The Department of Health’s latest response to a question on pelvic mesh removal highlights significant gaps in transparency and leaves several important questions unresolved.

Namely – how are surgeons being trained in mesh removal? How many surgeons are performing mesh removal? Is there a sample retrospective audit being carried out to calculate mesh complication risks as recommended in the First Do No Harm review?

The Government confirms that both partial and complete mesh removal are recognised treatment options under NICE guidance and between 2021 to 2025 there were 234 full mesh removals and 185 partial mesh removals

However, the response reveals that information on how many surgeons are carrying out mesh removal procedures in the nine specialist centres is “not held centrally”.

More notably, the Department failed to answer a key question: are mesh removal surgeons specifically trained in complete mesh excision and removal techniques? Instead, it simply stated that specialist centres must ensure surgeons are “appropriately trained” through local trust appraisal systems. Patients deserve greater clarity about what that training involves and how expertise is assessed.

The specification for complications of mesh inserted for urinary incontinence, vaginal or internal, and external rectal prolapse states that specialised mesh centres must use trust appraisal systems to ensure that surgeons are appropriately trained, current in their practice, that they adhere to clinical and NICE guidance, comply with Pelvic Floor Registry data requirements, and report any complications.

The response also raises questions about the implementation of Baroness Cumberlege’s landmark First Do No Harm report. While the Department says a sample audit of the POP/SUI database has been completed and used to inform future commissioning, it does not explain whether a broader retrospective audit of mesh cases, as advocated in the review, has been undertaken.

For many mesh-injured women, the issue is not whether services exist, but whether the NHS and Government are being fully transparent about outcomes, expertise and lessons learned.