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I note an interesting interaction between this session and the previous evidence session with Mr Adam, the minister dealing with the Government’s participatory and deliberative democracy agenda. There is a big concern about the attachment of community benefits to big planning projects, whether they relate to energy or something else, and it is an issue that needs to be addressed much more rigorously in NPF4. For example, I know from planning decisions made in Glasgow that there is real concern about funding disappearing centrally in council budget lines and not being attached to material and tangible improvements in the community that is the locus of the development.

There are clear issues that need to be tightened up and considered. There is also a potential interface with the agenda in Mr Adam’s portfolio.

I concur with what Mr Ewing said with regard to a need for remedy, which is clear in terms of natural justice.

I think that there is another stakeholder, because Glasgow City Council is the successor body to Glasgow Corporation. Any question of liability would probably need to be discussed, which therefore requires a response from Glasgow City Council as well as from the Scottish Government. We should therefore also make inquiries of Glasgow City Council.

The instincts in bureaucracy are to defend against liability and against extending liability, but that is the wrong approach in this instance. We should therefore try to establish a remedy for a group that has clearly suffered harm.

A common theme that came across from all the petitions is governance and the need for checks and balances in relation to the structures of health boards. The rights of rural communities would be better enshrined in a formalised setting by creating some sort of statutory body that advocates for them and places obligations on health boards. We need to set a safety standard that identifies very clearly that driving such distances to access critical care is inherently unsafe.

That would place an obligation on the health board to address that as a standard issue. Perhaps some reflection is needed on how that might look. The petition does not make that demand, but an issue emerged in conversation during the evidence session about whether some sort of body could say, “This is a defective system for these reasons. You need to address it.” Such a body might be equivalent to the Scottish Housing Regulator, for example, and it could place such obligations on health boards. It seems that the idea that that could be done through the health board was challenged—there was a feeling that boards might be prone to groupthink and that what is needed could not necessarily be achieved just by having a rural representative on a health board, because their voice would be drowned out.

My question relates to the question on the 50MW thresholds for devolved versus reserved planning applications. Has the Scottish Government engaged with Alister Jack at the Scotland Office or Greg Hands at the Department for Business Energy and Industrial Strategy on that issue—perhaps to seek a remedy through planning reform? I sense that, on the occasions when these issues are raised, they are discussed and, potentially, discrete elements could be devolved as a result or at least a mechanism could be established. It might be worth taking that action. If that is not happening, perhaps the committee could support that effort by calling for those ministers to come before the committee in due course.

A major point has been raised about wider and deeper engagement with local government. What is the Government’s response to the recommendation about deeper engagement?

Thank you very much for that. I want to ask a bit more about how that fits into the wider agenda on participative and deliberative democracy. How does the report fit into that wider vision or objective?

What is the Government’s view on how that fits into the wider open government plan? In particular, how do you see monitoring and evaluation working?

There are things like that.

Another example that I often encounter relates to the planning process. There are consultation events and opportunities to engage, but it is only when people suddenly realise that construction has started, and wonder why they did not know about it, that we get the emails and the agitation about why something is suddenly happening. We might say, “Well, you should have got in touch six months ago when the guy was at the community centre with those notice boards about it all.” They say, “I know, but I didn’t know anything about it.”

There are already these types of defective examples. Does the Government recognise where the limitations are and how to address them?

Okay. Thank you very much. I want to follow up on an instance that was mentioned earlier. It is in one of the submissions from a patient. The national complex mesh removal surgical service in Scotland accepts only gynaecological referrals. Why cannot patients who wish to have other types of surgical mesh removed utilise that service? Why is it restricted in that way?

I thank the witnesses for their contributions so far, which have been very interesting. I have some questions around mesh removal procedures and protocols. We have had a number of written submissions from members of the public—patients—who have experienced adverse outcomes and complications. Martin O’Neill commented that his life is improving now that he has had the mesh removed. He said:

“I’m still mesh afflicted due to the device being left so long in my body that pain and damage is permanent. BUT I have hope. It’s out! There is at least a possibility of me doing something with life rather than taking pills that don’t allow basic functioning, coupled with pain that still doesn’t stop sleepless nights and an overwhelming sense of wanting to die than live in that horror of pain that mesh causes.”

In other cases, individuals were told by surgeons that the mesh was too enmeshed in their body to be removed without causing serious consequences such as the loss of their rectum or testicles. Individuals have resorted to private surgery to get the mesh removed, with some even travelling abroad to do so.

In another written submission, Carole Coutts described difficulties in getting her mesh removed on the NHS in Scotland. She said:

“My GP ... discussed my case with other GPs. She said none of them knew much about mesh.?She tried referring me to the Scottish Complex Mesh Surgical Service”—

which is a service for women who are considering specialist surgical mesh removal—

“and I also emailed them”

as a patient.

“They refused my referral as they only accept gynaecological referrals.”

In 2018, your predecessor as chief medical officer wrote to the health board medical doctors in Scotland on the use of mesh in sites other than the vagina. In that letter, she said:

“The management of patients with mesh-related complications must follow agreed pathways which should involve a multi-disciplinary team of clinicians with appropriate skills and experience.”

In the light of all that, can you talk us through the “agreed pathways” for non-gynaecological “mesh-related complications” that your predecessor referred to in 2018? Do you believe that those pathways are operating as they should?