about that will inform which choice people go for. I think that we have to be clear that the needs for a number of patients is complex. It would be foolish to divorce a surgical procedure from a pathway of care that must involve services near to home, as well as those that are perhaps further away. It is important that patients with problems are seen by their local clinical teams. I accept that there may be potential issues around that, but that is really important because it is that local team that will pick up the problems if they occur, which are urgent or occur as an emergency. In discussion with colleagues in the local teams, we have been working with the boards throughout, there will be on-wood referral to the specialist mesh centre in Glasgow. It is reasonable that patients are assessed here in Scotland. There will then be a conversation with the patient about what they want. I speak to you as a commissioner who has been involved in similar issues with managing complex problems with inflammatory bowel disease. Patients want to go to various places, but there has to be a discussion about what is in their best interests and making sure that, by acting in a certain way, care is not prejudiced. We have been clear that the management of any patient must be linked to a competent multidisciplinary team for appropriate discussions and that our primary aim is to encourage patients and show patients the best care that they are going to get is in Scotland. However, that does not prove that we are unable to reconcile issues to allow care to go forward in Scotland. We will then advise that referral to mesh centre in NHS England in Northern Ireland or Wales would be appropriate. That can be discussed and a decision is made about that. All those centres in England will provide similar services to the centre in Scotland, again linked to credentialing measurements of experience and outcomes to benchmark the outcome of pathway of care. The process of care will also be benchmarked and categorised and identified. If, after all that, a woman feels that she just cannot undergo surgery within our NHS, and I think that that is a tragedy but we recognise the reality, then there will be the possibility for surgery either. At the moment of the discussion drawn going, the possibility of surgery is out with the NHS in two places, one potentially here in United Kingdom and one in America. However, that care must be tied into a competent multidisciplinary team. It cannot be that the women embark on management that is not overseen by the multidisciplinary team, we recognise that it is really important, as Baroness Cumberlatch did and the clinical teams do, and I am sure that the women do as well. It is important to ensure that any intervention is part of a pathway of care and does not prejudice what might be necessary or what is present going forward. Can I just ask one other question on this before we move on to talking about the bill to Mr O'Kelly? If a woman who has had mesh inserted into her that she has had problems with and it has been removed by a surgeon, if any of them have a nervousness about that surgeon who put the mesh into their bodies, also being the surgeon who might remove it, is that taken into account and respected? Yes, as I said, it depends where the woman had their surgery but in Scotland, if they engage with our mesh removal service, then yes, there are clinicians there who were there previously, but we have recruited new surgeons, they are well trained, well supported and will be credentialed. A woman absolutely has the right to elect to have care undertaken by that individual. Thank you for being here today. We heard some talk earlier about the importance of trust and mentioning that there is now a full complement of staff and the required expertise at the specialist centres. We heard from women today, some who had already been treated by Dr Veronica, that NHS imaging often cannot see mesh as it is placed behind the bone, and also about Dr Veronica's designing and developing new specialist surgical tools. Have our specialist centres considered those issues in those developments? Have there been lessons learned and incorporated into the processes? I think that that would be a real step in the right direction to re-establishing that trust. I have been involved with mesh since 2014 and Dr Veronica's has been an important figure in development of surgery. He has gained the trust of women, not only in America and the United Kingdom but elsewhere across the world. I do not think that his techniques are unique, and it is inevitable that surgeons develop abilities to undertake procedures. The evidence that we have, published evidence, is that the process and outcome of care offered by Dr Veronica's and other surgeons is no different from those who have expressed specialisation in the type of surgeon that would include our surgeons in Scotland. Dr Veronica's is a high-volume surgeon. He is technically, I am sure, very competent. What we need to make sure is that the care that we offer is at least as good as him, if not better, but supported by all the other