Louise O'Reilly (Dublin Fingal, Sinn Fein)
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I acknowledge progress has been made on this issue and that work is being done. I know the Minister of State would be aware of the scale of the problem. Some of the women impacted by this are in the Visitors Gallery and are watching the proceedings here.

We welcome the publication of the report. The women's voices are present throughout the report but that is coming from a fairly low base because there were not very many face-to-face interviews. We would like to see more of the women's stories reflected in that report. I acknowledge that the Minister for Health, Deputy Harris, has met the women. Before we went into the meeting, we had a very frank exchange and they had a very frank exchange with the Minister. It is not easy to talk about some of these issues. I raised them at Leader's Questions and know it is a difficult subject. It is a credit to the women that they put forward their own cases, along with Melanie their representative, in a very coherent manner. They rarely use euphemisms which is welcome. We are all adults after all but we acknowledge this is a difficult topic.

We know that the scanners are coming but by what date? It is impossible for many of the women to gauge the level of the problem and to know the best course of treatment. Is there a co-operation agreement in place or can one be put in place for use of the scanner that will be installed in Belfast? In that way at the very least we might have access to that scanner. Will the women be afforded access to the treatment abroad scheme? I know that is a tricky area. I know the rules and that the Minister of State knows about this issue not only from this debate but from constituency cases.

We have learnt from the report that the governance mechanisms were not in place at national level. Only yesterday The Guardiancovered this story and said that mesh implants made by one of the biggest pharmaceutical firms in the world were inserted despite the company being warned that the mesh could shrink and harden. I met a woman today whose implant was inserted only six months ago. I asked previously for the suspension of its use and it has been paused but this was in use until very recently. We want to see action on all the clinical and technical issues associated with the use of mesh as a matter of urgency because while there are some women in the Gallery there are many more at home because they cannot travel, and more come forward every day of the week to tell their stories and to seek help.

Jim Daly (Cork South West, Fine Gael)
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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.

Louise O'Reilly (Dublin Fingal, Sinn Fein)
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I thank the Minister of State for his reply and for his kind words. Anyone who has met these women could not fail to be moved by the manner in which they were treated. In his reply, the Minister of State acknowledged the bravery, commitment and dignity they have shown and I wish to associate myself with those remarks. I welcome the Minister of State's statement that he will come back to me on access. My questions were not designed in any way to trip anyone up. Like the Minister of State, I want to be able to tell these women when this will happen. There is an acknowledgement of what happened to these women and there is also an acknowledgement on the part of the HSE and the Department that action must be taken. We are looking for a timeline for that action and a date by which the women will start to see a material difference. I spoke to the husband of a woman from the Minister of State's county, albeit not from his constituency, last week. That couple had just cobbled together enough money to get to England to have a full removal procedure there. The husband had spent five and a half years looking after his wife who is in agony and they could not wait. I would dearly love to be able to tell that man when his wife would get treated. That is all people are looking for. While the acknowledgement and the fact that some progress has been made are very welcome, we need to join up the dots now and set out the date on which women will have access to a scanner or the treatment abroad scheme. They will then be able to start the process of recovering. Some of those women will never recover, but we must ensure they can get as well as possible. I appreciate that the Minister of State will come back to me with further information. I will be happy to share that with the women and their representative, Ms Melanie Power.

Jim Daly (Cork South West, Fine Gael)
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I appreciate very much the presentation the Deputy has made on this and I will ensure there is a timely response. I assure the House that I understand very well where the Deputy is coming from and the need of these people to know the where, how and, most importantly, when of the next steps. That is the assurance we would like to provide and as such I will certainly try to get a date for the Deputy without delay. The Minister for Health is committed to ensuring the safe and effective use of mesh implants and that there is an appropriate and timely response to women who suffer mesh complications. The Department has written to the HSE to request the preparation of a detailed plan for the implementation in conjunction with other stakeholders of the complete set of recommendations set out in the CMO's report. The Minister intends to meet with the Mesh Survivors Ireland group in the coming weeks to discuss the report. I assure the Deputy that I will get the answers she requests.