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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?

I want to build on the point about the Scottish complex mesh surgical service being the opportunity to evolve the model. Given that there is such a small volume of defects in the national population base, combined with Scotland’s relatively small geography and population base, the idea of a concentration of skills to deal with and rectify complex defects could provide a way to build the service to include some of the examples that Dr Spencer Netto has called for as key takeaways. Building that national centre would not be to say that everyone has to get a surgical mesh repair for a hernia in a national centre in Glasgow—for example, if they live in Lerwick. However, if there are complex or high-risk cases, that might be the most appropriate solution. Do you agree that we should look at that?

I think that the substantive issues in the petition have been addressed by the actions resulting from it. If there are subsequent areas of inquiry, there is no impediment to the lodging of a new petition that is focused on those issues, which will be addressed by the committee in due course. If people feel that that would be a tidier approach, I am happy with that. I have no strong feelings either way.

Thank you for that contribution. The point about there being such a small number of cases in the national scale of things requires us to reflect on how best to address it. The pathways perhaps need consideration of how we might establish learning curves so that defects can be addressed by a network of people who are robustly capable of doing it rather than it being a lottery.

Could the NHS consider establishing a protocol for investigating such cases so that it could understand, for example, why someone has gone for a private surgical solution, what the outcome was and what could have happened differently? Is there a way of addressing the concerns that are expressed in the patients’ submissions that we have received, such as by conducting a deeper analysis of what has gone wrong in their journey to identify whether there are opportunities for improvement?