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There is an absolute recognition that people with disabilities or long-term conditions will be more impacted by the cost of living crisis. If we think about it on the very human basis that you have highlighted, those people often have equipment that requires electricity, and the cost of charging and running it will be significantly more today than it was this time last year. If people are at home all day—and, following the pandemic, almost all of us have an insight into that situation—there is also the cost of heating their home to a liveable standard. I can move around and put on more layers, but that is not an option for some people with profound disabilities—and it is not an option that I would want them to face.

As you will expect, work is going on in Government to assess the situation and to see what we can do to meet those needs. Michael Kellet might want to say a little more on that and we can write back to you on the support that might be offered to those who are particularly vulnerable as we face this cost of living crisis, which we know comes on the back of other crises—Brexit and an epidemic. We are now right into a cost of living crisis in which food is costing more and energy prices have risen. It is a really difficult time for society and the Scottish Government is trying hard to ensure that our attention is truly focused on the people who need our care the most.

The cost of living crisis is impacting on every household in the UK, and the Scottish Government will continue to do everything in its power, within its fixed budget, to ensure that people, communities and businesses are supported as much as possible.

In the 2022-23 budget, the Scottish Government has allocated almost £3 billion to a range of supports that will contribute to mitigating the impact of the increased cost of living on households, including a £150 payment for those living in Scotland who are in receipt of council tax reduction and those in council tax bands A to D. That will support 1.85 million households. A further £10 million has been allocated to the fuel insecurity fund, which will help households at risk of severely rationing their energy use or self-disconnecting entirely.

Investments have also been made in a range of measures that are unique to Scotland. A payment of £520 was made for around 144,000 school-age children from low-income families through bridging payments in 2021-22, and nearly 82,000 unpaid carers have received £491.40 of additional support this year through the carers allowance supplement. Eight Scottish benefits, including best start grant payments, have been uprated by 6 per cent to ensure that those essential payments keep pace with rising costs. Moreover, 92,000 households have been protected from the UK Government’s bedroom tax, a policy that affected people with disabilities, in particular, and action has been taken to protect a further 4,000 households, 97 per cent of which have dependent children living in them, from the UK benefit cap, which reduces benefit awards by an average of £2,500 per year.

There absolutely are challenging times ahead. I am thinking, for example, of the cost of fuel and energy price rises, and their impact on public services. The cost of heating a nursing home, a hospital or even a sports hall is higher, as is the cost of running a swimming pool. All those things were, largely, not calculated for when budgets were being set just a few months ago. That inflationary increase in energy costs alone is having an immense impact on people’s ability to deliver public services.

There is also inflation in capital costs. I was recently chatting to a sports organisation that had managed to get a great deal of money to renew its ground, but it had realised that, within a year, £1 million had become £0.9 million. That is how high inflation currently is, and how fast the pot of money is going down. These are challenging times for absolutely everyone, and they are particularly challenging for those who are required to deliver public services. It is a challenge for the Scottish Government, for local authorities and for our NHS boards.

What is required in order to rise to and meet that challenge is innovation, creative thinking and careful prioritisation on what it is that we need to do. It comes back to what was said very early in the evidence session about the need to work collaboratively in a way that might not be particularly natural for us. The fact is that, in order to achieve some of the outcomes that we want to—and have to—achieve in Scotland, we will absolutely have to work together and pool our efforts. There is no way around that. Financially, things are currently really difficult, and it will be necessary for us to collaborate to an extent that we never have before.

The use of nicotine vapour products is not affected by the regulations. We do not have the power to include NVPs in the regulations, because they were not included in the 2016 act. The permitting of NVP use within the perimeter of hospital grounds will continue to be at the discretion of each health board. I know that that is likely to lead to a lack of clarity.

The evidence on the safety or otherwise of second-hand exposure to vapes is not yet clear. I think that vapes are potentially a useful tool for smoking cessation, and they are likely to be less harmful than smoking tobacco is, but I am deeply cynical about the efforts of tobacco companies to market them widely and to ensure that they find a replacement market with the reduction in smoking. We need to go very carefully with our use of vaping products in health promotion.

