The next item of business is a debate on motion 9241 in the name of Johann Lamont on petition PE1517 on polypropylene mesh medical devices. May I ask those who wish to speak in the debate to press the request to speak buttons? I call on Johann Lamont to speak to and move the motion on behalf of the Public Petitions Committee. Up to 13 minutes, please, Ms Lamont. Thank you very much, Deputy Presiding Officer. I am pleased and privileged to open this debate on behalf of the Public Petitions Committee and to play a small part in the opportunity to bring this critical issue to further public attention. Petition 1517 on polypropylene mesh medical devices was lodged in April 2014 receiving over 1700 signatures of support and attracting 212 comments. The committee will be considering a draft report in the petition in due course and will reflect in this afternoon's debate in consideration of that report. What is said today will help to shape that report, a report that I believe is a very important one. Before I move to the key themes and concerns raised by the petition, I would like to play some record of my thanks on behalf of the committee to the petitioners Elaine Holmes and Olive McElroy, all the other women, their husbands, partners, friends and family who have provided their own testimony of the impact that mesh has had on their lives, a testimony given often at huge personal cost. While we have, by their courage, been given a window into what they have suffered, we are not living with it every day as they do with impact on every aspect of their lives. The testimony is set out in the 80 plus written submissions that we have received on the petition to date. It would also be remiss of me not to acknowledge the MSPs who do not sit in the committee but who have joined us in our consideration of the petition. I expect that Jackson Carlaw, Neil Findlay, Alec Neill and John Scott will be contributing to today's debate, just as they have contributed to the committee's deliberations. The session 4 committee's consideration of the petition started in June 2014 with evidence from the petitioners. It is an indication of the impact of this evidence that, just two weeks later, the then Cabinet Secretary for Health and Well-being, Alec Neill, gave evidence to the committee. It was in the course of this evidence session that the intention was to establish an independent review and the request for a moratorium on the use of mesh devices was announced. It is worth taking a few moments to say something about that moratorium, as it transpired that mesh operations did continue while this was in place. We heard during our most recent evidence session from Dr Willagur that the cabinet secretary's request was disseminated to health boards by the chief medical officer. The request asked the boards to consider suspending the use of mesh in procedures for pelvic organ prolapse or stress urinary incontinence. However, it became clear that boards retain autonomy over their operations and, as such, were under no binding obligation to act on the request or to confirm whether it was intended that mesh procedures would continue in their area. Although I cannot speak for the members of the session 4 committee, I do not think that that would have been their understanding of what a moratorium entailed. That is something that should be reflected upon for any future circumstances in which a moratorium may be requested. I would welcome the cabinet secretary's commitment to ensure that that is done. With that said, I think that members will understand that I wish to focus most of my opening remarks on the process and outcomes of the independent review. Membership of the independent review comprises representatives of the urologists, researchers, professional bodies, patient representatives, public health professionals, the regulatory body for medical devices and the office of the chief medical officer. Secretariat support to the chair was provided by the Scottish Government. The independent review's published remit was, quote, to evaluate both the efficacy and the extent and causes of adverse incidents and complication rates associated with stress urinary incontinence and pelvic organ prolapse. Its formal title was, quote, Scottish independent review of the use, safety and efficacy of transvaginal mesh implants in the treatment of stress urinary incontinence and pelvic organ prolapse in women. At our most recent meeting, the petitioners informed the committee that they had, quote, to fight to get the word safety put in the heading of the review. That certainly gave me pause for thoughts, I am sure that other committee members too. The independent review got to work with a milestone reach when it published an interim report in October 2015. The independent review's interim report was tentatively welcomed, insofar as it represented signs of progress and enabled interested parties, not least the Government and mesh survivors, to reflect on the interim conclusions. It should be noted, however, that the petitioners produced a minority report, and the Scottish mesh survivors group considered that the recommendations should be actioned immediately and outcomes monitored before any further mesh procedures took place. The interim report produced eight conclusions, those related to the need for robust clinical governance, multidisciplinary team-working with appropriate levels of audit activity to ensure the recording and reporting of adverse events, the need for fully informed consent to ensure that women had the opportunity to discuss with their clinician all the options that are available to them and the pros and cons of each. Serious concern that some women who had reported adverse events were not believed. Concerns about the efficacy of short-term studies into the safety and effectiveness of mesh procedures, given that many adverse effects do not become evident until five, ten or more years after a mesh procedure. The lack of reliable or robust information systems to record the number of procedures carried out and, by extension, difficulties in accurately measuring adverse events. Concerns about the use of transorator mesh procedures, rather than retropubic mesh tape procedure, for what was referred to as quote routine surgery for stress urinary incontinence. Those concerns were based on information that was produced in chapter 6 of the interim report, accompanied by a number of tables. And similar concerns about the use of mesh and surgery for pelvic organ prolapse. The October 2015 report was explained as being interim, because the independent review was awaiting outcomes and findings from two pieces of work. The first of those was the final opinion of the European Commission's Scientific Committee on emerging and newly identified health risks on the safety of surgical meshes used in uroject gynaecological surgery. That opinion was published in December 2015. Its recommendations included the implementation of any mesh for the treatment of pelvic organ prolapse via the vaginal route should only be considered in complex cases, in particular after failed primary repair surgery. For all procedures, the amount of mesh should be limited where possible. The second was the prolapse surgery, pragmatic evaluation and randomised controlled trials, referred to as the prospect study. One of the primary outcomes assessed in this three-year study was the quality of life for women who had reported prolapse symptoms. The final report from the study was published in the Lancet in December 2016. It concluded that augmentation of vaginal repair with mesh or graft material did not improve women's outcomes in terms of effectiveness, quality of life, adverse effects or any other outcome in the short term. In addition, it found that more than one in 10 women, approximately 12 per cent, experienced a complication associated with mesh. The study concluded that follow-up was vital to identify whether there were any potential longer-term benefits for women and conversely to identify any potential serious adverse effects of mesh procedures for pelvic organ prolapse. With those two pieces of work completed, the independent review's final report was published in March this year. I have to say that it would be a significant understatement to say that the final report was not as well received as the interim report. There were resignations from the independent review, shortly before publication of the final report, amid reported concerns that it was not fully independent, was misleading and a backward step from the interim report. Indeed, the petitioners were reported by the BBC as feeling betrayed and concerned that the report was a whitewash. There were concerns expressed by the petitioners and members of this Parliament that information had been either emitted altogether or moved to a different part of the report. Significant concerns were related in particular to the removal of the shared decision tables in chapter 6 of the final report. Those concerns have already been raised in this chamber, both at topical questions and during the cabinet secretary's statement to the Parliament on 30 March. In May, the committee took evidence from the chair of the independent review and then from the cabinet secretary and the chief medical officer. Unfortunately, the evidence that we heard seemed to produce more questions than answers. We were unable to establish a clear understanding of how decisions were taken within the independent review, whether they were taken by subgroups, the full group or at the discretion of the chair. The committee felt that the lack of clarity could have been avoided through the provision of readily accessible minutes or notes of correspondence. There was also some confusion around the timeline of communications between the petitioners, the cabinet secretary and the chair of the independent review. That extended into decisions that were made following the receipt of the communications from the petitioners that they wanted all of their contributions removed from the report. That did not happen. The review's final report recommends that the reporting of mesh-adverse events should be mandatory. That is to be welcomed, although it appeared from the evidence that we heard that that was a conclusion that was reached quite late in the day. A number of the other recommendations are also welcome, insofar as they address symptoms and practices that should be in place as a matter of clinical governance. However, there are two specific recommendations that I would like to focus on. Conclusion 7 of the final report recommends that, in relation to stress urinary incontinence, women must be afforded all appropriate treatments. That is mesh and non-mesh. It adds that women must have the information to make informed choices. I cannot stress how important it is that, when considering their options, women have the opportunity to discuss those with their clinician and have their views listened to. Those discussions must be based on the most up-to-date information available. Conclusion 8 on the surgical treatment of pelvic organ prolapse considered that a mesh procedure did not provide any additional benefit over natural tissue repair. However, that conclusion seemed to be somewhat qualified by stating that, quote, "'Transvaginal mesh procedures must not be offered'—and I emphasise this next word—routinely." In evidence to the committee, the cabinet secretary advised that the Scottish Government would establish an oversight group to take forward the recommendations. She added that, quote, "'The key safeguards that are to be put in place must be implemented before any procedures using mesh are reintroduced routinely." When I sought clarification from the cabinet secretary and whether the moratorium would remain in place until such time as the recommendations have been implemented, she replied that the suspension will not be lifted until medical directors have assured the chief medical officer that all the recommendations in the final report have been implemented. It could be argued that much of what the petition called for has been delivered. For example, the moratorium was requested, the initiation of the independent review, mandatory reporting of adverse events and the progress that has been made towards fully informed consent. However, the outcome of the independent review is such that it would be absolutely inappropriate for the petition to be closed at this point. That reflects the fact that the cabinet secretary has commissioned Professor Alison Britton to conduct a review of the independent review. I have had the opportunity to meet Professor Britton along with the deputy convener to understand her remit and to flag up to her some of the concerns and issues that have come to light in recent months as part of our consideration of the petition. The cabinet secretary has offered her reassurances that the recommendations of the independent review's final report should stand, pending the conclusion of Professor Britton's review of the review. However, the overriding concern has come across during our consideration is people's lack of confidence in the independent review process and, as a result, in its outcomes. In the light of people's already fragile confidence in the governance and findings of the independent review, Professor Britton's review finds the progress of the process of the independent review to have been significantly flawed. How can the cabinet secretary, the Parliament and, most importantly, the public be assured that the outcomes of the independent review are robust and credible? I hope that today's debate provides an opportunity for that and other questions to be answered. We may sadly have to confront the harsh truth that the damage done to the petitions and others cannot be repaired. We must do what we can so that their experience is not repeated. Believing all those women and responding to their well-founded understanding of what must change would be a good start. I move the motion in my name. May I respectfully say to those in the gallery that it is not appropriate to either show appreciation or, indeed, otherwise during the debate? I call Shona Robison up to eight minutes, please, cabinet secretary. Thank you, Deputy Presiding Officer, for the opportunity to take part in this debate on what is a very important issue. For the chance to give the chamber an update on the Scottish Government's work in this area, I would also like to take the opportunity to thank the Public Petitions Committee for all its work and deliberations on the issue of transvaginal mesh, and most importantly, I thank the women of Lanehomes and all of McElroy, who brought this very important issue to light through their petition. Members might recall that I gave a statement on transvaginal mesh back in March. At that time, I spoke about what led my predecessor to establish the Scottish independent review of mesh. It was the brave action of