services that women need. We also need to offer a service that is responsive to women's wants and needs and can demonstrate that those responses have taken place. Certainly, the initial experience with the new service in Glasgow is that it is listening to what women are saying and responding. That is tremendous. Responding not only in words but in actions. It is an iterative process. As something changes, which was important and improved, something else comes along. It is an evolving service. We would like to see it as an exemplar for how services are developed across Scotland, not only for women's medicine and surgery but for other specialties as well. It is after all the people's service. We are now going to move on to talking about the reimbursement scheme and questions from David Torrance. Thank you, convener. Good morning, everyone. How long will the scheme last? Will there be any time limits on reimbursement? If there is a timescale, how is that going to be decided? Thank you, Mr Torrance. I might start and I might ask David Bishop to contribute as well here. Our present intention is that all the rough timings that are back to mention are dependent on proceedings on the bill. However, our present intention is that the scheme will open not very long after royal assent and that it will be widely publicised to the interesting people. It will not surprise that the committee will be encouraged to know that we have a hopefully now reasonably well-developed system of consultation with interesting people through the health and social care lines that have been very useful in developing policy but also through national services Scotland, which, as the committee will probably know to, has been leading on the implementation of the present mesh fund, which has been in operation for a little while now. We would expect the scheme to offer to open only a few months after royal assent and then be available for a period. We would expect it to be a closing date. We have not come to a final view on what the duration of the scheme being open will be, but it could, for example, be approximately a year. We would hope that, during that time, it would be practicable to bring it to the attention of everybody that is potentially eligible and to give it a very reasonable period to submit an application. As is the case now, with the Scottish Government mesh fund, there will be circumstances where an application needs to be added to or explored a little bit so that the particular circumstances can be confirmed. However, we would hope that that would be possible under that arrangement as well, not least because, as has already been said in the committee, there are a variety of circumstances here. Of course, as we have seen in the bill, it provides for a copy of the scheme to be laid before the Parliament after a royal assent. That is helpful. How will reasonable costs by individuals be defined in the bill? I think that I heard earlier that there would be no cap on surgery costs, but will there be a cap on daily costs? I will start from this, if I may, and then I might bring in my colleague David Bishop, who is in the financial memorandum. I hope that the reasonableness will be looking to the evidence of the situation. The surgery costs will be looking to reasonable proof of what those costs were and that we have some intelligence around the rough costs of that. In terms of the reasonableness of travel and accommodation, in drawing up the financial memorandum, what we have tried to do is to look to the reality of somebody planning travel on their own through their own budgets and through access that anyone else would have to travel on accommodation on the internet. David, you might want to say a little bit about the estimates that we came to in the financial memorandum. Of course, thanks, Greg. I suppose that it is important to say at the outset that they very much are estimates. They were based on the intelligence that we had at the time through the likes of correspondence and all that. In the period since doing that and in drawing up the scheme, which we are obviously still working on at the moment, we have been taking evidence from women who have lived the experience of doing this. We have been getting that evidence via the alliance. Obviously, we will take all of that into account as we draw up the scheme, which, as I say, we are doing at the moment. As part of that, there was a question about capped rates and similar. I would say that what we are doing around all that is engaging with women at the moment to see what evidence they can practically provide to support their applications. Maybe that they have not kept evidence for smaller amounts, whereas they probably do have evidence for the big-ticket items such as the treatment. That is the kind of thing that we are considering around reasonableness and what sort of caps might be applied and whether caps are appropriate at all or whatever. It is important to say that it is very much a work in progress at the moment. We will continue to engage with women as we continue to draw up the scheme. Many of those women who have