Surgical Mesh Implants

Jo Stevens Excerpts

Wednesday 18th October 2017 Westminster Hall

[Emma Hardy]

I completely agree. Sadly, that example is reflected across the whole UK. The Department of Health says that in the past 10 years 136,000 women in England were treated with mesh implants for urinary incontinence and organ prolapse, but it is only recently that NHS England has brought in guidelines that require surgeons to inform patients of the possible risks, and even now we do not have accurate information about just how many women are suffering complications after mesh implants. We know that mesh is the subject of international scrutiny, with legal cases in countries around the world, including Australia, Belgium, Canada, Israel, Italy, the Netherlands, the USA and Venezuela.

[Jo Stevens (Cardiff Central) (Lab)]

Many mesh implants have been fitted at private hospitals rather than NHS hospitals, and we know from the recent case of convicted breast surgeon Ian Paterson that in those circumstances private hospitals deny liability for private surgeons carrying out operations on their premises. Does my hon. Friend agree that that loophole, allowing private healthcare companies to operate under different rules from the NHS, should be looked into and amended?

[Emma Hardy]

We should be looking into that. I thank my hon. Friend for making that excellent point.

Recently in America, a woman was awarded damages of $57 million in relation to mesh implant surgery, and more than 800 women are currently taking legal action in the UK. Yet so far the Government have sat on the fence on this issue, acknowledging in answers to parliamentary questions from the hon. Member for East Renfrewshire (Paul Masterton) and my hon. Friends the Members for Bristol South (Karin Smyth) and for Ellesmere Port and Neston (Justin Madders) that it is a problem, but completely failing to create a robust system to ensure that all complications are accurately recorded.

The surgeon Robert Bendavid has argued for longer studies on the women who have had mesh fitted, because in short-term studies the data are not capturing the level of risk. Many of the women who have written to Sling the Mesh have reported difficulties three years after having the mesh fitted. The Department does not even have accurate data to show just how many mesh removals have taken place as a result of surgery complications. We must have a proper framework for building an evidence base to determine exactly how widespread this problem is.

The guidelines from the National Institute for Health and Care Excellence do not provide any information on mesh-removal surgery procedures. I accept the argument for clinical freedom for surgeons and that there are difficulties in testing objects that go into our bodies, but that makes the case for thorough and effective follow-up even more important. There is an ethical duty for surgeons to write and record where there have been complications, so will the Minister commit today to ensuring that all mesh procedures are properly recorded? Will she commit to the mandatory reporting of all complications, and will she commit to raising awareness of this condition?

Raising awareness is not just about raising awareness among the general public. Women are telling us that they are going back to their doctors and surgeons after surgery and being met with blank faces when they describe the complications that they are experiencing. It seems that without adequate research and awareness of the risks of mesh surgery, patients are not receiving the support and aftercare that they need. Although we welcome the resource guide that has been developed to provide GPs with more information about the risks of transvaginal mesh implants, more must be done to encourage dialogue on this issue between GPs and their patients.

Building an evidence base is not the only issue. Many people, most notably the Sling the Mesh campaign, have raised concerns about the fact that previous reviews, especially in England, of surgical mesh have focused solely on the procedural failures of mesh surgery and not looked into the safety of the product itself. That is in line with the findings of a report issued by the EU’s Scientific Committee on Emerging and Newly Identified Health Risks, which said that when assessing the risk associated with mesh application, it is important to consider the overall surface area of material used, the product design and the properties of the material used.

I completely agree with my hon. Friend the Member for Pontypridd (Owen Smith), the chair of the all-party parliamentary group on surgical mesh implants—he was of great help to me in preparing this speech—when he says that the fact that many companies have already taken their mesh product off the market should tell us that something is not right with these devices. We have to go to the core of the issue and investigate the fundamental safety of the products. Will the Minister commit to doing all she can to ensure that any future reviews of mesh products look at product safety as well as procedural issues?

--- Later in debate ---

[Jackie Doyle-Price]

I give my hon. Friend that assurance. To be frank, the same standards of consent and regulation apply in the private sector as in the public sector. A number of colleagues mentioned issues in the private sector, but there is no excuse; it is equally regulated by the Care Quality Commission and the General Medical Council, so the same standards apply.

[Jo Stevens]

On that point about the loophole between the NHS and the private sector, and the relationship and liability of private surgeons operating at private hospitals, will the Minister see whether that loophole should be closed?

[Jackie Doyle-Price]

I am not sure that there is a loophole. Surgeons are required to demonstrate their clinical competence as part of their regular revalidation, whether they work in the private or the public sector. Concerned patients may contact the GMC, just as they would do in an NHS trust. In addition, surgeons will be inspected by the CQC and their procedure examined to ensure that it meets standards. I cannot see that there would be any difference, but if the hon. Lady would like to bring to me a specific example, I would be delighted to look into it for her.

Clinicians working in private hospitals are under the same ethical obligations to ensure that treatment is based on consent, that complications are addressed and that information is shared with regulators as appropriate. Private hospitals are subject to CQC registration and must abide by those fundamental standards.

I am very short of time, but I suspect that we will come back to this matter, particularly after the NICE guidelines are published later this year. The most important thing we can do is make sure that the women have access to the support that they need, and that GPs know what to look for in order to give them that support, and I am always open to hearing representations from colleagues on this issue.