the Scottish mesh survivors, patients who had suffered serious complications and who petitioned Parliament. In doing so, they spoke very openly about the difficulties that they face on a daily basis. Indeed, it is those actions as well as the stories that I have heard from women who have written and spoken to me over the months and years. It led me to continue to treat this issue with the utmost importance. Given the complexity of the issue, it has proved difficult to reach a consensus, but what is important is how we move forward and the improvements that we propose will keep our aim of continuous improvement in NHS Scotland. Members will recall my commitment to look at concerns raised about the process of the independent review. That is why I asked Professor Alison Britton of Glasgow Caledonian University to examine the course of the independent review, and she will produce a report with recommendations about how similar reviews could be conducted in the future. Neil Findlay is much more than the process, I have to say. However, the point that I want to make is that there is not an issue here where it takes the women to have to go through that very long process of the petitions process to get to the stage that we are today and that they feel quite rightly that no one was listening. Shona Robison I think that Neil Findlay makes an important point that it should not have taken a petition for this issue to get the light that has been brought out into the light as it has done, but what has flowed from that has been some very important changes that I want to come on to highlight. Changes have been made, and it is important to record that. What is important is that we do not lose sight of the central issue here, and that is that we have to continue our work to address the issues raised by so many women and to build on the work of everyone who has taken part in the independent review and the other processes that Neil Findlay referred to. The review made eight clear key recommendations, and the Scottish Government has accepted all of those recommendations and expects all health boards to take note of future developments, as I will now explain. Officials have been working with the GMC in drafting updated guidance about shared decision making, and that is the important point that Johann Lamont made. The drafting of that updated guidance is now complete and will be subject to wider consultation, anticipated to start in the spring of next year. The emphasis of the guidance is on sharing information, explaining risk and giving choices. The importance of doctors working in partnership with patients and supporting them to make decisions is stressed, and all clinicians are expected to abide by it. When I made the statement to the chamber back in March, I explained that an oversight group would be established. That group is absolutely key, and I can confirm that healthcare improvement Scotland has taken forward that work in the months since I made that announcement. It will regularly review data relating to mesh procedures and will scrutinise adverse event reporting. However, what is particularly significant is that the group will continuously review new studies and new evidence and will carefully consider how that new evidence can be incorporated into pathways of care. The group will also help to ensure that patient information is relevant and up-to-date. Indeed, the production of a patient information and consent leaflet for pelvic organ prolapse and the review of the existing leaflet for stress urinary incontinence will be a key task for the group. What is important here is that the oversight group has absolutely the right people on board with the level of expertise and experience that is necessary to take forward such critical work. That is why I am pleased to be able to confirm that Professor Lorna McKee has been appointed chair of the oversight group. Professor McKee is now an emeritus professor of management and health services research at the University of Aberdeen. I wish Professor McKee well on her role to look forward to future updates on the progress that is being made in achieving implementation of the review group's recommendations. Neil Findlay has mentioned Aberdeen, and I do not know the individual involved, but is the Government aware of any allegations of research misconduct on the SIMS study that took place in Aberdeen, and has there been any communications with the Government and those who were involved in that study? Professor McKee is absolutely above reproach in that matter. It is very important that she is allowed to get on with the job of chairing the oversight group. I hope that there is no inference from Neil Findlay that she is in any way connected with that. Those issues are completely separate, and I think that we should allow Professor McKee to get on with the important work of the oversight group. Importantly, healthcare improvement Scotland has well-established procedures for engaging with the general public through their public partner scheme, and his will ensure that the oversight group has full representation of patients who have direct experience in the best way that they wish to be involved. The group will meet for the first time in early December, and that meeting will focus on future planning. The first full meeting of the group will take place in January. As my colleagues will be aware, I want to make some progress, if you do not mind. As my colleagues will be aware, there was an almost parallel process in NHS England involving a different group of patients, clinicians and evidence reviewers who published a report in July this year, which came to very similar conclusions. I wish to note, however, that in Scotland the independent review went further and used the language of the regulator, the general medical council, stating that mesh procedures must not be offered routinely for POP, whereas the NHS England report noted that the use of a general mesh in primary procedures to treat POP is not supported by the current evidence, and that should not be offered routinely for the first surgical intervention. Importantly, members will be aware that NICE will shortly publish their updated guidance on the use of mesh for pelvic organ repair as part of their interventional procedures programme guidance. As NHS Scotland is a full partner in this programme, the guidance must and will be implemented. Such procedures will be included in patient management pathways, and, as I have mentioned, the new evidence for those pathways will be overseen by the new oversight group. I await the revised guidance with interest, however, what we have already in place in Scotland is a clear set of recommendations that place a clear emphasis on patient safety. I can also confirm that the chief medical officer has today written to all NHS board medical directors and the oversight group, drawing their attention to the forthcoming nice guidance. The CMO has also written to the MHRA, who, after all, as we have discussed many times in this chamber, are the only organisations that can ban mesh, pointing to the recent publication from the Australian Therapeutic Goods Administration. I think that it is important that we hear back from the MHRA about their response to that publication. I would also like to be clear, meanwhile, that the request to suspend remains in place and will do so until the chief medical officer is satisfied that all the recommendations have been implemented, including all upcoming changes to guidance and necessary safeguards are in place. In essence, what we expect is that the consent procedures and other safeguards will be put in place, taking into account all new guidance into pathways, meaning that the situation in the future will not be greatly different to that under the current suspension. What we all want to see is a change in the whole approach to that condition. I hope that I have been able to set out, over the last few minutes, the up-dated position. I will, in the closing remarks, Mr Scott, because that will be the time. I can allow you the time. I hope that I have been able to give members reassurance that the Scottish Government takes this issue very seriously. Indeed, we have made progress since the publication of the independent review report. I will come back to members in the closing remarks with any other issues that they want to raise. I call Jackson Carlaw for seven minutes, please. Presiding Officer, this full debate brought to the chamber by the Public Petitions Committee is long overdue and especially welcome. It is now nearly some four years since my constituent, Elaine Holmes, visited my constituency office on crutches, anxious about the nature of what she had to discuss and share, but absolutely determined even then that she would do all she could to bring a spotlight to mesh procedures and to what has gradually but inexorably become a worldwide scandal and in Scotland a devastating tragedy for far too many women. I do not say scandal lightly. Born in 1959, I remember my bewildered shock when, as a child in the mid to late 1960s, I read Sunday Times' newspaper features on thalidomide. That too was marketed as a convenience for women and a safe one at that. Facts were concealed, lives ruined, lives compromised to this day, women patronised by experts, living, practising, operating, researching and preaching from the rivalry towers. Mesh is the 21st century's thalidomide, a worldwide scandal every bit as devastating. Presiding Officer, at the heart of the mesh scandal is the most deeply personal testimony. Who can ever expect to have to, without warning, find themselves suffering from chronic pain, a loss of sexual function, to have mesh protrude through the bladder or bul, sometimes being removed with horrendous consequences, organs trapped and entwined with mesh, shrinking and moving inside the body, slicing through nerve endings, tissue and those same organs. I've met the women in wheelchairs and in crutches and who am I us cannot also appreciate the courage in these women stepping forward to discuss these intimate details and, in many cases, with male politicians. The Public Petitions Committee led. Alex Neil as Cabinet Secretary for Health and Well-being led. No one doubted the commitment to have Shona Robison as the review committee established in 2014 went about its business. Presiding Officer, that is why the sense of betrayal and dismay among all those mesh survivors is so profoundly felt. They thought, I thought, we all frankly thought that government was on their side. Again, the rest of the world took note. As litigation, which has now generated billions in compensation commenced, here was political leadership in Scotland, where the unique circumstance of a smaller NHS made action possible and credible. We were ahead of the rest of the UK. Slow they were to pull all this together given the many health boards in England and the lack of co-ordinated patient networks. Patients there also looked to Scotland. Throughout, I've listened to many experts. They've presented both to the Petitions Committee so-called experts like the lamentable MHRA leadership who denied an irisible and dismal performance here at Holyrood that there was even an issue or that many women were afflicted, even as those women sat packed in rows behind them, or experts who have dared to suggest that women perhaps might seek psychiatric help. Yet surely the most reason and impressive of all these experts was the consultant physician Dr Weylerger, also a constituent who, along with Elaine and Olive McElroy, resigned from the review committee in abject dismay and professional fury at the bowdlarisation of the draft report of the review committee, the travesty of chapter 6, into the shameful and widely despised whitewash of a report finally published. The new chair was deeply unimpressive witness. It was Dr Agour who spoke without artifice and with sincere clarity. As he talked through his own journey towards believing in a complete ban, he also exposed the fallacy of the informed consent process. Of the 22 women who made use of his health board's shared decision making tool to assess whether mesh was appropriate for them, only one, yes, just one, decided in favour of the procedure and that was because she hadn't read the leaflet properly and when she did changed her view. I understand and take note of what the cabinet secretary said about the advice and guidance that is underway and is going to be subject to scrutiny and I look forward to seeing the outcome of that. Presiding officer, there was talk ahead of today's debate of amendments to the motion to make a much more direct demand of government. Now I understand these calls but I'm not yet convinced the moment has arrived where this Parliament must divide. However, I do want to be very clear with the cabinet secretary. This is last saloon chance territory. If decisive progress is not forthcoming, then we will however reluctantly seek to find common cause with others in this chamber to require a mandate action and change. As the SNP MP Brendan Ahara stated in the Westminster hall debate in October, this devastation for women and their families is absolutely intolerable and must never be allowed to happen again. Presiding officer, there must be no interruption to the current suspension ban. There must be a full public consultation on the content of the review, which took place, to be published alongside the procedural view led by Professor Britain. There must be a sustained engagement with the Westminster Government in respect of the actions and performance of the MHRA. Politicians of all sides will willingly join in this, here and at Westminster, where Owen Smith MP and my Easter Emffisher colleague Paul Massarton MP respectively chair and co-chair the all-party group and mesh. The Scottish Government must act in Alex Neil's proposal to conven an international summit here at Holyrood to allow Scotland to regain the public political initiative. There may be aspects of the scandal that are reserved and others devolved, but for pity's sake, we can no longer be a defence against the most determined and joint close working and co-operation. Presiding officer, our glass is run. Huge legal compensation claims the world over are landing with health services, more than 800 are now under way in the UK. This too is an issue of immense concern all on itself. But this issue, which will all be about money, about consent, about all the most basic issues of women's dignity and our quality of life and that of our family and that too of the increasing number of men who have also had mesh implanted demonstrating complications is about more than that. Led by Elaine and Olive, these Scottish women are an inspiration. I'll confess to being a sentimental sort, but the coldest glass eye could not be in the company of women, compromised in so many ways, who have become a joint support network, a hugely entertaining social party and one of Scotland's most effective campaigning groups and not be moved by their efforts. Presiding officer, I want Scotland to lead again. I want us to prevent mesh destroying more lives ahead. I want in all sincerity this Parliament to be able to look to our Government to regain that leadership. We have waited patiently as due processes promised hope, only to thwart it instead. I look to the Government for justice and I'm sorry, cabinet secretary, I say to you now, please act and please act now. I call Neil Findlay around seven minutes, please. Thanks, Presiding Officer, and I thank the Petitions Committee very much for bringing us forward. It's been a long time coming. Five years ago, on becoming my party's shadow cabinet secretary for health, I was handed a portfolio of issues from a colleague, Jackie Baillie. It was a few news curtains about an issue that no one was really talking about, transvaginal mesh. Along with Tommy Cain, my researcher, I soon met with the then small group of women affected by that product. We immediately struck up a friendship that is sustained to this day and are some of the finest people I have ever met. I'm proud to call them my pals. All have been affected by this probably proper product, permanently inserted into their body in an attempt to address incontinence or prolapse. And when implanted, body tissue grows through its pores. It cannot be removed without serious nerve and tissue damage, and removal has been compared to removing chewing gum from a person's hair. In many patients, the mesh lost its pliability. It became rigid. It started to break up, dispersing shards and fragments throughout the body. The last five years of this campaign has been very emotional. Let me tell you why, because women—young, middle-aged and older—were told by surgeons and health boards, many with a conflict of interest that they would be treated by a short procedure that was the new and, I quote, gold standard in care. After that, all would be well. Well was it?  