had to take their husbands, partners or family members with them for support, will the bill include reimbursement of their costs? From what we heard this morning, the biggest issue appears to be with the women having the money up front to fund this, because this is ultimately a reimbursement bill. We have also heard that there could be some significant on-going costs that are unplanned for regarding the removal of the mesh and the surgery and the complications, in particular when they are accessing this through the private sector. Is there something that we can do to help that? It is not a very equal service if there are women out there who cannot have the resources to have the money to pay up front and then claim back, but they cannot then access ultimately what this bill is trying to achieve? What we try to highlight is that, as apologies for repeating myself, the bill here is concerned about things that have happened in the past and people spending their own private money. We are trying to make sure that they are appropriately and reasonably reimbursed for that. In terms of what happens now and in the future, as Terry and others have said, focus is on continuing to improve the specialist centre at Glasgow. As Terry has always said, it is not just about the surgeries but the breadth of services. Of all sorts of different types, those will be free through the NHS as normal. I mentioned earlier that we still have the continuing Scottish Government mesh fund, which is providing help for people affected by mesh complications. That fund remains open at present. Thank you for clarifying that, Greg. Very helpful. If the women who have had the surgery for their mesh removal are not quite gone to what they expect from the outcome, how, when the outcome is not being as successful as they hoped or for and there are still an awful lot of on-going issues, how will that be covered or facilitated in the bill? That is a very fair question, but it is not the subject matter of the bill. Perhaps I might bring Terry on that, because I think that your question is focused on what happens in the press and when any surgery that is happening now is not quite as successful as a patient in search and would hope for. I think that this is where the... As Greg said, the reimbursement bill is about care that occurred previously. What we are addressing through our work and NHS and NHS more broadly is care for women going forward. If patients have had remedial surgery, which has not achieved their expectations and further management is required, this is absolutely the domain of the multidisciplinary team. It is about engagement with patients, understanding what their issues are, what it is that they want and how that can be achieved. In reality, it is unlikely that, if surgery is involved in further remedial surgery, that that is going to be the domain for out-of-NHS care. That is the truth, because we are then into pretty complex engagements that might themselves be associated with risk. Having said that, it may be that there is a bit of residual mesh and it might be appropriate for care elsewhere, but, again, it would have to be, through discussion, sent on what the patient wants, but, importantly, taking into account what the true needs are and trying to align those opinions. I recognise that that may not be what every woman wants to hear and maybe what the committee does not want to hear, but it is the truth. We have to make sure that, in managing patients, we absolutely take into account what they want, but we have to also align what they want to, what is required and what is reasonable. Is that the realistic medicine that you referred to earlier on in the discussion today? Yes, it is absolutely. I think that that is dominating the way that we are going forward in the health service in Scotland. We talk about realistic medicine. People sometimes say that this is cheap medicine, but it is addressing what people want. It is seldom that clinicians ask that question. It is empowering for patients. There are experts involved in all that. There is the clinician who knows about the disease, the processes and treatments, but it is also about the patient. They are the experts about themselves. Sometimes, patient's expectations might be unrealistic, but it is trying to find some way that we can help them to give them as much as we possibly can along what they need. Evelyn Tweed and I have a couple of questions about reimbursement and what it might cover and eligibility and proof. One of the things that I am not quite clear on is that a woman had surgery-involving mesh in Scotland, but when she was opting to go wherever it was privately and have the mesh removed but was not resident in Scotland at the time, but maybe even be back in Scotland now, she is not eligible for this reimbursement. Is that correct? If she was not resident in Scotland at the time of the mesh removal surgery that she has paid for herself? If I understood that question correctly, I will be careful to check the record that I am understanding correctly. I think that that is correct. Section 13b says that the qualifying