Surgical Mesh

Julian Lewis Excerpts

Thursday 19th April 2018 Commons Chamber

[Owen Smith]

My hon. Friend is right. The whole point of mesh is that it is designed to induce scar tissue in order to fuse the mesh with the muscle, and therefore trying to excise the mesh is incredibly difficult. That is why there are partial removals and some women are left with pieces of mesh inside them, even after surgery. Those sorts of complications are clearly very worrying. They ought to have been explained properly to women, but obviously were not, in very many cases.

[Dr Julian Lewis (New Forest East) (Con)]

The hon. Gentleman is making an excellent speech, and I thank him for his work. Will he go back to what he said a few moments ago about the idea of it being acceptable that 1% to 3% of cases might go wrong? It might be acceptable if we are dealing with a small overall total, but when we are dealing with over 100,000 cases, we are saying that it is acceptable for 1,000 to 3,000 people to suffer devastating, life-changing injuries as a result of this procedure. Surely that is anything but acceptable.

[Owen Smith]

It absolutely is not acceptable. I hope that the Minister is not going to repeat what other Ministers have said in written statements and in this place, which is that 1% to 3% is the sort of failure rate, or complication rate, that one would expect with all sorts of surgery. The reality is that the numbers are far greater than that—far, far greater—as the audit this week shows. I will come on to address that.

--- Later in debate ---

[Dr Julian Lewis (New Forest East) (Con)]

I start by saying that I think the steps taken in Scotland, as described by the hon. Member for Glasgow North (Patrick Grady), sound extremely sensible as interim measures until final decisions can be taken. I echo the thanks due to the hon. Members for Kingston upon Hull West and Hessle (Emma Hardy) and for Pontypridd (Owen Smith), their associates in the all-party group, and Sling the Mesh campaigners. I also thank my three constituents, Emma, Eileen and Helen, who have all shared with me their harrowing experiences of the procedure.

There is no doubt that when vaginal mesh procedures go wrong, the results can be truly catastrophic. A letter from the Minister states clearly that

“women have suffered atrocious and debilitating complications”

from these implants. Her counterpart in the Upper House, Lord O’Shaughnessy, has conceded this:

“While these treatments can be effective, in a small minority of cases meshes can cause serious long-term injury and disability, and prevent or reduce the ability of affected women to work.”

According to a letter from the Health Secretary to parliamentary colleagues in February:

“Clinical experts here and abroad agree that, when used appropriately, many women gain benefit from this intervention, and hence a full ban is not the right answer.”

I find it difficult to follow that logic. There might be an acceptable argument if we were talking about a procedure in which the numbers of interventions were in the hundreds, but, as I said in an intervention and as the hon. Member for Pontypridd (Owen Smith) endorsed, we are talking here about over 100,000 people. When we are talking about over 100,000 people, if even the Government’s low figures of 1% to 3% going badly wrong are right, that is still 1,000 to 3,000 people. I have been given, by my constituent Emma, a leaflet from Sling the Mesh that says that its estimate is that at least 15% of people are seriously and badly affected. On that scale, we are talking about over 15,000 people being seriously damaged by this procedure.

[Owen Smith]

I thank the right hon. Gentleman for giving way and for his kind remarks. Would he be surprised to learn that the chief medical officer, Dame Sally Davies, speaking alongside the Health Secretary in a Facebook Live broadcast just a few months ago, said that she thought the serious complication rate was between 15% and 20%? I have written to her asking where she got those numbers, although as far as I am aware she has not replied to me, because that is at odds with all the previous comments by Ministers and officials.

[Dr Lewis]

Indeed. I would be surprised at that, because if that is what Dame Sally believes she ought to be making different recommendations.

I have been given a particular study, which is described as the largest study of surgical mesh insertions for stress urinary incontinence. Over 92,000 women were surveyed in this particular examination, including all NHS patients in England over an eight-year period. The conclusion states:

“We estimate that 9.8% of patients undergoing surgical mesh insertion for SUI experienced a complication peri-procedurally within 30 days or within five years of the initial mesh insertion procedure. This is likely a lower estimate of the true incidence.”