But the reality is that tens of thousands of women across the world live with chronic pain and mental pain, and a lifetime of hopes and dreams lost, forced to struggle against the might of the medical establishment and the cosy relationship between big medical companies like Boston Scientific, Johnson & Johnson, surgeons, health boards, Governments and the MHRA, all of whom denied there was a problem, all of whom told the women they were imagining things or exaggerating. Month in, month out, my office staff and I worked with the Scottish mesh survivors, led brilliantly by Elaine Holmes and Oliver McElroy. We took them to meet the then cabinet secretary, Alex Neil, and we asked him to ban mesh, but at that time he said he couldn't as he feared being sued by the manufacturers. After numerous FOIs, PQs and much lobbying, we found ourselves up against a brick wall, so we advised the women to take forward this petition. I'll never forget the day that it was presented to the committee. Dozens of sobbing women sat hugging and supporting each other in solidarity, and what David Stewart, the then convener, said was one of the most emotional days of his political career. The petition forced Alex Neil to suspend mesh, but not before yet more women had been implanted. We then forced the establishment of the so-called independent review in which Elaine and Oliver sat. It met at least 10 times and unanimously agreed an interim report. Then the chair resigned and new chair came in. No meetings took place in 10 months, well actually they did take place. It's just that Elaine and Oliver were not told off them and no minutes were circulated. With the new chair in place, the final report was radically changed to the point where neither Elaine, Oliver or Dr Agour could sign up to it and all resigned. At that point, we met the new cabinet secretary and asked her to ensure that the mesh survivor's contributions were withdrawn before publication. We were assured that this would happen only for the report to be published without the changes being made—a shocking breach of faith. In the run-up to that event, over 100 MSPs from across parties signed a no mesh whitewash pledge. The view of the Scottish mesh survivors is that the report is a whitewash and a big, deep murky barrel off it. On that review, we are four surgeons—Dr Karen Guerrero, Dr Valua Granithostis, Dr Agour and Mr Paul Hilton. Three of them are subject to litigation by mesh survivors. None of them declared this conflict of interest before taking part in the review. Mr Paul Hilton is one of the main witnesses for the NHS central legal office in the forthcoming civil action for damages brought by 420 patients in Scotland. His position on mesh was predetermined before taking part in the review. Mr Hilton also failed to declare that his wife, Dr Lucia Dolan, is also— Can I stop you there, please, Mr Finlay? I would just like you to bear in mind that there may be subjudice matters here. Could I say, Presiding Officer, that I have clarified this with the chief executive of the Parliament? Dr Lucia Dolan is also subject to litigation in Scotland. Does the cabinet secretary still, after all that, believe that the review is independent? Will she allow the report to go out for public comment, as Jackson Carlaw suggested? Will she agree to the indefinite suspension? Will the cabinet secretary tell the NHS to clear its shelves of mesh so that it no longer can be used in Scotland? She has the procurement powers to do that. Will she end its purchase for use in Scotland? Will she write to the medical companies, urge them to settle litigation cases quickly, and to stop their deliberate stalling? Finally, will she instruct a judge-led inquiry, similar to the baby ashes inquiry, into what is the biggest multiple litigation in the history of Scotland's NHS? Scotland had the opportunity to lead the world on mesh. Everyone was watching and we flunked it. The review was compromised from the outset, but the Government has let down mesh victims. That is a tragic tale of corporate power and greed, institutional arrogance by the medical establishment and government ambivalence and delay. Only by refusing to give up have we got this far. Let me tell the cabinet secretary that we aint gone away. That is the last chance to make radical changes to the way forward, or we will bring political motions that seek to unite the opposition on that issue. We now move to the open debate. I would ask for speeches of around six minutes, please. I do have a little bit of additional time in hand, so I can allow for interventions. I have Alex Neil, followed by Brian Whittle. Thank you very much indeed, Deputy Presiding Officer. Can I begin by reiterating what every speaker has said so far to pay tribute to the work of Elaine and Olive? All the mesh survivors and their campaign has been absolutely fantastic, and well motivated and very effective. I also pay tribute to the petitions committee, and in particular to the convener Johann Lamont and the vice-convener Angus MacDonald, who have done an excellent job so far, because they are still a way to go on this particular petition. I also pay tribute to the late Chrissy Bradshake, a Canadian campaigner who died last week of sepsis and who was in the process of suing Ethicon for the way in which she was treated and was part of the Canadian mesh survivors group. That is not just a Scottish issue, but a worldwide issue. I thank Jackson Carlaw for reiterating my call for the petitions committee with the support of the full Parliament to call an international conference to take co-ordinated action against those who are the real culprits in the manufacturers of this mesh equipment that has been neither properly tested nor trialled before it was introduced worldwide. I also say that I hope that we can unite the whole chamber. That is not just about opposition against Government. I think that we all share those concerns, and we all need to do and want to do what is right by the survivors and to prevent that happening again. Let me briefly say that I am going to be open, honest and transparent. One of the reasons why I took longer to commission the independent inquiry than I did because, quite frankly and very unusually, I was not convinced by the information that I was being provided by the official advisers when I was the Cabinet Secretary for Health on this matter. On no other matter did I have any reason to doubt, but I increasingly felt as though I was not being told the truth, the whole truth and nothing but the truth, and I ended up doing a lot of research into the subject. The more and more I researched the subject, the more and more I became convinced that we had to do something, that we had to, at the very least, suspend these procedures until we could be much more sure as to their safety. I am glad that we did that. Let me also just, for the record, make it very brief, Neil Findlay. Can I ask if he thinks that the same people who are advising him are the same people who are advising the Cabinet Secretary now? I have no idea about that whatsoever, but also just for the record, I made it absolutely clear that, when we appointed members of the independent review group, none of them should have a commercial interest in mesh. That did not actually happen, and I am very critical of the fact that it did not happen. John Scott mentioned, and in his time as Cabinet Secretary, did he make any assessment of the potential contingent liabilities in terms of damages due to the class actions going on elsewhere in the world to Scottish survivors of the mesh implants? Alex Neil. We were very much aware of the legal proceedings in Scotland and the rest of the United Kingdom and, indeed, in the rest of the world. That was one of the considerations and a bit of research that I found out more about myself, rather than relying entirely on the official advice. That reinforced my view that there was something seriously wrong here that had to be addressed. Previous speakers have already quite rightly addressed the whole procedure of the independent review and the very good and unanimously agreed interim report. Something happened between the interim report and the final report. One of the things that happened was that, in between those two reports, more research came out and that was never taken into account in the final report. However, again, like Jackson Carlaw, I thought that one of the best witnesses that came in front of the Petitions Committee, apart from the Winnerman himself, who were the best witnesses, was Dr Ruggart and what the point he made and why he resigned as a member of the group. I honestly think that as well as reviewing the process, the contents of the report are now so disrespected that we need to review the contents itself, because, quite frankly, there is not the universal agreement to accept the contents as they stand. Fortunately, as the cabinet secretary outlined, we have made advances and decisions that have been made in Australia. I believe that we should listen and learn from what they have decided. There are the nice guidelines and the GMC guidelines. However, once all those guidelines are available, obviously we need to police them to make sure that, at least in Scotland, those guidelines are adhered to and adhered to very well. However, I do not believe that that is going to be enough. There are other things that we need to do. I would ask the cabinet secretary to look at and I very much welcome her comments about the establishment of the oversight group. However, I think that proper oversight in this case needs to have some form of patient involvement, because one of the drawbacks in this whole procedure has been the patient's feel and the survivors feel as though they have not been listened to. That is not in any way to second guess or undermine the role of the medics. Clearly, none of us who are not trained can exercise medical judgment, but patients, particularly patients who are the survivors, have a lot of potential input into what to look for in an oversight arrangement. Health Improvement Scotland uses lay members anyway in most of its inspections, and I believe that we should look to using patients and involving patients in the oversight procedure. There are two other things that are important. I mention in passing the current state of the leaflets that I will write separately to the cabinet secretary with the details of those, because there is a clear commitment from the cabinet secretary quite rightly to ensure that the leaflets are up-to-date and easily accessible and easily readable. There are three other things that we have to look at very quickly. One is that I think that there should be a notice on any surgeon who has any commercial involvement with the producer of a product that he or she is using on a patient to tell that patient that they have a commercial interest in that product. Secondly, it is very clear that the MHRA is not fit for purpose, is partly funded by the mesh manufacturers, and I do not see how it can be truly independent. And thirdly, we must make sure that they are in future. When there is an independent review, it is genuinely an independent review, and we do not again—and I look forward to Professor Britton's report—to have those processes tainted by the suspicion surrounding the outcome of that particular review. I believe that, if we implement those suggestions, as well as all the other points that were made by the previous speakers and no doubt want to come, then hopefully we will get the right answer to that and make sure that no other woman or no other man have to suffer, because some men have suffered as well. None of them have to suffer, but those women have had to suffer and endure, in some cases, for the rest of their lives. Can I remind those in the public gallery that neither appreciation nor otherwise should be shown? I call Brian Whittle to be followed by Rona Mackay. I refer the chamber to my register of interests and that I have a close family member who is a healthcare professional in the NHS. I welcome the opportunity to speak in this debate today, and this issue has been in the Petitions Committee agenda since before my arrival in this place. It is fair to say that it has delivered some of the most harrowing of evidence sessions that I have been involved in in my short time. It has certainly focused my mind on the fact that what we do in this place, amid all the other white noise of political debate, has a profound effect on the lives of people in Scotland. In the case of today's debate, a topic that has far wider reach and implications than just within our own borders is not overstating the importance of this debate to suggest that the eyes of other nations are watching to see how this Parliament deals with the continuing issue of polypropylene mesh implants. I also wanted to say, Deputy Presiding Officer, that the site of the Cabinet Secretary and the chief