of surgery is surgery in relation to a person who was at the time the surgery was arranged ordinarily resident in Scotland. The surgery that we are talking about here is the removal surgery. That is the thing that is being reimbursed. I do not know if it ails the surgery. Would you like to add to that if we have understood the community question correctly? The mesh removal surgery, if the person was not resident in Scotland at the time that they were having that, that is not included. To be absolutely precise and answering you, convener, at the time the surgery was arranged, there will be a gap of course between the surgery being arranged and it happening, but if the person was not ordinarily resident in Scotland at the time the mesh removal surgery was arranged, that is not within the scope of a possible scheme. Ailsa, do you want to clarify anything that I have said there? Ailsa? Sorry, I do not know. Am I unmuted now? No, you are not. Thank you. Greg said that correctly. The key point is that when the surgery was arranged, if the person was resident ordinarily resident in Scotland at that point, then they would be eligible to be reimbursed. You have covered some of the things. David mentioned that there might be some smaller expenses that a person maybe had to removal surgery a good few years ago. Things like taxis and mails and whatever, they have not kept the receipt. They never thought they were going to be reimbursed for it. There is going to be a flexibility there, I understand, around that. However, if somebody has raised money to pay for their surgery has been taking it alone, that obviously has an additional cost in terms of interest, is that sort of thing going to be covered by the reimbursement? You are not unmuted if you can ask broadcasting to unmute Greg. I repeat what I said there. I think, convener, we want to give that careful consideration in terms of the exact working of this team. It is a point that we can undertake to reflect upon from your question. We have, for example, in the explanatory materials reflected that, in some cases, it may be that people have received donations through crowdfunding and other things, and that is a relevant thing to take into account. Clearly, circumstances where people have the overall financial cost to the person, which will obviously need reasonable documentary evidence to be available if there is a large amount of money, is something that we will be happy to reflect upon in the drawing of the scheme. A person has applied for reimbursement, and they are not satisfied with the level of money that they have been given as a result of their application. What avenues might be open to them to challenge that? That is the potential to cover that in the scheme that is addressed in section 2, H, of the bill. It will be the intention that the scheme covers a route of review. David, you might be able to clarify that. I think that that is a route of review at the moment in relation to the present Scottish Government mesh fund. There is, yes. We are working through the detail of the reimbursement scheme and how an appeal process might work, but we are looking at including one in that as well, so that is something that we are giving consideration to. Thank you. Evelyn, you had some questions around this. I have one question left, because you have asked quite a lot. Could I ask if a woman comes forward to use the scheme as set out in the bill and she is unhappy with the outcome? How can she get redress? Where would she go to say, I am not happy about what has been offered, and how could we help with that? As David could have alluded to before, we do intend that the scheme will cover an explanation of how a review can happen. We will explain that in detail in the scheme. I imagine that, in the ordinary course of events, the process of review will be through the body, which in all likelihood will be National Society Scotland, who have been considering the application. However, the scheme will establish a route for somebody to ask for a review or to make a complaint. We turn to the financial memorandum. We are running out of time, but some members have some questions around the financial memorandum. Can I come to Paul O'Kane? Just on the financial memorandum, I think that the analysis of that so far would suggest that there are no unknowns and that we do not have clarity on how many women may come forward in terms of using it. Therefore, the finances are still at the stage somewhat estimated. I am keen to understand, firstly, what contingencies there would be in the FM to account for any increase in the numbers of women coming forward that might have not been anticipated. I suppose that, knowing all along that we do not have to confirm official information about the numbers of women that have sought mesh removal surgery in the past, what we are trying to do to be helpful to the committee, hopefully to the Parliament, is to measure those things in a kind of per diem basis. If there is variation in terms of the number of night stay or the number of people who have been accompanied against those who have