Surgical Mesh

Jackie Doyle-Price Excerpts

Thursday 19th April 2018 Commons Chamber

[The Parliamentary Under-Secretary of State for Health (Jackie Doyle-Price)]

I add my thanks and congratulations to the hon. Member for Kingston upon Hull West and Hessle (Emma Hardy) on securing this debate. She approached this issue with her characteristic passion and forthrightness and gave me a number of challenges—again. I am pleased that she acknowledged that, since we last debated this, there has been progress. It is in that spirit that we need to continue this dialogue not just to address the issues, but to make sure that we do the right thing by those women who have been harmed by the use of vaginal mesh.

Ultimately, the tragedy of this case is that women have put their trust in the medical establishment to look after them and to make them well, and they have come out with the most debilitating, life-changing injuries. In many cases, these were very young women. It is very clear from the clinical guidance on these products that they should not be used as a first intervention, and should be used only in very extreme cases. We are to be very concerned about the extent to which this has been adopted.

It is great that the evidence shows that the use of this product is less than it was. Clearly, as the hon. Member for Pontypridd (Owen Smith) pointed out, there was a spike in the use of the product, and that use was not always appropriate. That highlights the need for proper understanding of the risk of any medicine or product, and underlines the need for very mature and sensible conversations between medical professionals and their patients so that people understand the risks of treatments, as opposed to understanding just the benefits. Most of all, it illustrates the need for informed consent on the part of the patient. I have been horrified in this debate to hear how many women did not understand the treatment that they were getting. That is clearly unacceptable.

In that spirit, I want to continue this dialogue. As the hon. Member for Central Ayrshire (Dr Whitford) pointed out, women are often sent away and told that, “It’s women’s problems.” Women are often patted on the head by members of the medical establishment. None of us women in this place is a shrinking violet, but we have also fallen victim to that behaviour, which is just not acceptable. We need to do more to change the culture of our health service and the way in which medical professionals interact with women. If we do not, the outcome is exactly the experience to which those ladies who are sitting in the Public Gallery can attest. I am very grateful to them for sharing their experiences. Sharing our very intimate and distressing personal details is not the most comfortable thing in the world, but the work they have all done in sharing their experiences has raised awareness and put the issue on the agenda. It has also made us more vigilant about protecting our own health when we are faced with problems. I thank them all.

Although there may be some specific points on which we differ, it is clear that we all share a determination to address the issues that have been raised. Clearly, a number of women have experienced extreme suffering, and it is important that the NHS does its best to make life better for those women and gives them the treatment that they need. I say to Members that if there is any evidence that women are not getting the treatment that they should be getting following a complex mesh procedure, please raise that with me and bring it to my attention and I will take action accordingly.

[Gordon Marsden]

I am very grateful to the Minister for giving way. She is acknowledging the depth of disquiet, suffering and pain, but she will also be aware from my hon. Friend the Member for Kingston upon Hull West and Hessle (Emma Hardy), and indeed from my hon. Friend the Member for Washington and Sunderland West (Mrs Hodgson), who spoke from the Front Bench, that there have been persistent calls for NICE to speed up the process. I ask the Minister a very specific question: what conversations has she had with her officials and NICE as to why they cannot bring this forward? Is it a question of a lack of appropriate aggregate evidence; is it a question of their own internal priorities; or is it a question of resources?

[Jackie Doyle-Price]

It is actually an issue of rigorous process. We need to make sure that NICE guidance has clinical integrity. The guidance to which the hon. Gentleman refers comes at the end of a longer process of other guidance that is going through the system. None the less, that intelligence is shared throughout—it is an entirely consultative process. The issues that we need to settle are all part of the public debate. Essentially, the publication of the NICE guidance comes at the end of that. The important thing is that everyone knows the issues and that we are very clear about the context in which this is an appropriate treatment. The guidance is very clear: this treatment should not be offered as a routine first intervention.

[Owen Smith]

I am not sure that that answer is correct, in as much as we know that there is no new clinical evidence to be produced in this area; there are no outstanding trials. Therefore, there is no reasonable reason why NICE cannot bring forward that guidance, and it certainly does not make sense for it to wait another year.

Finally, was the Minister surprised when the chief medical officer, who was sitting next to the Secretary of State, said on Facebook Live that she thought that the rate of complication in respect of mesh was between 15% and 20%—a stark difference from all previous estimates by Ministers or officials?

[Jackie Doyle-Price]

Let me emphasise that it is the robustness of the process that is at issue here. The guidance will be published for consultation later this year, and completed next year. There is a robust process for doing so.

The hon. Gentleman is right that the CMO suggested that there was a 15% to 20% complication rate, but I understand that she has written to him explaining that she misquoted the statistics and that the situation is more complex. That is one reason why the retrospective audit is so important. We now have a body of evidence that we can properly analyse, and as has been mentioned, my noble Friend Lord O’Shaughnessy has tasked the CMO with properly analysing the audit published this week so that we might more quickly draw conclusions.