medical officer being cross-examined in committee by committee members and former members with so many women affected by this procedure sat behind them. Many wheelchairs are one that is a vivid one. It was uncomfortable to watch and listen to that evidence session with reaction from behind the Cabinet Secretary for those who seem so aghast. The fact that the current committee was joined by Jackson Carlaw, Alex Neil, John Scott and Neil Findlay highlights the cross-party strength of feeling and support for this campaign and the need for this Parliament to join together and end this scandal. To that end, Deputy Presiding Officer, I want to add my sincere gratitude to the Scottish Mesh Survivors campaign for its unrelenting and resolute campaigning to try to ensure that what it has had to endure will be spoken about in public forum and that no-one else needs to have their lives devastated by the potential repercussions of this procedure. The campaign also highlights the international impact that a public campaign can have through the Public Petitions Committee. However, there are questions to be answered. Firstly, how a former health secretary in Alex Neil can take the robust action of imposing a moratorium on the use of transvaginal mesh only for certain health boards to continue to use the procedure to treat stress and urinary incontinence, with some 400 women undergoing this procedure since the moratorium? Who is ensuring that the moratorium has been adhered to? Who does the responsibility lie with? Why do we set rules if there is no system to enforce those rules? It was news to me and to many other MSPs, apparently, as well as the campaigners that a moratorium called for by the Government is not binding. That has to be an area of concern and something that this Parliament must address. Had that moratorium held in the manner in which I believe that it was intended, we would not be in the position that we find ourselves in today. Worse than that, however, is the debacle of the initial review and the resignations from the review board amid allegations of changing of language, of omissions of key evidence and finding from that review. Ultimately, there seems to be clear evidence of an attempt to whitewash the issue. Although we are not trying to be part of political tear, I think that the response from the Government and the Cabinet Secretary in particular has been at best sluggish and indecisive. With that weight of evidence piled against the procedure, action could have and should have been clear cut by now. It was obvious to all that all was not well within that review panel. For the involvement of the MHRA, which has already been mentioned in here, has been absolutely shocking. A body in which we place a great deal of trust and responsibility has been exposed as inadequate and incapable of applying any degree of logic and care. Experts have claimed that sufferers' pain could actually be psychosomatic, so at no point is there a duty of care or candour. It was painful watching the new chair of the review board squirm in the chair under questioning during an evidence session, as Jackson Carlaw has stated. Her answers were causing gas from the woman seated behind her. A certain lack of empathy and understanding was all too evident. I have to agree with my colleague Jackson Carlaw in his assertion that there must be a full public consultation on the content of the review that took place. I also want consideration given to Alex Neil's proposal to conven an international summit here in Hollywood to allow Scotland to once again lead the way. Putting an end to the procedure is well overdue, Deputy Presiding Officer. The ban must remain in its entirety in the way in which it was originally intended. That must surely be a precursor to an end to the operation for good. I once again want to thank the petitioners for their courage and their persistence, and I would like to close by assuring them that their voices are now certainly being heard. I call Rona Mackay to be followed by Monica Lennon. Today's very important debate is one that I wish wasn't happening, because the circumstances surrounding it are shocking and upsetting, particularly to the thousands of women whose lives have been devastated by transvaginal mesh implants. That is not or should not be a political issue, as others have said. Long before I was elected, colleagues from across this chamber, particularly former Health Secretary Alex Neil, Neil Findlay, Alison Johnstone, John Scott, Jackson Carlaw and others, have fought tirelessly to help women affected by the issue. I say that it should not be political, because the mesh survivors watching this could not care less about party politics. They are simply searching for answers, asking why this has happened to them and why a surgical procedure that was supposed to help them has ruined their lives. My former colleague, journalist Marion Scott, who spearheaded this campaign from day one, along with mesh survivors Aileen Holmes and Olive McElroy, did not get involved with the campaign because it was a good story, despite displaying the very highest standard of investigative journalism, all too sadly lacking these days. Marion has supported mesh sufferers because their pain and distress is all too visible. Their quest for justice despite their suffering was and is relentless. They deserve our full praise and admiration. However, mesh sufferers are not looking for praise. Olive McElroy and Aileen Holmes do not want TV cameras in their living rooms. They want answers. Before they knew each other, Olive and Aileen were trying to cope with the crippling after effects of surgery. They were told that they would change their lives. Both have been told that they were unique. They weren't. We now know that thousands of women worldwide have been affected—mothers, daughters, sisters, aunts, grans. The mesh survivors are not campaigning for themselves. They are not doing it for money.  I vividly remember seeing on TV in 2014 the joy and delight in the faces of the women led by Marion Scott at the committee meeting as a suspension on mesh implants introduced by Alex Neil was announced. However, as I understand it, since then at least 400 women have had a mesh tape implant to treat the very common condition of stress urinary incontinence since the suspension. Incidentally, for anyone who does not know what this tape implant looks or feels like, imagine a bale of newspapers being bound by strong plastic tape, the kind of tape that cuts your finger if you touch it in the wrong way. That is what women are dealing with when it is put inside their bodies. I do not pretend to be a medical expert, but what I know is that, when clinicians cannot agree, as we heard in Elaine Smith's powerful members' debate on thyroid diagnosis and treatment a couple of weeks ago, it is the patient who suffers. I like the thyroid problem. The vast majority of mesh sufferers are women, and I leave you to draw your own conclusions on that. The Scottish Government cannot ban the use of medical procedures, but it cannot ask health boards to suspend their use, which is what was done. As a result of the petition, some progress has been made, albeit slowly, such as mesh should not be offered routinely to women, and all patients must have access to clear, understandable advice to help them to make an informed choice. All appropriate treatments should be made available, subject to informed choice. A helpline has been established. Reporting of all procedures and adverse effects will be mandatory. A new oversight group, as we have heard, has been set up to ensure that the conclusions are implemented. Progress is a last heading in the right direction. However, it is the UK body, the MHRA, who decides what medical products are safe, and I believe that we must put complete pressure on the MHRA, who, as Jackson Carlaw and others have said, have been in total denial over this issue from day 1. We should say what more proof do we need that this product is not safe. Here are the victims. Tell health boards that this product is not available for use. Of course, there are clinical risks with every surgical procedure and side effects to all medicine taken. However, when hundreds of women are so severely affected, then that risk is surely too great and we must stop doing it. As a member of the Petitions Committee, I am well aware of the serious issues that the report of the review and the review into the review throws up. Time does not allow me to delve into and others have outlined it very well. I accept to say that when those in authority in whatever field stop listening to the people at the centre of the issue, the people they are supposed to protect, it is a disaster. The Scottish mesh survivors hear our voice campaign as an outstanding tribute to the courage and determination of the women determined to effect change. Those in power must start hearing their voice, albeit belatedly, before more women's lives are destroyed. Thank you very much. I call Monica Lennon to be followed by Alison Johnstone, please, Ms Lennon. Thank you, Presiding Officer. I am grateful for the opportunity to speak in this debate today, and I add my appreciation to the Public Petitions Committee for their work on this important petition this far. However, most of all, I am grateful for the incredible bravery and strength of the mesh survivors in Scotland, who's tenacity in campaigning to raise awareness of this issue has led us to the point that we are at today. Like all, I believe, all of the MSPs in the chamber, I am totally in awe of the strength and the passion of the women I've met who are part of the Scottish mesh survivors group. Earlier this year, I joined parliamentary colleagues at a meeting with the Scottish mesh survivors organised by my colleague Neil Findlay, who's been a long-time champion for the voices of the mesh survivors and has done some excellent work in raising awareness for these women, as have several other MSPs from various parties. Nothing can prepare you for the stories of these women. I can only imagine the pain that they have had to endure over the years, but I share their rage, the rage that this has been allowed to happen to them. All of the Scottish mesh survivors, ordinary women with ordinary lives, have had their lives turned upside down by the implantation of transvaginal mesh. Intending to address incontinence or pelvic prolapse, the insertion of polypropylene mesh was for many of these women a procedure that they had been led to believe was first class, safe and would make their lives better. For so many of the women who have undergone these procedures, this could not have been further from the truth. As we now know, in many patients, the mesh began to break up, dispersing fragments throughout these women's bodies and causing incredible damage. Some of the women that I met earlier this year told me about ruined relationships and careers, the daily struggle of having to live with chronic pain, the loss of the full use of their legs and the unbelievable pain of having to deal with how those changes have utterly changed their lives, shattering hopes and dreams for the future. The implantation of mesh implants in women across Scotland on the NHS is a national scandal, and the way in which those women have been denied, first by their doctors when those women expressed their concerns, told that they were imagining or exaggerating their symptoms, then by the big medical companies, and now by Governments tasked with investigating the toll debacle, is nothing short of an outrage. During the drive to get MSPs to sign up to the say no to mesh whitewash pledge earlier this year, one of the women I met with told me about the experience she had when she first started having problems following mesh surgery. Her surgeon repeatedly told her that she was a unique case, the only one he had ever known to have been experiencing those adverse side effects, and for months she was none the wiser. It was only through the discovery of the mesh survivor group and discussion with other women who had gone through the surgery, some with the same surgeon that she discovered this doctor had been telling several other women the same thing. It is an absolute outrage that these women's health have been put so terribly at risk through this procedure, because not only is the implantation of mesh unsafe, but some practitioners and medical companies who advocate the use of mesh have clearly known about the dangers and yet have been complicit in misleading women about the dangers and effects. Earlier this year, a few of us launched the cross-party group on women's health. I am the convener alongside Alison Johnstone MSP, who is the vice convener. The purpose of the cross-party group is to inform Parliament and policymakers on a range of health issues that only predominantly or disproportionately affect women, to consider the impact that gender and inequalities have on women's health and their ability to access healthcare and treatment, and to empower women to make informed choices about their health and ensure that they are treated with dignity and respect. In large part, the discussions that I was having with a range of groups, as my party's inequality spokesperson, sparked the need for this group to be established, and the experience of the women from the mesh survivors group absolutely played a role in the desire of these issues of women's health to be looked at more closely. The way in which so many of these women have been brushed off and disbelieved is outrageous, and it should never be allowed to happen again. These women deserve justice, so I echo the calls of my colleague Neil Findlay that the mesh scandal must be investigated with a judge-led inquiry that is truly independent of the health service and the Scottish Government, and I urge the Cabinet Secretary for Health to give this serious consideration. As a 2016 MSP, I am fairly new to the parliamentary scrutiny of mesh, and I am struggling to understand how health boards were able to disregard the moratorium and get away with it without any apparent consequence, so I ask the Cabinet Secretary if she can give an answer to that in closing. The mesh survivors in Scotland and across the world have been silenced, sidelined and brushed aside for too long. It is beyond time that their concerns were investigated seriously through a truly independent inquiry and that the calls of their petition are considered by the Scottish Government. I ask the Cabinet Secretary to give that her wholehearted commitment in closing. I also wish to thank members of the Public Petitions Committee for their work on this critically important issue and to thank MSP colleagues who have supported the women and, most of all, the mesh survivors themselves, who have campaigned to make the risks of mesh surgery clear, to suspend those procedures in Scotland and to protect other patients from harm. Meeting the mesh