Vaginal mesh scandal - Scotland's unlikely political allegiance

When the Scottish Government released the findings of the independent review into the use of synthetic transvaginal tapes and meshes, it hit the headlines.

Campaigners branded the report “a whitewash” after it was significantly altered before the final draft was published, recommending that the controversial procedure should be reinstated in Scotland, albeit not “routinely”.

The complications some women have suffered as a result of these invasive implants have been devastating. These can include repeated infections, organ failure and even death.

The reaction by the women campaigning against the use of mesh to the report was understandable.

However, in the chamber of the Scottish Parliament, the most impassioned articulation of disappointment at the report came from three male MSPs – the former health secretary Alex Neil and two former shadow health secretaries, Labour’s Neil Findlay and Conservative Jackson Carlaw.

This was notable not just because of their gender, but also because they are normally vociferous political rivals. 

Carlaw called the report “a whitewash of damning evidence now traduced and downgraded”.

Findlay called the episode “a tragic tale of corporate power and greed, institutional arrogance by the medical establishment and government ambivalence.”

And Neil said he was “disturbed and disappointed” by the outcome of an inquiry that, after all, he himself had established when he was health secretary.

In a debate on the subject in December, Neil went further and said he had “not been told the whole truth” by civil servants when he went against their wishes and ordered the inquiry in the first place.

Holyrood gathered the three together over breakfast to find out how such an unlikely alliance came about.

“We’re forming a new party,” jokes Neil.

There is a recognition from all three that the issue has not been an easy one to win allies on, given it involves discussing pelvic organ prolapse in women.

Findlay says he has been surprised by “a reluctance” from female party colleagues to get involved in the campaign. 

“It’s not the issue somebody like me would naturally discuss with older and middle-aged women. It’s just not the kind of thing you’d normally discuss,” he says.

“There has been a reluctance, not just from female colleagues but also from colleagues across the piece, to talk about this. Even a case of ‘we’ll call it mesh, don’t call it vaginal mesh, because it’s easier’.”

Findlay remembers telling campaigners Elaine Holmes and Olive McIlroy that the conversation would be “more embarrassing for me than you, so let’s forget being embarrassed about it and just get on with it.”

Carlaw picked up on Holmes’s apprehensiveness when she first came to visit him in his constituency surgery.

“I immediately realised the only way to approach it was in a completely business-like discussion to put her at ease. The minute she realised that, it was perfectly easy. 

“But I agree with Neil, there’s almost a slight Presbyterianism, if I can put it that way, among some of my female colleagues here at the parliament about just the sheer bluntness of the terminology and the issue at hand. 

“I was quite struck, because I think in terms of a potential ongoing health scandal this is every bit as big as thalidomide was, in its own way. But thalidomide was an easy picture, it’s an easier scandal to discuss.”

This has been “an impediment” to proper scrutiny and parliament taking action on the issue, he suggests.

Some notable exceptions have taken up the issue, adds Neil, including Johann Lamont, Rona Mackay and Rachel Hamilton, while Michelle Ballantyne admitted in the debate she had had a mesh operation.

“So, the situation is beginning to change. But the interesting thing is all the decision-makers on this are women, including the chief medical officer. Yet we feel as though we’re still battling people who have not fully come on board. They have admitted the issue and all the rest of it. 

“I think the chief medical officer certainly gives the impression she’s one of the ones reluctant to go for a full ban. I might be misrepresenting her, but that’s certainly the impression I get. I find that surprising, especially now that Australia and New Zealand have imposed a total ban.”

When the overwhelming preference is for patient choice, banning a treatment completely may seem a difficult moral quandary, but Neil argues that a growing understanding of the scale of the scandal means fewer women are likely to choose it anyway.

There was no particular moment when the three MSPs decided to work together. 