I reiterate my point about acceptable and unacceptable percentages. When we are talking about these very large numbers, even relatively low percentages make the procedure too risky to be used in anything other than last-resort circumstances similar to those described by the hon. Member for Glasgow North.

In the past decade, my constituent Emma has undergone X-ray-guided injections, ultrasound scans, MRI scans, in-patient stays, tests galore, more and more scans, and, eventually, a biopsy. She has been refused referral to a mesh specialist centre. It seems highly likely that she should never have been given a mesh implant in the first place after the trauma of such a difficult birth, which leads me to the next point about inadequate warnings. I understand from my constituents that they were given little warning, and in many cases no warning at all, about the potential dangers.

[Kevin Hollinrake (Thirsk and Malton) (Con)]

My right hon. Friend is making some very important points. Does he agree that prevention is better than cure? If physiotherapy were offered to women after childbirth, that might obviate the need for any surgery at all as a result of these kinds of complication.

[Dr Lewis]

Indeed. The problem with this issue, as it has been impressed on me at any rate, is that this has been put forward as a quick-fix alternative to other procedures, whether surgical or not, which would take much longer.

Having paid thousands of pounds for private specialist assessment, in the end Emma eventually managed to get the sort of referral she wanted. I have been given the following clinical summary of her condition:

“Vaginal mesh; foreign body giant cell reaction, chronic inflammation and fibrosis.”

I have a page here that lists some 50 different symptoms related to implant illness and foreign body giant cell reaction. I venture to suggest that if this ghastly catalogue of things that could go wrong had been shown in advance to those 100,000-plus women who have had a mesh implant, more than 90% of them at least would have turned it down.

This is what my constituent Eileen wrote to me:

“The effect that this has had and is still having on my life is massive. I can no longer carry out basic tasks at home or do things with my children due to the pain. I need to take medication every day from my GP to try and ease the pain. I cannot go to work at present due to the pain and I am currently on sickness absence leave from my job. The mesh implant that I have had has and is continuing to destroy my life. I need an operation to remove the mesh implant, but the operation is very complex and unfortunately there are limited amounts of surgeons who are experts in the full removal of these mesh implants. Due to my financial situation, I am not in a position to be able to afford to have the full removal of the mesh implant done privately and therefore I am having to wait for this to be done on the NHS which is taking far too long.”

I turn now to Helen, who probably has the most horrifying story of the lot. She was 35 when given what was described to her as routine surgery 16 tortured years ago. She was initially told that it was her fault that her body was rejecting the two mesh implants. She then went through a cycle of implants, the removal of protrusions and eroded segments and seven bouts of surgery. Three TVTs—trans-vaginal tapes—are still inside her, she suffers chronic pain from orbital nerve damage, constantly needs painkillers and has had constant side effects, indifferent treatment and a refusal to admit fault or to refer her to an out-of-area specialist in mesh removal. She writes:

“I do not want anyone from the hospital coming near me ever again. I have lost complete faith in them. I have been lied to and told repeatedly it was my body rejecting the mesh; but, unbelievably, they kept putting more in.”

She suffers from truly terrible bowel problems, some no doubt caused by the side effects of the painkillers and the sleep aids she has to take. Consequently, she suffers from depression, loss of confidence and lack of self-esteem. She further writes:

“I feel let down by professionals who were supposed to treat me to the best of their ability. There has been information about the adverse effects of mesh around for years, yet these doctors are still happily inserting them into thousands of women.”

She is desperate to be referred to one of the few doctors who specialise in mesh removal and feels trapped under the control of the very people who have let her down. She continues:

“I want these devices out of my body.”

Who can blame her?

Let me conclude by quoting, from an article in The Daily Telegraph of 23 October last year, a lady who suffered for eight years:

“I just wish I had never, ever had it done. I would rather have coped with that very minor problem of stress incontinence than this. If I had known even one of the possible risks of the surgery there is no way I would have had it done. I am furious that I was never told that this could happen.”

--- Later in debate ---

[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.