survivors when they came to Parliament was eye-opening. Women of different ages and backgrounds gained great strength by coming together, by realising, as Monica Lennon has just pointed out, that they weren't alone, they weren't unique, unfortunately. So I met this room packed with women, women reliant on wheelchairs and crutches. What chronic condition or illness was responsible for these life-limiting symptoms, surgery here in Scotland? I spoke to women who had worked in high-level roles in justice, in care, in services that we all rely on, no longer able to make a living, rely on others for help and support. No one appreciates more than the women themselves how debilitating, how life-restricting incontinence can be. While we all appreciate that surgery can never be guaranteed 100 per cent safe or side-effect free to have such high hopes of life-improving surgery, only to have such devastating outcomes in a group of patients is absolutely unacceptable. What is clear here is that the consent given to surgeons by these determined remarkable women was far from informed. That is why their work in campaigning is so important. Incontinence is an issue affecting millions, yet it is rarely discussed in public. The mesh survivors have ensured that this will change. I will never forget meeting one of the survivors attending with her husband. They explained how their relationship had been changed forever by this procedure. Imagine your partner going to hospital for surgery to treat incontinence, and this resulting in them facing the rest of their life in a wheelchair. Incontinence considerably worsened, autonomy and self-esteem shattered and physical intimacy have fading memory. I met a woman in tears because she was no longer able to lift up her beloved grandchildren. When we discussed reversing or rectifying the surgery, I too, as Neil Findlay has heard from survivors, told that removing mesh could be likened to removing chewing gum from hair. I appreciate the forthright evidence that Elaine Holmes and Olive McElroy presented to the Public Petitions Committee in September, and the detailed account that Dr Agour gave of his involvement with the independent review, in which he noted key differences between the interim report and the final report that was published. Dr Agour is firm that the final report did not do enough to reduce harm and was too ambiguous about the risks of mesh surgery, contrary to the evidence that analysed the long-term adverse effects of mesh surgery, including mesh erosion and chronic pain. From Dr Agour's evidence, it is clear to me that, at one point, the work led by the independent review group did indeed make it the first authority in the world to formally express concerns about a procedure that many clinicians and surgeons and other authorities around the world considered to be a gold standard. Scotland had an opportunity to show global leadership on mesh, and I am, like other members in the chamber, extremely dismayed that the final report did not reflect that. We missed the opportunity to lead then, and we let down mesh survivors in the process. The Public Petitions Committee has reflected that Professor Alison Britton's report on the independent review will focus on the process that was followed and will not revisit the findings and recommendations of the report itself. In Dr Agour's view, recommending that transvaginal mesh procedures must not be offered routinely does not give sufficient clarity. I, too, believe that the findings of the report must be revisited. It has been well reported that draft guidance from NICE will acknowledge the serious, well-recognised concerns about transvaginal mesh and recommend that it is not used, or only used, in the context of research. I hope that the cabinet secretary will provide clarity on the Scottish Government's position on NICE's advice and whether advice for clinicians in Scotland will follow it, given the challenges that the Government's own independent review faced. Will the work of the new oversight group change to reflect any updated advice? When the cabinet secretary made her statement on that review in March, she stressed that only the medical and healthcare products regulatory agency has the power to ban the use of mesh implants. However, the forthcoming NICE guidance is clearly another way to restrict the practice of this surgery. Why then did health authorities in Scotland not take a similarly protective approach? Ultimately, I agree with Elaine Holmes and Olive McElroy that procurement is a matter for the Scottish NHS and the Scottish Parliament. The fact that it is a UK-wide body who decides if medical products are safe does not mean that the Scottish NHS must buy everything on offer. Alex Neil has previously made his concern about the MHRA's independence and effectiveness as a body protecting public health clear to the Public Petitions Committee. I agree. Complete transparency regarding vested interests must be the norm. Presiding Officer, work to improve reporting of adverse incidents related to medical devices is more urgent than ever. The case for imposing a real suspension of all transvaginal mesh procedures is stronger than ever. I urge the cabinet secretary to open the final report of the Scottish review of mesh surgery up to public consultation. We must learn from the mesh survivors. We must make sure that they realise that we hear your voice. We must leave no stone unturned in delivering justice for them for making sure that not one more life is affected by those implants. We hear your voice. I call Alex Cole-Hamilton, followed by David Torrance. I am grateful to the Petitions Committee for securing time today for us to address something that for every one of the hundreds upon hundreds of women who are mesh survivors in this country, that is nothing short of a public health disaster. I am very proud to add my voice to some incredible and passionate speeches this afternoon. I want to put on record my thanks to Neil Findlay for the visit just described by Alison Johnson, where many members in this chamber met mesh survivors, many in wheelchairs, all in abject pain. That experience then prompted me to hold a member's debate just two weeks ago on the need for a national continent strategy, given that 80 per cent of cases of incontinence can be alleviated with appropriate physiotherapy, but having all too many cases led to the insertion of those potentially devastating implants using devices that, whether they are pharmaceutical in nature, may never even have made it out of trial phase. I was contacted over the weekend by a constituent of mine called Kathy, and she has given me permission to share her story with you now. In 2010, after suffering some very mild issues within continents, Kathy was referred by her physiotherapist to a consultant who suggested that she could undergo a marvellous new procedure. Somewhat bewildered, Kathy was asked to sign a consent form right then and there, and she said that it felt like she was entering some kind of clinical trial, although it was never really spelled out to her quite like that. In fact, nothing was properly spelled out to her at all. I think that that speaks to the fact that, if we credited those fully grown women with the facts about what was going to happen to them, they all might have made very different decisions. Despite being booked in for the more invasive tension-free vaginal trans-obdurator implant, which is secured via spikes through the obdurator muscle, Kathy received very little information other than it would cure her incontinence. When she awoke from surgery, she could not move. The nerve damage that she had sustained in her obdurator muscles radiated pain throughout her abdomen, her legs and her back. So bad was her condition that, when she was discharged, she would not allow her son to travel more than 30 miles an hour along the bypass. From three days after that, and all the following week, with no let-up in the pain, she tried to call the hospital but never received a call back from either nursing staff or doctors to add insult to injury and, in the cruelest twist of irony, her incontinence worsened for a time. When she visited a doctor, she was told that the pain might be related to the fact that she'd stopped smoking at the time of her operation, or that she should perhaps try to cut fat out of her diet as a means of helping. At no point did any medical professional suggest that there could be a physical problem with the mesh implant. All told, Kathy went a full five years of trying to cope with abject pain before the cause was identified as being the mesh implant. A routine check-up with her gynaecologist revealed that the tape was in far too tight on the right-hand side and, as such, was constantly tearing at her obdurator muscle. On seeking the advice of her surgeon, she received the devastating news that, because her tissue had grown around the implant, it could not be removed without further significant nerve damage. Had someone taken her call at the hospital in the days after her operation, a reversal or a correction could have been performed? Imagine her horror at receiving this news, considering also that, at the time of her surgery, she, like several others, had been told that the mesh plastic would simply melt away over time. Once the cause of the pain was identified as the physical obstruction within her, she was heavily medicated with gabapentin. That, as always, had a very soporific effect on her, which indeed forced her to retire from the job that she loved way way before she planned to.  For Cathy, the mesh implant has devastated her quality of life and she is left with the options of making do or having it removed with potentially far greater nerve damage and resultant pain. As I stated at the top of my remark, she felt rushed into that procedure. She was not clear of her options and she had the impression that, given the lack of understanding about possible side effects among the clinicians who tended to her, she was part of some kind of clinical trial. She is far from alone in feeling like this. Indeed, I was contacted by another constituent yesterday called Tress who underwent a similar procedure, but for a prolapse this time, resulting from a hernia in 2010. She has allowed me to read a very brief passage from the message that she sent me as a message to you this afternoon. I feel that it was an unnecessary operation but was bullied into having it, being told it was my last option. I was not a form of the risks. My life has changed. I suffered from chronic pain as well as recurring infections and I have to have antibiotics in the house at all times. I have been for investigations but was told my mesh was safe. No, it's not safe. No mesh is safe and we have lost several lovely ladies through having a mesh fitted. It is the human cost in Tress's words that underscores this as a public health disaster. At the end of October, the world lost Christina Lynn Brachock, a formidable Canadian mesh campaigner, to sepsis for the infection that she has sustained relating to her mesh implant. She is part of an increasing death toll. As such, I would like to add to my voice calling for this petition to be kept open for a full and frank assessment of the final review, which I think that we can see has crossed party consensus as now being unsafe, and for a policy response that protects patients in absolute terms from the horrors of mesh implant side effects with a full and continuing moratorium. I now call David Torrance. We are followed by Michelle Ballantyne. Mr Torrance, please. I also put in record my thanks to the Public Petitions Committee and to the mesh survivors group. During my time in the Public Petitions Committee in the last session, we heard evidence from a range of different women, as well as from medial co-organisations, charity and many fellow MSPs. We listened to opinions on the evidence of several patients, we were asked to reconsider the best mechanism for complying research evidence, and we analysed the statistics, as well as both patient and expert views, in order to find out more about the nature and scope of the problem. We listened to women who had undergone surgery, the committee travelled to Brussels to give evidence to the EU scientific committee and the committee on petitions to update them on the work that we have carried out in mesh implants. The committee listened to clinical experts locally, as well as around the UK. The Scottish public health network provided us with an objective review of research literature alongside the information services division of national services Scotland. I can say with confidence that evidence that the committee took from the women affected by mesh implants was the most emotional evidence myself and the committee members have heard during my time as a vice-convener. Some have experienced a severe constant about abdominal pain, infections and bleeding, some have been left unable to have sexual intercourse, while others have been left disabled as a result of a procedure. Early last week, a Canadian well-known campaigner against vaginal mesh procedures became the first woman to die what has been known as a vaginal mesh scandal. I am deeply sad to hear that she had only minor complications that a simple procedure could have prevented. As she became immune to antibiotics, she was given as a result of major complications from the procedure. Her death comes just a week after a draft report of the UK's national institute for health and care excellence recommended banning vaginal mesh as a routine for prolapse, claiming that implants should only be used for research and not routine operations. Since 2014, more than 400 women in Scotland have gone through procedures since a health secretary called for a use to be suspended in June 2014. Although thousands of women have had implants over the past 20 years, many of them have experienced agonising and life-changing implications. Three years after their suspension, fierce debate still continues. However, not these devices should be banned completely. However, the medical and healthcare products agency has found no evidence to indicate that mesh implants are unsafe. In a report published in 2014, the MHRA claimed that, while a small number of women had been affected by adverse implications, the benefit of tape and mesh implants outweighed the risks that could have helped in dealing with upsetting conditions. However, while the MHRA announced that only 12 women UK-wide reported cases to them, over 3,000 women have undergone repeated operations and attempt to resolve any problems and complications from surgery. What has debate over the past few years has shown us is that there is a serious lack of information that has been circulated in Scotland regarding the surgery. In line with the recommendations, patients should be provided with information and need in order to make informed choices. It is outrageous