not, although our base assumption is that almost everybody going for this surgery will have had a partner or a husband or a partner or companion with them just because of the practical circumstances. What we are trying to do to help the process is to make it as simple as we can in terms of coping with variation as information becomes available. I suppose that it is best to be straightforward and honest in the circumstances in that we policy officials have had a number of conversations with a number of people in different fora over the past little while. We have been offered a similar overall picture about the number of potential applicants. Of course, we cannot know for sure that there are people out there who are just hitting from us at the moment because they do not involve a risk. What we are trying to do in all those estimates is to provide for variation and where there is a plausible risk that somebody is not going to have receipts, a taxi or a lunch, which is perfectly understandable, that we come to some sort of standard approach whereby somebody is fairly reimbursed for those reasonable expenses. So far, I am very interested in just leading on from that question about how we make sure if there are any women out there who do not know about the scheme or do not know how to apply for the scheme, how we make sure that information is very accessible and that the women feel at ease to apply should they have to. Has there been any work on that? It is certainly—as Terry and others have said, we wish it wasn't the case, of course we don't, but we recognise that there is a nervousness of interacting directly with the Government because of the circumstances. We have been throughout seeking to work with the health and social care alliance, which I think is what others have to judge finally, but I think that it has got a lot of expertise in terms of engaging with groups that are sometimes hard to reach and who are ambivalent about working directly with the Government. They have held a number of focus groups over the last little while to inform the development of the scheme, the bill and other points. We will continue to do that. We will continue to work through National Services Scotland, which has established routes. We know that many hundreds of people have already applied for the Scottish Government mesh fund. Although we cannot be certain, we would imagine that anybody who has applied for the mesh fund will include those who might not be relevant in terms of the bill, so there will be that route as well. Of course, I hope that, without saying that the Scottish Government will use its follow-ups channels if the bill gains royal assent to publicise scheme through social media and other steps to bring to people's attention. It might be our final question. I am just looking across my members to double-check. Thanks, convener. It might be that Greg has alluded to this already in the financial memorandum. It says, it is expected upon establishment of a scheme that all applications will be made within one year of the scheme opening. With social media advertising, you will know who has already had mesh implant surgery. Is the one-year time frame quite narrow, or do you think that that is reasonable? We hope that it will be reasonable. I suppose that what we will want to ensure is that we align the activities so that we open the scheme after we have made people aware of it. We would hope that a year will be sufficient and that it instinctively feels that a full calendar year after the scheme opening will provide enough time. I suppose that one thing that is saying is that that period will be a period for applications. As a number of members have said, and I am sure that it will be the case, just because of the complexity of the circumstances, I am sure that there will be a number of cases where the determination of any grant or payment continues up on after that year. There is no date for that, but that will be based on the circumstances of use case. I do not know if Elsa would like to call off anything else out there. No, I am very happy with everything that Greg Scott said. That is as asked all of our questions of you. I want to thank you all for your time this morning and for clarifying certain aspects of the bill and the scheme as you develop it. At our next meeting on 2 November, the committee will continue its scrutiny of the Transvaginal Mesh Removal Costry in Bursamont Scotland Bill and consider some subordinate legislation, but that concludes the public part of our meeting today. Thank you, everyone.