“We had a reshuffle and I took over the shadow health post from Jackie Baillie, and she passed on a folder with topics on the agenda, and at the very back there was a couple of pages of articles from newspapers about mesh, and I thought, ‘I wonder what this is?’” remembers Findlay.

He set up a meeting with the campaigners.

“We sat down and one woman in particular struck me. She could have been my auntie, my cousin or my sister. She was a straightforward, no messing, working-class woman, and she told me she had lost a kidney because of this. And the way in which she articulated her case, I just thought, ‘Well, something has to happen here’.”

Carlaw then met Holmes as she was his constituent.

Findlay continues: “Alex was the health secretary and we put a lot of pressure on him at the time and eventually, eventually we got him to do something. He didn’t do it right away, and he was listening to his civil servants or whatever who were telling him a different story.

“Ultimately, it comes down to people and believing the people who were presenting us with ‘this has ruined our lives’. Thankfully, because all of us have form with each other disagreeing vehemently. I mean, I tried to get him sacked one time.”

Alex Neil quips: “This is the first time Neil’s been on the right side of the argument.”

Findlay goes on: “But we have struck up a relationship on this issue. On other issues, we’ll tear each other to shreds.”

Carlaw adds: “Although I would say, actually, it is encouraging the atmosphere where we can talk about other issues as well.

“The image that was striking, actually, was when Neil came along to one of the petitions committees when this was being discussed,” Carlaw remembers.

“At that time, the petitions committee was all men. Alex was giving evidence as the cabinet secretary. So, from Alex and all the way in the other direction of the room was all men, and sitting behind Alex were about fifty or sixty women who were suffering from mesh.”

Findlay describes the moment as “a game changer” and Neil agrees.

Carlaw adds: “Maybe there was a sense of the three of us realising that there was a responsibility on us to do something.”

Neil ordered an independent review and suspended the procedure in Scotland, which was against the advice of his officials. 

“To be fair on some of the people providing the advice, they hadn’t twigged just how serious this was, but, ironically, every one of them was a woman,” he says.

“I was pushing them internally. I couldn’t put my finger on it, but the more I listened to the [campaigners], the more I was convinced that the women were right and the advice I was getting was wrong and decided to act.” 

For Neil, being influenced by the petitions committee raises a more fundamental issue about how parliament works. 

“The official committees of the parliament are supposed to be the ones to give ministers a hard time. My experience as a minister, in every one of the four jobs I’ve been in, is actually, the committees are run by the whips in reality, for all the parties.”

Carlaw suggests that if an issue emerges out of the spotlight and is therefore not picked up by the party machines, it is more likely to engender cross-party alliances.

“The minute the spotlight lands on an issue, everybody runs to the four corners of the boxing ring to prepare for battle,” he says.

“But if the issue emerges despite the party process, it’s amazing how much more common ground and common sense is applied to whole discussion. This is one of those issues.”

If it had emerged from a party-political campaign, the three agree, their alliance would not have been formed.

“Everybody would be in their bunker,” suggests Neil.

That lack of a spotlight is partly the fault of a reluctant press, though. Carlaw remembers being told by one national broadcaster “We don’t do fanny politics”, while a newspaper journalist told him, “We don’t do icky women’s issues, Jackson.”

Findlay says the first press conference he called on the mesh scandal saw only two journalists turn up.

“After it I spoke to some of them and they said, ‘Oh no, we don’t do that stuff.’ I thought, ‘It’s 2015 or 2016, is this where we are? Running away from issues around a woman’s reproductive system?’ Jesus.”

Neil points to the fact the numbers in the press offices in the parliament have reduced considerably since 1999. 

“The press pack move even more as a pack now because they rely on each other to get their stories. They don’t have the resources.”

Former Sunday Mail journalist Marion Scott is the notable exception when it comes to writing on mesh, the three agree, for her empathy and thorough approach. Findlay also credits the Sunday Mail for running the ongoing story too. 