that some of the women who had experienced problems told us that they were not aware that the implants were permanent. Informed consent should be introduced fully and uniformly throughout Scotland's health boards. They would encourage the MHRA to reclassify TVM devices to heighten their alert status to reflect on-going concerns, not just in Scotland but worldwide. Informed consent is a fundamental principle underlying all healthcare interventions. It is extremely important that women know the ins and outs of the procedure before agreeing to it. What is most appalling, however, is that some of the women who had adverse effects felt that they were not believed, adding to their distress and increasing the time before any remedial intervention could take place. Women felt that voices had not been heard as they were raised concerned about the side effects a number of them had suffered. Many of them eventually felt that the only way to bring us to the attention of a Scottish Parliament was to lodge a petition bringing the issue to the attention of the Public Petitions Committee. There is a serious possibility that the implant will continue to have a profound impact on the lives of many Scottish women. I am pleased that this is a general agreement in the conclusion of the sessions of the Public Petitions Committee. We need to revise and enhance governance around both the launch of new medical procedures and approaches. We need to give women more opportunities to report any adverse effects that should arise. We need to re-evaluate how women are assessed and treated. The lack of understanding of the effects of the implant means that the Government and the key stakeholders need to ensure that the guidance that is given to NHS clinicians is based on the most robust, up-to-date and accurate evidence. Similarly, good information is essential to good potential patient care. We need a lot more of these than they are currently providing them with, including adequate time for discussion and reflection, making them aware of patient choice and shared decision making supported by robust clinical governance. Ultimately, we need to see recommendations, as well as the evidence from women affected being reflected in patient safety clinical governance strands of the NHS. While the debate will continue and what the Government needs now to progress for us, it is to co-operate with key stakeholders to address information gaps and ensure the available information is used effectively as possible to support safe and effective care. In conclusion, the Scottish Parliament must act to under restraints of the lack of authority in regards to withdrawing the product. Moving forward, it is our job as policy makers to challenge the state school and to represent those women so that their voices are not drowned out. I ask my fellow MSPs to support the continuous suspension of TVM implants and to expose some of the false information that is currently being circulated regarding its potential life alterating procedure. I call Michelle Ballantyne to be followed by Willie Coffey and Mr Coffey will be the last speaker in the open debate. I would like to first echo the sentiments of gratitude towards Elaine and Olive for bringing this petition and for their unyielding courage to share their stories with us and the world. I am relatively new to this petition and indeed I am new to the Public Petitions Committee itself, but after just one meeting, hearing of their strength and courage through adversity, their will to stand up and speak out on behalf of mesh survivors across the country, I can empathise fully with their resentment and dismay towards the review process, not least because I have undergone a mesh procedure. Presiding officer, I think that it is important that these women are heard today because their words, their own words shaped through pain, angst and frustration should resonate with us all as human beings as well as parliamentarians. They said that their voices were drowned out and stifled. They said that they endured adversity and pressure for almost three years as patient representatives on the review group. They said that they felt physically sick upon reading the final report. Those words encapsulate what we heard at committee, that the recommendations of this report will not reduce the harm to patients from this procedure. Those are not my words, Presiding Officer. Those are the exact words of Dr O'Gurr and his evidence to the committee. He told us in no uncertain terms what mesh can do. He spoke of mesh tape procedures causing chronic pain, and he expounded upon the devastating problems that this can cause in terms of intimacy in a relationship. Dr O'Gurr has performed mesh procedures, many of them. He speaks from a place of experience and expertise, and he is quoted telling of his incredible pride when he joined the review group to protect women in the future. That pride was short-lived and supplanted by dejection. He now says that Scotland failed to live up to expectations, and since NICE have recommended banning the use of vaginal mesh operations to treat pelvic organ prolapse in England, the powerful words of Dr O'Gurr take on a new profundity. Now, of course, Presiding Officer, hindsight is a wonderful thing. We must remember that this procedure was at first wholeheartedly embraced by the profession and by patients as a simple, quick and life-changing solution to really troubling medical problems. It would be quite wrong to direct all-blame at the surgeons and specialists, like Dr O'Gurr, who performed these procedures in the expectation of improving their patient's quality of life, but it has become very clear that procedural and regulatory deficiencies have been abundant. It has been acknowledged at committee that there was no robust framework for ensuring fully informed consent. Indeed, even when the adverse consequences of mesh entered broader medical perception, heads remained firmly buried in the sand. Unfortunately, Presiding Officer, as my colleague Jackson Carlaw has highlighted, the whitewash of this report indicates that some heads are still there. Survivors, professionals, experts and politicians are speaking with one voice. With that voice, we ask, did the MHRA have an undue influence in the arrangement of this report? Why was Chapter 6 deleted from the final report? Why is the report engineered in such a way to exhibit the benefits of mesh for incontinence while obstrucating the potential for mesh erosion? Damage to reputation does not justify it. A loss of funding from manufacturers does not justify it, and fear of litigation does not justify it. In closing, Presiding Officer, the review report does not, should not and cannot justify lifting the suspension of polypropylene transvaginal mesh operations. When we make decisions on this issue, we should be able to look Elaine, Olive and all survivors in the eye and honestly and transparently say, this will protect women from the pain you endure. This is the right way forward. I do not believe that the cabinet secretary can do that today, not based on this report. No amount of whitewash can conceal the facts. When Australia and New Zealand are banning the procedure, when legal actions are taking place all over the globe and when acclaimed academics are describing the procedure as a catastrophe, one has to question why the Scottish Government is dragging its feet. The Scottish Government must set aside obstinates in favour of engagement, so that I urge it to act decisively, ban mesh, before it ruins more lives. Thank you. Can I just politely remind members in the gallery that it is not appropriate to clap? I understand why you are doing it. It is not appropriate when the Parliament is sitting in session. I now call Willie Coffey, who is the last speaker in the open debate. I was made aware of the issue as a result of representations made to me by constituents in listening to their experiences first-hand at my local surgeries. I also sat in one of the petitions committee meetings where a number of women, who were affected by the mesh implants, attended. We also offered their time throughout that particular day to provide more information to MSPs and the conditions that they are now enduring in their daily lives since undergoing their procedures. Some of that was pretty harrowing, and I have to say in my 10 years in this place that I have not come across many cases like those from constituents. The issues are very challenging, and while I would not pretend to understand all of the medical complexities involved, I hope that the debate at least allows those concerns of all the affected women to be heard in this Parliament and, for some hope, to be given to those concerns that are being listened to and acted upon. The review carried out by the Scottish Government, notwithstanding the disagreements about what was or was not included in the final report, at least went some way to meet the initial demands of the petitioners. In terms of achieving a suspension of mesh procedures, mandatory reporting of all adverse events and bringing in fully informed consent and, of course, the call for the review itself. Further safeguards must also be put in place by health boards before any procedures are reintroduced. As we know in respect of the pop of the pelvic organ prolapse, the current evidence did not indicate any additional benefit from the use of mesh, and it is not to be offered routinely, as other members have said in the chamber this afternoon. I have to say that some of the conclusions of that review could reasonably have been put in place at the outset, especially in relation to issues about provision of information, consent and mandatory reporting of any adverse events. Why on earth this would not be routine in any case for such procedures with known risks associated with them is a bit of a mystery to me and to some of the women that I spoke to. I also had a look at the MHRA report that was carried out in 2014. As members know, they are the UK body who have the sole authority to withdraw those products or not. Their conclusion then was that the benefits of the use of mesh devices outwead the risks involved, and there was no justification for taking action to remove all such devices from UK hospitals. Those are words directly from their own report. In saying that, I looked to see in the report how that conclusion had been reached, given the numbers of adverse incidents being reported subsequently. Interestingly, the MHRA themselves do not have any data showing the numbers of mesh devices that had been implanted. Instead, they were relying on sales figures to get an indication. Their data showed that, for SUI devices between 2005 and 2013, there were 29 variants of those devices, 170,000 sold in the UK, and around 291 adverse incidents reported in England—remember, that was English data at the time—and for the POP devices, about 25 variants of those, with about 24,000 sold in the UK, and about 110 adverse reports. My point is that I could not see in the report any comment on the statistical significance or otherwise of the data, and that leads to the conclusion and how that led to the conclusion that the devices were safe. One incident is a matter for great regret, but more than 400 during that period were reported, but there was no assessment of whether that was what should be expected statistically. I am still wondering how they can conclude that the devices themselves were safe if they do not address and dismiss the numbers of incidents in terms of statistical probability. Perhaps that is something that we could clarify or attempt to clarify, even with the MHRA. Presiding officers, members have already commented on the very sad news from Canada where Chrissy Brachec, who was treated with a mesh device for mild urinary incontinence, has died recently. No doubt that tragic news will mean further demands to reconsider those procedures will be made. A more rigorous assessment of risk and potential impact on women should those risks materialise, may well be given more prominence now. I said at the outset that it is impossible for us as lay people to analyse and assess the evidence and the impact of mesh devices on the women who have come forward. However, we have to listen. Offer a forum for concerns to be heard and to expect those on whose professional judgment we rely to get this right. However, that cannot be the end of the story. The numbers of women affected adversely by those procedures may be small in relation to the total numbers of procedures being carried out, but the impacts are particularly severe when they occur. Confidence is everything here. We have to be challenging our clinicians more about the risks involved, and we have to restore that confidence to women involved before we proceed any further with those mesh procedures. I move to closing speeches. I thank Johann Lamont and the Petitions Committee for bringing forward this important debate today and for giving Parliament the opportunity to contribute to its deliberations. I think that today we have heard the best of our Parliament. We have heard stories from across the chamber, a story of courage, an emotion of strength and determination and of dignity. Dignity and determination in the face and the might of Scotland's medical establishment. We have heard about the campaign driven by a group of women who have been forced to struggle every step of the way against a medical establishment, which has closed ranks to protect their own. Just like every other member who has spoken on this debate so far, I want to pay tribute to all the survivors, many of whom are in the chamber today, for their bravery, determination and courage in not taking no for an answer and pursuing the issue, not just to get justice for themselves but to make sure that they can protect patients in the future. I want to pay tribute to Elaine, Oliver and all the campaigners for the determination and the dignity in which they continue to campaign. We have heard in the debate today how medics close ranks to protect their own reputation. We have heard how the medical establishment closed ranks to protect their relationships with medical companies. We have heard how the women affected have had to fight to even have their case heard. I want to praise the work in particular of my colleague, Neil Finlay, instead of fastly supporting the women affected and ruthlessly pursuing the truth, but also to thank other parliamentarians of other political parties, particularly Jackson Carlaw of the Scottish Conservatives, and Alex Neil, who was a previous health secretary, who has continued to campaign passionately and principally on the cause since vacating that position. I want to thank them too, in particular alongside Neil Finlay and the women who have continued to campaign to this day throughout Scotland. Without their campaigning, we would still be having mesh implanted into women's bodies with the consequences