Hi and welcome to the session. Today we will discuss about perimeter of closed figures. Suppose we have a figure A, B, C, D, E and we need to find its perimeter. So first of all let us learn what is perimeter. Perimeter is the distance covered boundary forming a closed figure when we go round the figure once. This figure perimeter will be equal to A, B plus B, C plus C, D plus D, E plus E, A. Sites of the boundary of this figure. Now suppose we are given the measurements of these sides then its perimeter will be equal to 15 centimetres the length of the sides of this figure. Also as the unit of all the sides is centimetre so the unit of the perimeter will also be centimetres. Now let us learn to find out the perimeter fin rectangle. We have a rectangle A, B, C, D in which B, C and A, D are the lengths of the rectangle which are equal. So let us denote it by L and A, B and D, C are the lengths of the rectangle which are also equal. So we will denote them by B closed figure so its perimeter will be equal to A, B plus B, C plus C, D plus D, A that is B plus L plus B plus L which will be equal to 2 times L plus B. So perimeter of rectangle is equal to 2 times length plus we are given that the length of this rectangle is 3 centimetres and the width of the rectangle is 2 centimetres then its perimeter will be equal to 2 times length that is 3 centimetres plus width that is 2 centimetres. So it will be equal to 10 centimetres. Now let us see how to find out the perimeter of regular shapes and we need to know what are regular shapes or regular figures are called regular closed figures. For example, equilateral triangle, regular pentagon etc. Now let us see what is the perimeter of a square. So here we have a square A, B, C, D and we know that in a square all the sides are equal. So let us say that all the sides of this square are equal to A so its perimeter will be equal to A, B plus B, C plus C, D plus D, A that is A plus A plus A plus A which will be equal to 4 times A and this can also be written as 4 into side of a square. Thus perimeter of a square is equal to 4 into length of a side which is equal to A over here we are given that the side of a square is equal to 2 centimetres then its perimeter will be equal to 4 into side that is 2 centimetres. So this will be equal to 8 centimetres. We will find out the perimeter of equilateral triangle. So here we have equilateral triangle A, B, C and we know that all the sides of equilateral triangle are equal. So suppose that all the sides of this equilateral triangle are equal to A, B, C will be equal to A, B plus B, C plus C, A, A plus A which will be equal to 3 A the length of the side of equilateral triangle is equal to 3 centimetres then its perimeter will be equal to 3 into 3 centimetres that is carefully then square is a regular length of a side similarly is a regular closed figure with three sides and its perimeter is number of sides that is 3 into length of a side. So by this we can say that length of a consider a regular pentagon. So this will be equal to 25 centimetres. In this session we have learnt to find out perimeter of a rectangle perimeter of any regular closed figure. With this we finish this session hope you must have understood all the concepts.


The Ministry of Education, through the Early Childhood Services Unit, unveiled the release of a new audio-visual initiative entitled Bonding, creating stronger parent-child relationships. Comprising of a 10-part television series, the production was aimed at educating on ways to foster and fortify the crucial bond between parents and children. One of the primary focal points of the innovative series was the enhancement of social-emotional development in children. The programme delved into strategies and insights that aid parents in supporting this aspect of child growth and stressed the significance of nurturing emotional intelligence and social skills in infants. Ms Ruth Phillips-Savier is a training officer within the Early Childhood Services Unit. We tried to zero in on what we believe are some of the more pressing challenges in terms of one of the areas, especially in the age group we were looking at really, which was the birth-to-age cohort as social-emotional development. At that time, parents normally want to force children, well, not force, but focus a lot on the cognitive development. And what we are seeing is that that component, which is so critical, has not been addressed adequately or sufficiently. And in order for the children to do well, cognitively, sorry, in the academics, they have to develop that sense of self-confidence, have that self-esteem. They have to learn to share, learn to self-corregulate. So a lot of the things we focused on there was on social-emotional development, also child development, because sometimes our expectations as parents may be too great for the age the child is at, and we have to understand that things happen in progression. The initiative not only demonstrated the commitment of the Ministry of Education and the Early Childhood Services Unit to prioritize the holistic growth of children, but also underscored the importance of investing in the crucial relationship between parents and their young ones. The program encompassed a diverse range of topics and discussions which were aimed at empowering parents with practical tools and guidance to foster a stronger and more fulfilling relationship with their children. The series airs on Tuesdays and Thursdays on a national television network NTN, as well as other television and radio stations, ensuring widespread accessibility for viewers across the country. For Government Information Service, I am Kendall Eugene.