“I mean, you pick up the Sunday Mail and look for the back page to the front, as you do on a Sunday morning, eating your rolls, and getting to a thing like that is not really what you’d expect. But it’s been dogged and they’ve pursued every single twist and turn of this.”

There are further twists and turns in the mesh story ahead.

The UK Government ordered a retrospective review of the use of the implants and they have been banned outright in Australia and New Zealand, using the evidence gathered in Scotland.

Meanwhile back home, Health Secretary Shona Robison commissioned a further review by health academic Alison Britton, which is due to be published this year. It is looking at the process of the independent inquiry, and why it was changed between drafts.

The three MSPs credit the persistence of the two women who brought the petition to parliament and the work of the petitions committee, which also has a final report to produce.

“You don’t have the equivalent in Westminster,” says Neil. 

“I mean, there is a committee that will look at petitions, but it’s not the same. I think the petitions committee has been one of the outstanding successes of this parliament from day one. 

“I think John McAllion was the first convener of it. It’s always been a great committee. 

“We’ve got this ridiculous system where the party leaders decide who sits on what committee, which I think needs fundamentally changed, but that’s a separate issue for another day. But the party leaders, from day one, have put people on the petitions committee who were perhaps regarded as a bit of an awkward squad. People who have, you know, been a bit…”

Carlaw, once a longstanding member of the committee, interrupts: “I think particularly when the parliament was initially founded and there was still a Westminster experience in the leadership, they saw the petitions as it was seen at Westminster.”

“They saw it as a side show,” adds Neil.

Carlaw continues: “Yes, and I actually thought it was interesting when Jim Murphy became leader of the Labour Party, he kind of downgraded the petitions responsibility within the party because he didn’t think it mattered terribly much, whereas those of us who have grown up through the system here know that it’s a much more powerful committee than that.”

Neil agrees. “It’s one of the most powerful committees in the parliament,” he adds. 

The committee recognises that the petitioners were let down in this case, he says. 

“The review of the review wouldn’t have happened without the petitions committee, quite frankly, and I think the review of the review is going to be what blows this whole thing open,” he predicts.

Carlaw remembers: “The electrifying moment for me was when the man from the [UK Medicines and Healthcare products Regulatory Agency] MHRA turned up and said there was only about half a dozen women affected, when sitting behind him were about 60 women who were affected. They absolutely couldn’t contain themselves at that point.”

Carlaw suggests petitioners could get more support when facing the committee, an idea he fed into the Presiding Officer’s commission into parliamentary reform.

“I sat in one petition when somebody passed out during the course of giving evidence so we had to suspend proceedings,” he remembers.

“Only because they were listening to you,” quips Findlay.

In the case of the mesh survivors, the group established its own support network, which Carlaw describes as “a rock for Elaine and Olive through all of this.”

“They’ve done it with tremendous clarity and persistence and courage. That’s been a key thing too. That spurs us on, actually.”

“Yes,” says Neil. 

“Totally,” agrees Findlay.

At one point, Neil had suggested Scotland could host an international conference on mesh, and he and Carlaw are still hopeful such an event could happen, but Findlay suggests that the moment has passed.

“We had the opportunity to lead and we blew it. We flunked it,” he says.

“But now we’ve started to penetrate the political system in England, where it was not on the agenda at all.”

Findlay’s former aide Tommy Kane, who originally drafted the petition alongside the campaigners, now works in Westminster and has supported Owen Smith MP to form an all-party parliamentary group (APPG). 

“Plus, my colleague Paul Masterton, who is of course Elaine’s MP now,” adds Carlaw.

“He was very good in the Westminster Hall debate,” says Findlay, “so it’s now starting to get through into the consciousness down there.”

Neil suggests the three of them should go down and talk to the APPG at Westminster, to advocate replacing the MHRA.

“This is not the only issue they have failed on,” he says.

“We’ve all agreed with that,” says Carlaw.

Like the vaginal mesh scandal, this unlikely alliance seems set to continue.