that are now well evidenced. We would not be standing here today debating the use of a procedure and a product that is causing so many women to face a lifetime of chronic pain if it was not for that campaigning spirit both in this Parliament and outside of this Parliament. However, this debate comes fundamentally down to one word—confidence. The reality is that the survivors of this scandal do not have confidence in what has happened since that scandal. The review is compromised and we have to accept that the review is compromised. The MHRA is compromised and we have to accept that it is compromised. Government action, I am sorry to say—I do not mean this in a party political point at all, but I will come to how we can move forward in a moment—it is also compromised. Unless we can give the survivors of this mess scandal the confidence that their Government, that the institutions and the medical establishment are working in their favour and for their justice rather than against what is in their interests, we can never deliver justice for the survivors of the mess scandal. Confidence is crucial in how we create a climate of confidence in the review process, the actions that come out of that review and what happens long-term in terms of the use of this product. There has been a cover-up for medics to fail to declare a conflict of interest while serving on a review body is simply unacceptable. If that was a Parliamentarian taking part in a committee process where they had a conflict of interest, they would be hauled before the Standards Committee and they would be rebooked in this Parliament. If it is not acceptable for a Parliamentarian to behave in that way, it is not acceptable for anybody of any profession who serves in a so-called independent review to behave in that way either. The fact that there is litigation over the use of a product and those people who are facing that litigation serving on that committee and failing to declare that interest is shameful behaviour that brings the conduct of that review and the wider conduct of medical professionals into disrepute. I think that we should call that out for what it is. The evidence of the misuse of a product that is not fit for purpose is clear. In the US, manufacturers of this product have already paid out over £1.5 billion in compensation. What I do not think that the survivors want to hear is that somehow this may be a cover-up to try and protect money for public purse or indeed private company's money rather than seeking justice, and that is why what we do going forward is so important. The fact that the nice has banned the use of mesh operations in England speaks for itself. The fact that this product is banned in Australia and New Zealand also speaks volumes. The use of this product was wrong and its consequences have been lifelong. Today, we have an opportunity to put that right. More than 100 MSPs have already put their name to a call for an honest and transparent review, a review not compromised by the actions of the medical establishment, but a review that has process at its fair front and is not tainted by a cover-up, because we cannot allow this Parliament to look like it is part of a cover-up. That is why we need to hear a commitment from the cabinet secretary that there will be a judge-led inquiry to bring this tragic and murky scandal into the full light of public scrutiny. A review that will give women the chance to be listened to, a review that will lead to action that has been taken against those culpable, and that is why nothing less than a judge-led review will suffice. I want to end with specific and direct questions to the cabinet secretary. I say this in all sincerity. I think that we have an opportunity from the way the debate is being conducted to bring all our parties together, whether it is opposition or in government, to get to the bottom of this and to give justice to the mesh scandal people. I think that the cabinet secretary has an opportunity following this debate to unite our Parliament in that process. I want to repeat what Alex Neil said. The truth, the whole truth and nothing but the truth. For a former cabinet secretary, to say that he did not believe that he got that from his most senior officials when he was a cabinet secretary in this Parliament, of his Scottish Government, is damning. It is absolutely damning. I do not think that we should take that lightly. We have to understand whether those people are still giving the same advice to this cabinet secretary and if they are, how we expose it and make sure that that changes. How we make sure that when we have a moratorium, it actually means a moratorium. That actually we review mesh procedures not just in women, but as we have heard from Alex Neil again, from procedures in men also who are undergoing complications. How we actually genuinely have an independent review, whether we will open it up to the public for public comment before we have final publication of a review, whether we have the indefinite suspension of mesh, whether we will use the powers of our Parliament and the procurement powers to end the purchase of this product and whether we will actually settle the litigation cases quickly to stop deliberate stalling by companies. Anything less than that will be a failure and a betrayal of the women sitting in that gallery today. Anything less will betray the best of this Parliament and the best of our country. That is why, working together, I hope, across this Parliament, across all political parties, we can once and for all give justice to the mesh survivors in Scotland. That never happens again. Thank you very much. Can I call Miles Weeks to close to the Conservatives, please? Thank you, Deputy Presiding Officer. I am pleased to close today's debate, which I think is presented a useful and thoughtful discussion. Like others, I would like to pay tribute to current and former members of the Parliament's Public Petitions Committee for the consistent work that they have done on the subject over a number of years. Today's debate is another good example of the important role that the Public Petitions Committee plays in the political process of our modern Scotland. Like other members, I also want to commend the original petitioners, Elaine Holmes and Olive McElroy, who have done so much work to speak out for those who have suffered as a result of receiving mesh implants and take procedures. I would like to welcome all those in the public gallery today who have campaigned so hard. I just hope that, as politicians, Parliament has given you a voice and done you justice. A number of members have spoken in detail about the horrendous health impact that some women have experienced as a result of mesh implants and tapes for prolapses and stress incontinence. As a newly elected MSP, I, along with many other MSPs, first met with the mesh campaigners in Parliament following the publication of the draft report of the review committee. I have to say that, having met them that day, how angry I felt going home, I am angry that those women who were in good faith, desperately seeking answers, had been put in a position where the review committee and the report hoped would provide and challenge and seek the answers and clarity that they had been looking for, had been compromised and a whitewash of a report finally published, which helped no one. Those women have been badly let down. The whole chamber will have personal sympathy for them, but they do not want sympathy. They want answers and they want action. Jackson Carlaw expressed very clearly the frustration and anger of mesh campaigners over the course of the past few years. It took a great deal of pressure before the then health secretary, Alex Neil, announced the independent review in June 2014. The health secretary also at that time announced the suspension of the use of mesh implants, but we know that half of Scotland's health boards continue to use these devices, with over 400 procedures having been carried out despite that ban. I think that it is a very important point that is developed by both my colleagues Brian Whittle and Michelle Ballantyme, raising real concerns about the role and impact of ministerial directives on NHS health boards in Scotland. Monica Lennon also pointed that question. Why, when we have these directives, are they being blatantly ignored? How can the cabinet secretary and the Scottish Government have been totally disregarded by some Scottish health boards when they put this out? I think that that is something all of us in this chamber would want to see addressed. During this time, hundreds of women have received mesh tape implants despite the position of the Scottish Government and the continuing worries about their safety and the fact that the NHS in Scotland is facing several hundred damages claims from women who have been affected. Having been involved from the outset, I thought that we saw three great speeches today from Jackson Carlaw, Neil Findlay and Alex Neil, who made some real pointed speeches today. All three demonstrated how the contents of the report have been compromised and now diminished. I also very much endorse Alex Neil's call for patient involvement and their experiences in any future guidelines. The fact is that the cabinet secretary has had to appoint Professor Alison Britton of Glasgow Caledonia University to conduct a report into how the inquiry process was undertaken. That only highlights the extent of the concerns that are still around it. In recent weeks, we have seen a major new development, with the news that NICE's sector recommended that mesh operations should be banned from treating organ prolapse. It is understood that the draft guidelines from NICE say that the implant should only be used for research and not routine operations. Evidence of long-term efficacy for implants treating organ prolapse is inadequate in quality and quantity. NICE's move will mirror a similar decision by equivalent bodies in Australia and in New Zealand. It also comes at a time when more worrying academic evidence has been produced around mesh erosion rates. To conclude, Deputy Presiding Officer, NICE's guidance should act as a further wake-up call for the Scottish Government and should also prompt it to take decisive action to ensure that there is no interpretation of the current suspension of the use of mesh in order to prevent any more women or men being harmed. Patients in Scotland deserve better than the response to the major issue that has been provided to date. I agree with Jackson Carlaw and Alec Neill that the Scottish Government should act now to convene an international summit here in Holyrood to allow Scotland to help to seek the answers and, once again, gain the political initiative to seek those answers for families. I hope that this debate will help push ministers to address in full the genuine and legitimate concerns of mesh campaigners and to ensure that the safety of patients is always the overriding priority when the use of such invasive surgery and new technology is actively being considered. On 7 November, the First Minister apologised on behalf of the Scottish Government to gain men convicted of now abolish sexual offences. That was a welcome moment in this Parliament's history and so parties across the chamber come together as an injustice was addressed and acknowledged and so the Scottish Government takes action. For women and their families across Scotland who have been so clearly failed, I believe that the Scottish Government and this Parliament now need to make amends. There is a lot of work to do to regain the confidence of women and families who have been affected by the mesh scandal. However, it is time now that the Scottish Government Minister has acted and, once again, made Scotland a leading beacon for all those who have been affected by the mesh scandal and the survivors of the mesh scandal. Thank you very much, Mr Wiggs. I call on Shona Robison to close the cabinet secretary. Thank you very much, Deputy Presiding Officer. I thank members for their contributions to this afternoon's important debate. I will try to respond to as many points as possible that have been made. I hope that we can work together to go forward on this important issue, as other members have said. First, I will touch on the role of the MHRA. Many members have raised concerns and referred to the key role in being the only organisation that can ban a procedure or a product. To highlight what I said in my opening remarks, it is important that the MHRA takes account of international evidence emerging and the action taken by other areas, such as the Australian Therapeutic Good Administration. That is why the chief medical officer has written to the MHRA asking what their response is to the action taken by the Australian Therapeutic Good Administration to remove mesh for pelvic organ prolapse and single incision mini slings. It is not for stressurian recontinence, so it must be very clear what it is that it has done. It is focused on removing mesh for pelvic organ prolapse and single incision mini slings. We await the response of the MHRA on that issue. John Scott I appreciate you for letting me in. Given the alleged conflict of interests of the MHRA and the source of some of their funding, does the cabinet secretary think that it is time for a review of their corporate governance arrangements? Is this something that the cabinet secretary might consider pursuing? I am happy to pursue that. We have raised a number of concerns about the role of the MHRA, not least from points that were made by members in the chamber. We have regularly put to the MHRA and the Department of Health that has oversight of the MHRA, so I am happy to do that. Many issues have been raised about the independent review process. I will come on to one specific issue in a moment, but I think that we should allow Professor Britton to carry out her review, which will look at all the issues that have been raised during the debate and not least the issue that was raised by Alex Neil and Neil Findlay about how interests are disclosed and registered. Not just for this independent review, but for future independent reviews about any issue, it is important that there is full disclosure of interests and that those are registered. Professor Britton will be looking at that issue, along with the many other issues that have been raised about the independent review process. Neil Findlay has just said that that is very important. Is it now your view that the review itself was compromised by that? I certainly understand the concerns about the review process. I would not have asked Professor Britton to look at the independent review if I did not have concerns. That does not detract all for the important recommendations that the review has made. Indeed, the issue of POP has effectively restricted that procedure to exceptional cases only. I will come on to a minute to take that even