Welcome to Access a Trader, the number one community for those who are committed to taking control of their trading in order to achieve success, profitability and longevity. Thank you for joining us. Here's Dan Shapiro to help you find your edge, master your process and own your future. Nasdaq spreads on Wall Street as the market pulls in one and a half percent, and now the Nasdaq is only up 53% on the year. Hey guys, good evening everybody. Welcome to another edition of theaxisandtreaded.com, a nightly update show, hope everybody is doing well. Obviously, I'm just joking around, we'll get to that in a second. If you are brand new to the channel, guys, thank you. Thank you very much for finding this. Thank you very much for tuning in and thank you very much for spending a few minutes with us, kind of discussing the day and the day ahead. That's it. Nothing more, nothing less. Nobody knows what's going to happen a week from now, let alone tomorrow, but again, we're always prepared. So let's talk about the tape. Everything was going normal today. If you've been trading the market just in the last several weeks, you kind of know the story, higher highs, higher lows, every dips have gotten bought, everything was all good. Matter of fact, if you look at today's day, start out very orderly, just like everything, everything else, right? We talked about Microsoft yesterday, 53, 373, 76, 374, 20, needs to build and confirm pre-market highs, softy went to 76, and we'll get back to the downside in a second. In the video, 497 upside, 49 downside, in the video right up three points, hung out there pretty much the whole day, Apple 197 needs to build, right? Apple went up almost a dollar, Deer stopped basically at that level, Google was definitely the trade of the day today, 39 rejected twice, 3940s needs to confirm, went almost to 42. Everything was good, right? Everything was good. Holdout didn't do anything, Marvel 60, 30s went up about 30 cents, came back and nothing, nothing really there, and that's about it, right? So everything was going good. I longed off around 230, the Nasdaq was up 30 points. I went to the gym, clear my head, get my workout on, and I joked around, literally joked around, I said, come on, market guys, just give the bears, give the bears a red clothes, throw them a ball, and good lord, man, the Shapiro algo really kicked in. By the time I got to the gym, by the time I got to the gym, I saw all these people texting me, like, the hell is going on at the market? I'm like, I'm in the gym, I don't know what's going on in the market. And there was obviously no news, and look, the most important part, we've been talking about this for weeks, if you go back to video, after video, after video, we don't know when this was going to stop, right? I've been saying that pretty much on every video in the last three, four days, we don't know when it was going to stop. Is this a day type of an outlier event?   But the point is, if you kept on pushing and pushing and pushing, especially stocks are way overextended, eventually you're going to get caught. You know, we primarily now trade channels, I did get, we did sell, I did sell my Tesla, my last 10% of Tesla, I was up about 11 on it. I sold it up $3 today, but it's all right, you know, it is what it is, good trading regardless. But, you know, this is one of those scenarios that the market really didn't need news, it really didn't need an excuse. We know, we've been saying this for a long time, the market is never as good as you think, and the market is never as bad as you think. And if you were irresponsible, and if you didn't know the previous days' channels, and you didn't know all that good stuff, you're going to get caught. I think we actually talked about this in the last night's video that if you really, you know, traded with the euphoric glasses on, rose-colored glasses and didn't understand the previous days' range was important, you could give back. And I think we, I literally said that in the last night's video. You could literally give back a month, two months' worth of progress in one candle. And that's exactly what happened, you know, roughly around, as soon as I left, around $2.30, again, everything was all good, right? And then the earth just fell, just fell, and then Nasdaq just completely imploded, absolutely imploded. As you can imagine, everything involved with the Nasdaq, everything, I think everything in general, it was exactly the same chart.  How does the market recover? Now, we're only up 53% for the year, with, you know, roughly about, what, 78 days left in the trading year. I'm obviously tongue-in-cheek here, but, you know, again, this is the market. Again, is it really crazy to think we could get a day two tomorrow? Honestly, I would like to see a day two. I really would. You know, this is the first close, and if you were watching the video, you kind of know the importance of the five-day moving average. At least for me, this is the first close below the five-day moving average on the Q's. That means it's probably going to be the first close below the five-day moving average on a lot of your favorite names, a lot of the high flyers. You don't really need to be very creative just, you know, looking at charts, say, the big flyers, Nvidia, Tesla, Amazon, Meta, Microsoft, right? The big high flyers. Is it possible for them to get