[Owen Smith]

That is very interesting. I do not believe I have received a letter from the chief medical officer explaining that she got the statistics wrong. May I press the Minister to make sure that when the CMO looks at the register she offers a proper narrative analysis of what the numbers mean? We still have contested analyses of whether they show a bigger problem than we thought or whether it is the same. I think it shows a much bigger problem, but we need to understand the numbers.

[Jackie Doyle-Price]

I can absolutely give the hon. Gentleman that assurance. It is crucial that we address the matter transparently—that is very much the spirit in which I want to take this forward.

[Dr Julian Lewis]

Before those interventions, the Minister said that if people are still not getting adequate treatment, it should be brought to her attention. As I mentioned, I have been contacted by constituents saying they felt trapped because the people who did the procedures were refusing to refer them elsewhere for a second opinion and for possible help from the very small number of people who specialise in the rectification and reversal of these procedures. What advice can she give my constituents about how to break out of this restriction on being referred to people in whom they can have more confidence?

[Jackie Doyle-Price]

I listened carefully to my right hon. Friend’s representations on behalf of his constituents, and they filled me with alarm, because we have given a clear indication on this point and have established 18 specialist centres to deal with the consequences of mesh. There is, therefore, no excuse for patients who require further intervention not being properly referred. Perhaps he and I could take this up offline to make sure his constituents get the support they deserve.

I want to put this in the context of our broader emphasis on patient safety. We have learned, through difficult experience, that there is never one measure or magic bullet to suddenly transform services for patients; it is about sensible dialogue between patients, clinicians and sometimes politicians—sometimes we can have a role in catalysing the debate. We all need to pull together to tackle all aspects of the issue. In some respects it is about the actual product—the vaginal mesh—but it is also about clinical practice and behaviour, as we have talked about. The most important thing, however, is the need to listen to patients, who, in this context, are of course women. We have to make sure that we listen to women when concerns are raised so that we can properly tackle those concerns as they arise. As I have said before, I am concerned about informed consent for patients, but the issues go much further, and generally we could do much to improve the performance of the NHS by placing a greater emphasis on that.

We need to consider the whole issue of clinical advice. We know that this product should not be routinely offered as a first intervention, yet clearly it is. I am horrified to hear of women in their 20s and 30s being treated with this product, when clearly it is not intended for them. It is obviously easy for me to make a superficial judgment on that without knowing about the particular cases, but on the face of it, it seems quite wrong.

The issue has been raised of what is an acceptable level of risk. I do not like to think about that in terms of percentages, because the acceptable level of risk will differ from patient to patient. If we are talking about some new mums, the level of risk clearly would not be outweighed by the benefits, but if we are looking at women suffering from horrendous conditions of incontinence, that is a very different debate. Again, we need to think about the broader issues. It all comes down to making sure that the guidance is properly applied and that clinicians who are recommending the use of mesh are properly making that assessment in discussion with their patients.

There has been a demand for a public inquiry. We have introduced the Cumberlege review, which is designed to make sure that we properly assess the interests of patients going forward. I know that many patients have felt that their views have been ignored. Baroness Cumberlege is very keen to hear directly from individual patients about their experience, and will be going round the country to do exactly that.

I could say much more, but I must conclude so that we can move on to the next debate. I will write to hon. Members, who I thank for contributing to the debate, to address some of their other points. We are determined to do our best for women who have been badly treated in having this procedure.

[Emma Hardy]

I thank everyone who has contributed to this debate, and I welcome the continued dialogue between the all-party group and the Department of Health. It was interesting to hear for the first time that the Department recognises that it is not just the process but the product about which there are serious concerns. I also welcome what appears to be an admission that NICE is introducing draft guidelines this year—is that correct?

[Jackie Doyle-Price]

indicated assent.

[Emma Hardy]

That is excellent. That is one of the things we called for. One thing that has come out more and more is that there needs to be informed consent. People need to know a lot more about the risks. All the risks need to be written down in front of someone in block capitals so that they know exactly what they are letting themselves in for.

I press again, as I did at the beginning of my speech, for all new mothers to be offered pelvic floor physiotherapy, as happens in France. As the Minister has just said, it is unacceptable that a new mother with a small, relatively minor inconvenience should be offered something that could result in permanent, life-changing disability. I urge the Minister to look into that as well.

I very much welcome the fact that we will have the draft NICE guidelines next year. As we have spent a lot of this debate talking about our mums and what they say to us, I will quote my mum. She always said, “Where there’s a will there’s a way”. If there is a way of bringing forward those NICE guidelines, let us make it happen, because if there is a determination across the House to make it happen, I am sure that the Department can find a way to do it and end this misery for so many women.

I end by thanking again all the fantastic women up there in the Gallery right now watching this debate. We are only talking about this now because of your bravery in coming forward and speaking out, and I thank each and every single one of you. We cannot undo the suffering you have experienced, but by speaking out and being so incredibly brave, you will stop women in the future going through what you have gone through. I and every Member who has spoken today thank you.