further. It is important to recognise, as other members have, that some of those recommendations are very important. Members have asked how procedures could have still gone ahead in the light of the suspension and moratorium of mesh procedures. As I have said in this chamber before, in a small number of cases, where a woman who is fully informed of the risks still wanted to go ahead with the procedure because she was experiencing very distressing symptoms and wanted to proceed if that was a clinical judgment that was reached in a fully informed discussion between the clinician and the patient, because the procedure is not banned, there was nothing that could be done to stop the procedures going ahead. I understand members' frustration about that, but those are clinical decisions and this is a procedure that is not banned. However, it is very important that the restrictions that are placed on the use of mesh are fully implemented and consistently so. I will come on to say a bit more about that in a second. I wonder if the cabinet secretary can clarify what she understands the moratorium to be and what advice she was given and what a predecessor expected a moratorium to be. I cannot speak for what Alex Neil wanted to happen. I assume the same as me that boards would suspend those procedures, but we were fully aware that it is not a banned procedure. Therefore, if a clinician with a fully informed patient who wanted that procedure to go ahead, there is nothing that could be done to prevent that, because it is not a banned procedure. I have explained that in this chamber a number of times. It might be frustrating for members, but those are the facts. It is not a banned procedure. The only organisation that can ban that procedure is the MHRA. I have already said what we are doing to make sure that they are fully informed. Brian Whittle I appreciate you taking another intervention. I recognise the MHRA and the ones that can withdraw the particular device. Surely the NHS fund those operations. You have the capability of taking away that funding, so the procedure could not go ahead. Cabinet secretary, I am not a clinician that can make a judgment about withdrawing funding from a procedure that is not a banned procedure. I think that that gets us into very difficult territory indeed. We have to be guided by what the clinical advice is. If the MHRA is going to look at the issue again, and I understand that they are continuing to look at the international evidence on the issue, they will be looking at the Australian evidence and other evidence. I hope that they will keep that under review. I would like them to reach a different conclusion, but so far that is not the conclusion that they have reached. Alison Johnstone asked a very important question about the nice guidance. First of all, it is very important to understand what their nice guidance is saying. What they are saying on pelvic organ prolapse is that it could only be delivered as a procedure for research purposes only. They have been clear that they cannot ban mesh procedures. It is only guidance, so I have to be very clear on that. It is nice that they have been very clear that they cannot ban that procedure. It is guidance, but it is guidance that we will follow. NHS Scotland always follows nice interventional guidance in the same way as would be the case in the rest of these islands. I hope that that reassures Alison Johnstone that, absolutely, that further restriction beyond what the restrictions that are already in place for POP are important. The oversight group will incorporate that additional guidance into the guidance that it is developing. Finally, on Alex Neil's point about patient involvement, because I thought that Alex Neil made a number of important points. Probably the most important one was how are patients going to be involved in the oversight group going forward. I can confirm absolutely that patients will be involved. I understand the trust issue that many of the women involved—not least Elaine and all of them—would be very hard and perhaps unreasonable to ask them to be involved in any other processes personally. I would hope that they would consider that. The other women who have had personal experience are exactly the women that we would want to be involved in the oversight group taking this issue forward, developing the leaflets for women that can make sure that people have the full information and can make fully informed decisions. I would certainly hope that patients will be involved in that process. I think that it will make the procedures and the work of the oversight group very important and perhaps can help to rebuild the confidence in the material that is being put out to help to make sure that patients are fully informed about any procedure that they undertake in that area. I am sorry if I have not been able to respond to all members. I know that there are some specific questions that perhaps I have not been able to come back to, but I will certainly write to members to make sure that they get the full information that I have not been able to cover in my closing remarks. I will now call on Angus MacDonald to close for the Public Petitions Committee. Mr MacDonald, please. Thank you, Presiding Officer. How long do I have? How long do you wish? Nine minutes. That is absolutely fine by me. I might even give you 10. Perfect. I am certainly pleased to be able to close this debate on behalf of the Public Petitions Committee. I thank members across the chamber for their excellent contributions this afternoon. I will turn to their individual contributions in a short while. As the convener mentioned, in opening the debate, the petition was lodged during session 4, and I have been a member of the committee throughout the consideration of the petition to date. In that time, a wide range of evidence has been presented from the petitioners and the Scottish Government and also from relevant parties. I think that it is fair to say that the strength of feeling and the emotions evident at each of the evidence sessions where the petitioners and fellow sufferers have been present has been tangible. The substantial amount of evidence that we have taken has included a lawyer representing mesh damaged women who are involved in litigation in America, and the Medicines and Healthcare Products Regulatory Agency, which is responsible for licensing medical devices in the UK. It has been made clear throughout this afternoon's debate that there is no doubt as to the seriousness of the issue that is raised by the petition and the physical and emotional impact of adverse events arising from mesh procedures. It is clear that it was partly, if not wholly, thanks to the petition that the Scottish Government asked health boards to suspend the use of mesh in 2014 due to the clinical concerns, which clearly reflect the seriousness that the Scottish Government attaches to the issue. I also have to commend Alex Neil for the action that he took as health secretary introducing a suspension and review until all the necessary procedures, approvals and restrictions are in place. The petition asked for several things, including suspension of all mesh procedures, the establishment of an independent review, mandatory reporting of adverse events and the introduction of fully informed consent. Much of that has been or will be achieved as a result of the original petition, so I join the convener and other members in paying tribute to the work of the petitioners on putting the issue in the spotlight. During the course of the debate this afternoon, we have had valid and salient points raised by Jackson Carlaw in a strong contribution, who is a former member of the PPC, asked searching questions during our evidence sessions and has raised a number of those points this afternoon, not least the woeful performance of the MHRA when they gave evidence to the committee. Another member who has doggedly pursued the issue as it went through committee and has worked on the issue outwith the committee system is Neil Finlay, who has made a significant impact in the campaign and continues to raise concerns regarding the way the whole issue has been handled as we have heard today. Alex Neil made a heartfelt and candid contribution to today's debate, including his call to review the contents of the initial review. He is also at committee in September and today in the chamber suggested an international mesh summit to address the growing global crisis. There is much merit in that, however, I think that it may be beyond the capacity of the Public Petitions Committee to conduct such a summit, however. I am sure that it is something that we can consider for the forthcoming committee report, which will hopefully be completed in the not too distant future. Irona Mackay detailed the recommendations from the review and, along with other members rightly questioned the role of the MHRA, Monica Lennon spoke of the rage being felt by the mesh survivors referring to the whole issue as a national scandal and an outrage, along with her call for a judge-led review. Alison Johnstone highlighted the lack of informed consent and concentrated in much of the evidence given to the committee by Dr Agur. David Torrance highlighted the successful visit that the Public Petitions Committee made to Brussels under the convenership of Dave Stewart. We made sure that the issue was well and truly on the radar of the European Commission. Michelle Ballantyne, a new member of the Public Petitions Committee who has made a strong contribution to the committee's works since she arrived, highlighted Dr Agur's evidence to the committee during which he detailed the adverse impacts of mesh implants. Willie Coffey spoke of the harrowing evidence that was given to the committee when he was present. Brian Whittle, among many salient points, questioned the failure of the moratorium to be fully implemented. In addition, Alec Cole-Hamilton went on into some detail of the situation that his constituent had endured. We have had excellent contributions from the floor of the chamber today. I am sorry, I cannot dwell on many of the other points that have been raised. In the closing speeches, Anas Sarwar spoke of the medical establishment, closing ranks and conflicts of interest. We hope to get to the bottom of that through Professor Britton's review of the review. Miles Briggs highlighted the disregard of directives by some Scottish health boards and the current situation regarding nice guidance. While there has been a focus throughout on the issue in the Scottish context, there is little doubt that the issues that we have been considering extend far beyond our own borders. Indeed, it has been referred to as a global scandal. There was a sense back in 2014, when the then cabinet secretary, Alec Neill, announced, as I said, the independent review and moratorium, that Scotland was actually taking the lead on what was considered to be a matter of significance around the world. As work in Scotland has continued, there have been developments in other countries, and it may now be the case that some other countries are seen as leading the way, which is unfortunate, given where we were. I will leave the judgment of who is leading the way to others, but I would comment on some recent developments and other jurisdictions that have already been mentioned. Last week, it was reported that, later this month, the National Institute for Health and Care Excellence will issue updated guidance on the use of MESH. On that point, it is worth noting that the Office of the Chief Medical Officer has previously advised NHS boards and directors that the investigation and treatment of all patients should follow NICE guidelines, which, although not mandatory in Scotland, are recommended as good practice. I hope that the cabinet secretary will provide an update to the committee in terms of best practice across Scotland in the event that NICE does update its guidelines. As recently as 28 November, the Therapeutic Good Administration in Australia, the equivalent of the UK's MHRA, announced that, with effect from 4 January 2018, transvaginal mesh products, whose sole use is the treatment of pelvic organ prolapse via transvaginal implantation, will be removed from the Australian Register of Therapeutic Goods. That decision was based on the TGA's belief that the benefits of using transvaginal mesh products in the treatment of pelvic organ prolapse do not outweigh the risks that those products pose to patients. It adds that the TGA also considers that there is a lack of scientific evidence before the TGA for it to be satisfied that the risks to patients associated with the use of mesh products as single incision mini slings for the treatment of stress urinary incontinence are outweighed by its benefits. I believe that it is a case thanks to information received from the petitioners that is also the situation in New Zealand. For the Public Petitions Committee, the recent developments both here and abroad will be something to reflect on as we consider our draft report. In time, I think that it is more likely that we will also consider the findings of Professor Alison Britton's review of the review. I hope that it will be a robust review that should report on the process and flaws of the first review so that lessons are learned for the future, including ensuring that patient representatives feel that they can fully participate, which sadly was not the case in the first review. Professor Britton's review will consider the process of the independent review and will make recommendations around the conduct of similar reviews in the future. However, the professor will not re-examine the evidence that is considered by the initial independent review and our conclusions will therefore have no bearing on the moratorium that was ordered in 2014 and continues to this day. I understand that Professor Britton will soon begin undertaking consultation on her work, and I hope that individuals who have been impacted by mesh feel able to respond to that consultation. In fact, I would encourage them to do so. In the meantime, the Public Petitions Committee would continue to welcome any contributions from members of the public who want to ensure that this Parliament hears their voices. I am sure that I speak for all the committee members, if not the whole chamber. When I say that, I look forward to working on the draft report to ensure that the petitioners and campaigners who have ensured that the dreadful set of circumstances is on the radar are given their voice and listened to. To paraphrase the convener's remarks in her opening speech, the petition is far from closed. Thank you very much, Ms MacDonald. That concludes the debate on the petition PE1517 on polypropylene mesh medical devices. It is time to move on to the next item of business and I will suspend briefly to allow you to take your seats for the next item, which is the emergency question.