a day two tomorrow? No, that's kind of my game plan for tomorrow. You know, I would love to see, I would love to see a gap up tomorrow, because we did see, again, we did see the loss of the five-day today. I would like to see a gap up tomorrow. Stocks get stuffed into the declining supply zone. Take out today's channels, right? Take out today's bottom channels, and maybe give us a day to move to the downside, because, again, we do have room. Like, if you look at the Q's, if we confirm today's channels tomorrow, who knows? Maybe we get down to $3.99. Again, that's $4 on the Q's. That's fine, right? If you look at Nvidia, right? If you look at Nvidia for a second, Nvidia closed right at the 10-day moving average. If we confirm that, maybe it gives us another $5, $7, right? To the next support zone. That's fine. If you look at Tesla, right? If you look at Tesla, this is how quickly, you know, things change in the market. If you look at Tesla, you know, it came back down. It's going to be basically around the 10-day moving average. If it loses the 10-day tomorrow, who knows? Maybe it gets down to $41.42, another four or five clients in there. So, there's definitely a lot of value for tomorrow. Again, as the saying goes, stocks take the, you know, stairs up and they take the elevator down. And we've been basically taking the stairs up now for 11 and three-quarters of months going into the last seven, eight days of the trading day. You know, what is shock me?  Again, that's what the market is, but the value, okay? I don't know how the market's going to close tomorrow. I'm not looking here trying to guess, but the value, the value, the meat and potatoes of potentially what can happen tomorrow in the tape is obviously to the downside. So, you know, I am prepared to the downside tomorrow. I'm basically watching, you know, the 10 stocks that we trade. I figure if one loses the bottom of the range, they're all going to lose the bottom of the range, right? They trade in tandem. If you look at every single stock, right? Every single stock is going to mirror the Nasdaq 100, right? Look at Tesla intraday, right? Look at Tesla Microsoft. They might as well be the same stock, right? It's the same chart. Once they one go, they all go Apple, Meta, Amazon. It doesn't make a difference. Every single one of it. It's literally the same thing. So, the best value for tomorrow, again, I don't know the closing price of what the market's going to do tomorrow, but the best value, at least for my book, is if we could get a gap up, or if we don't get a gap up, we do get a gap down, opening range lows after the first rally attempt and see if we could get a second day of selling. We'll say, you know, we'll see at this point, I would only seven, eight days left in the year. I'm just basically going to scalp channels. You know, that's all it is. I'm just looking at the scalp channels. I don't even care which way, you know, but from what I see here based on today's close and how everything looks going into tomorrow's session, if we could get that second day of selling, you're going to have some pretty good intense second wave of seller stepping. We'll say, you know, we'll see exactly what happens.  I know a lot of people try to compare 2020 with the dotcom era of 1999 and 2000. And I said, I don't think so. And then a lot of people tried to compare 2023 with 2020. I'm like, ah, nah, I think 2023 is closest. I think we started talking about that yesterday. If I did, I apologize for repeating it. But I think 2003 is going to go down to a memorable way of traders that traded in 2009 was that V shape recovery after the financial crisis. And that's exactly what we saw here. We saw this magical V shape recovery from the October lows. And the way we talked about this for, you know, for a while, we talked about this, you know, the way the same way sellers got tired in the October lows, is it possible buyers has got tired today? Right. That's that's the whole point. That's the whole point, guys. You have to always understand the markets never going to be as good or bad as you think. Every single day is its own momentum. Every single day is its own value. Certain days you'll get phenomenal value, right? Expansion of expansion of channels. Everything is crazy. And then the next day, we're going to go through a distribution zone and deal stocks to trade within 50 cents of each other for three and a half hours. So I don't think we'll have that distribution day tomorrow. I do think if we do confirm today's channels, I believe we will have a second day of selling. If I'm wrong, I'm wrong. It's not going to cost me any money, but at least that is the game plan. We're going to keep it nice, sweet, short today.  It's Thursday. Again, you don't need to be creative going into tomorrow's session. If you're looking for value to the downside, just go through the Nasdaq 100. The first 10 names I trade every single day. Basically, I'm just watching their channels back to the downside. Let's just see, right? Let's see if today was literally a one day of an outlier event in the markets and go right back up tomorrow, or are we going to get our magical day to, you know, carpet pole or right pole, whatever that is called. We shall see, said the blind man. We shall see. Guys, have a great night. God bless, and I will see you all in the field tomorrow. Take care.