I would not rule out looking at vaping products should the evidence firm up that second-hand exposure is problematic. I would not rule out including them or considering future legislation on that. It seems to me that new primary legislation would be required, given that the 2016 act does not give us the ability to regulate.

Absolutely. I expect the instrument to be effective in preventing the problem, but you are right: if financial costs arise that have not been predicted, we would be more than happy to hear from local authorities.

As a Highlander, I have to say that, although Edinburgh might have more hospitals, a lot more travelling distance would be involved in monitoring the hospitals in the Highlands and Islands. Those are just the challenges that our local authorities and health boards face.

No, thank you.

Thank you for inviting me and giving me the opportunity to return to this important topic.

I am pleased to say that we have made significant progress in our action on transvaginal mesh. We have established a national service for the management of mesh complications, and women have options with regard to their treatment, which can be undertaken in Scotland or elsewhere in the United Kingdom and with an independent provider if desired.

Most recently, the Transvaginal Mesh Removal (Cost Reimbursement) (Scotland) Act 2022 was introduced, and the associated scheme opened on 6 June—just this Monday. The contract with Spire Healthcare has been concluded, and arrangements are being made for the first patients to attend for surgery. Meanwhile, discussions with Dr Veronikis are progressing.

I am mindful of the concerns that have been raised by campaigners over the years about the use of mesh in other sites, such as in hernia repair. That is what I will focus on. I am sorry to hear of any instance of complications and the adverse effect that they have had on individual patients and their wider families.

As members know, the Scottish Health Technologies Group has looked into the use of mesh in hernia repair and published two reports on the subject, one of which was published shortly after my previous committee appearance. Those reports, which are based on current published evidence, support the continued use of mesh in a variety of abdominal wall and groin herniae. That is, of course, subject to all the tenets of realistic medicine: ensuring shared decision making and informed consent with knowledge of the benefits, risks, alternative measures and the possibility of doing nothing.

We have discussed the findings of those reports with professional bodies, including the royal colleges and the British Hernia Society, and we will continue to work with them on that important issue. Work is also going on to establish the medical device information system—MDIS—which will provide important surveillance and outcome information.

Since I last appeared before the committee, the chief medical officer has—in December 2021—written to board chief executives and medical directors to draw their attention to the SHTG report. In the letter, the CMO asked health boards to consider the availability of non-mesh surgery, how best to address skill gaps, if they exist, and the development of broader clinical networks for the management of complex cases. The actions resulting from that will be discussed at a meeting of the Scottish Association of Medical Directors in August.

I know that the committee has received a report from Shouldice hospital in Canada. Although the results reported are notable, it is important to remember that Shouldice hospital is a specialist centre dedicated to natural tissue repair and that it operates in a healthcare system that is very different from the national health service in Scotland. For that reason, the report should not be considered in isolation; rather, it needs to be considered in the context of the wider available evidence.

As I have said before in front of the committee, there are, of course, still some gynaecology procedures for which the use of mesh has not been halted. In those circumstances, there is a high vigilance protocol in place across NHS Scotland. It is important to remember that some of those procedures are complex and long established with few, if any, viable alternatives. Therefore, to suspend the use of mesh would leave a cohort of people with limited or no treatment options.

I reassure committee members, as well as the campaigners who lodged the petition, that the Government is absolutely committed to ensuring that everyone with mesh complications gets the care and treatment that they need.

I look forward to answering any questions that members have on the matter.

It is probably worth going to Mr O’Kelly on that question. As I understand it, Shouldice has a very specialised unit and patients there are somewhat pre-selected. It is therefore not a population that would be reflective of the general population who seek surgery in Scotland. That aside, its results are impressive and we are very interested in the work that is being done over in Canada. However, as I understand it, if we were to compare the population who use the unit in Canada with that seeking hernia repair in Scotland, there might be significant differences, for example in terms of obesity or ambulation.

I will hand over to Mr O’Kelly, who will be able to give you a better explanation.

It might set the context and answer some of the questions that you are keen to put to me.

Convener, I have an opening statement, if you would like to hear it.