Jim Daly (Cork South West, Fine Gael) | Oireachtas source

If there is something I admire more than anything else in politicians of any hue, colour or creed, it is consistency. The Deputy's consistency in this subject matter for a long time is commendable. The report to the Minister for Health, Deputy Harris, from Dr. Tony Holohan, Chief Medical Officer, on the use of urogynaecological surgery in the treatment of stress urinary incontinence, SUI, and pelvic organ prolapse, POP, in women was published on the Department of Health website on 21 November 2018. Synthetic mesh devices have been widely used in the surgical treatment of SUI and POP in women over the past two decades. However, controversy about the safety of mesh devices has arisen in many countries because of concerns about the frequency and severity of complications associated with their use.

In responding to these questions and in recognition of the complexity of the matters arising, the Minister requested the Chief Medical Officer, CMO, to prepare a report for him on the clinical and technical issues involved in ensuring both the safe and effective provision of mesh procedures in urogynaecology and an appropriate response to women who suffer complications as a result of undergoing such procedures. Preparation of the report has involved consultation and engagement with national and international bodies. The report has been informed by a review of international reports and safety reviews of mesh surgery which have been published in recent years. The report has also been informed by the personal experiences of women who have suffered complications following mesh surgery. The Minister for Health acknowledges the bravery, commitment and dignity shown by the women he met and those women who have written to him in sharing what were harrowing and deeply personal experiences.

The report identifies that for many women, surgical procedures using synthetic mesh devices have provided a more effective and less invasive form of treatment than traditional SUI and POP procedures. However, mesh devices are associated with significant and severe complications in a minority of women. These are of concern given the difficulties of mesh implant removal. The report makes 19 recommendations, including the development of patient information and informed consent materials; surgical professional training and multidisciplinary expertise in units carrying out mesh procedures; the development of clinical guidance; the development of information systems to monitor the ongoing use of mesh devices; ensuring the reporting of mesh related complications; and ensuring timely, appropriate and accessible care pathways for the management of women with complications. A programme of work to advance some of the report's more important recommendations has already commenced in the HSE in advance of its completion. The HSE was also asked by the CMO on 24 July to pause all mesh procedures where clinically safe to do so until a number of key recommendations have been implemented. The Deputy acknowledged that in her contribution.

A priority recommendation being progressed by the HSE is the clarification and development of treatment pathways and appropriate referral services for women suffering from mesh-related complications. This includes identifying the appropriate specialist clinical expertise and facilities required at hospital group level and nationally. The HSE will also examine the need to look at sourcing services from abroad to address any immediate shortfalls identified, either through utilisation of the treatment abroad scheme or by commissioning services from abroad. Decisions to remove mesh devices in women who experience complications must be made on an individual basis following detailed clinical assessment and discussion of the risks, benefits and treatment options by women with their treating clinicians. The HSE has published a dedicated website page on vaginal mesh implants, including contact information, for women suffering complications. I hope this is a useful resource, the link to which can be made available.

I appreciate I have not answered the two direct questions on the date for the scanning machines and whether there is a co-operation agreement with Belfast. I was also asked about the treatment abroad scheme. I will get clarity on those matters for the Deputy and forward the information to her.

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