���˿���

In short, yes. If women needed to go through multiple surgeries to remove mesh, that would be covered.

That is an excellent question. I can assure you that some of that is happening right now, as you would rightly expect to be the case. All of us should say, however, that those women should not have had to take the time and make the effort to bravely come forward, campaign and fight hard while they were still suffering the complications with their transvaginal mesh implant to get a solution in place—I hope—to help with that suffering. I appreciate, however, that many of those women will continue to suffer until the contracts are signed, they go through the pathway and they get the corrective surgery. Some of that learning is taking place now.

The process is evolving. I have referred to the complex mesh removal service in Glasgow, which has had to evolve and develop as we have continued to receive feedback from the women involved. To me, that is the crux of the issue, and that is the promise that I will certainly make, as cabinet secretary. I know that my officials also understand that. We will continue to listen to the women. It is not a case of introducing the bill, which I hope will pass, and putting a pathway in place, then once the contracts are signed, that will be the end of the engagement with the women. Far from it. We will continue to engage, listen and hear what the women have to say, and we will continue to evolve our processes and practices, where possible.

That does not mean that we will be able to do 100 per cent of what is being asked of us. I will always try to ensure that we do as much as we possibly can, understanding the suffering that the women have gone through. However, some matters involve clinical decisions, as I referred to in a previous answer. Generally speaking, however, we should be open to listening to the feedback that we get from the women involved.

Yes. We have taken what we think are the reasonable costs into account. Those include the reasonable costs for corrective surgery overseas or in the UK and for reasonable costs such as taxis, hotels, food and subsistence.

Our detailed engagement over a number of years has given us an idea of how many women we think have been affected by mesh surgery and would be eligible for reimbursement. That is how we got to the figure in the financial memorandum. There may be women who have not yet come forward, although I told Dr Gulhane and the convener that we are regularly contacted by women who have been affected. If there are women who have not previously contacted us but who do so after the bill has been passed, we will look to make more resources available.

Yes. We think that the number of women who will be eligible for a reimbursement scheme—if not the overall number of women who have been affected by mesh—will be relatively small, so we do not think that the application scheme will require huge resources. To go back to Marie McNair’s point, it is important to get the right balance between having a quick application process for women who may have been waiting years for reimbursement and giving those women enough time to gather the required evidence of their costs.

I go back to my opening remarks to the convener. We recognise the suffering of the women involved, and we should try to apply as much flexibility as we possibly can. We must balance our public finance and funding obligations, but we should be flexible.

If the bill passes the appropriate parliamentary process and gets royal assent, we hope to be able to open the scheme as soon as possible, which should be in the summer of 2022, and initially keep it open for a year. However, I give the assurance that that does not mean that people will have to wait for a year. There will be a rolling process for reviewing applications, but the scheme will be open for a year because it might take people a bit of time to get the appropriate invoices from the independent providers or to contact the airline that they used a year or two years ago to get the required proof.

If it was necessary to extend the deadline, we would look at that favourably. We want to take a flexible approach, because we realise that people do not keep airline stubs from five years ago. We will try to be as flexible as we can while being mindful of our public finance obligations.

That is a really good question. I do not think that we have considered what the appeal process will look like, but there should be one. It is necessary for any such application scheme to have a process for individuals to question why certain costs have not been reimbursed. However, I hope that we would not get to such a position and that, if a cost was questionable, we would go back to the woman to understand more about that before an absolute decision was made.

My direction to those who operate the scheme will be to be as flexible as possible, within the public finance rules. It is understood that none of us would keep certain receipts for years and years, so it is important for us to take a fairly liberal view of what a reasonable cost is, although I am mindful—I can almost feel Ms Forbes’s eyes on the back of my neck—of our public finance obligations, which are important when we spend even a single penny of the public’s money.

My officials and I are not getting pressure from finance colleagues or from anyone else in Government. No one is sitting on a pot of money and saying that we cannot spend a penny more than that. We want to keep spending within the scope of the financial memorandum, but if we have underestimated certain reasonable costs that people can demonstrate, no one will be constrained in that respect. You are right that we must have an application system that is user friendly and not onerous for the women involved, but which is also mindful of and aligned with our public finance obligations.

Without going into detail, I am dealing with a case to which that question is relevant. The NHS is well versed in dealing with people whose first language is not English. Once the eligibility criteria have been decided, which the Parliament will do in passing the bill, that will allow us to engage in the process around eligibility. When that process is well defined, it will be important for us to ensure that we communicate through all possible channels and reach out to communities whose first language is not English. Because of the pandemic, we have good experience of how to do that. We have made good progress on that engagement, with the help of many organisations, such as Black and Ethnic Minority Infrastructure in Scotland, or BEMIS. We will continue to use those networks.

A good question is what we can do now, because the issue is not just about the eligibility criteria for the scheme, although that is why we are discussing the bill today. There are also the pathways, which can be complex to explain and understand. We can maybe do a bit more work with our networks on explaining the pathways when the contracts are finalised, which I hope will be soon. We will explain the pathways for women to the complex pelvic mesh removal service in Glasgow and the pathways thereafter in terms of the multidisciplinary teams and women who want a referral to independent providers. Emma Harper has raised a good point. After this committee session, I will double check on what networks we are reaching out to.

That is a good question. I will keep emphasising the point about trying to be as flexible as we can. We chose 12 July as the cut-off date for eligibility for the scheme because that is when we made the announcement about the independent providers. In all the communications that have followed from 12 July, we have been keen to say to the women that we are working as hard as we possibly can with those independent providers to finalise the contracts and to put the appropriate pathways in place and, if they can hold off from arranging any surgery with independent providers until the scheme is in place, that would be favourable.

Some women had arranged their surgery prior to 12 July, but it would not have taken place until after 12 July. In those cases, they will be reimbursed when the scheme is open.

To go into the granular detail, what we mean by “making an arrangement” is something for us to consider. If the patient, the surgeon and the clinical team that was to perform the surgery understood that it would take place on a certain date, that would be an arrangement. If an initial preliminary inquiry had been made but nothing had been booked, that would not count as “making an arrangement”. Again, however, we will look at each circumstance and each individual on a case-by-case basis.

It is important to separate what we are doing in relation to the complex pelvic mesh removal service and the pathways for the independent providers, and what the bill seeks to do. The issues are clearly interlinked but, to answer your question, I will separate them out.

There has to be a cut-off date in the bill. If I was really being pushed hard on it, we could absolutely consider where the flexibility lies.

I hope that contracts will be finalised relatively imminently, but there are no contracts of that nature, particularly given that we are dealing with providers overseas so, naturally, working through where those services are different from the NHS services will take a bit of time. Once they are finalised, there will be a pathway for women that will include, for example, a multidisciplinary team that will include Dr Veronikis and Professor Hashim from Spire Healthcare in Bristol. They will be part of the MDT process that will decide what the best pathway for those women is.

I would not see a reason, when that pathway is up and running, to have to reimburse because, if the MDT decides that the procedure provided by Dr Veronikis is the best route, that is provided free of charge anyway. I do not think that it would make sense to have eligibility criteria at the end, when the bill receives royal assent.

I can see that Ms Baillie wants to come back in.