MP Emma Hardy and Sling The Mesh drafted a letter to MP Maria Caulfield for an update on mesh centres, waiting times and outcome measures. The letter was sent in January 2023 and the reply has been received this week June 2023.

Dear Emma,

Thank you for your correspondence of 19 January 2023, co-signed by Alec Shelbrooke, about surgical mesh. Please accept my sincere apologies for the delay in replying.

NHS England is working to ensure high-quality data is collected at specialist mesh centres. All centres must meet at an annual clinical summit to promote best practice, present data and share patient outcomes.

Number of women seen and treated in mesh centres – NHS England advises that in the nine specialist mesh centres in England, from April 2021 to October 2022, 1,913 patients have been referred for treatment, 393 have received surgery, 192 are on the surgical waiting list and 136 opted for non-surgical treatment.

Average waiting time for a first outpatient appointment was 15 weeks, and the average waiting time for surgery was 23 weeks.

Mesh Centre outcomes – In the December Independent Medicines and Medical Devices Safety Review (IMMDSR) update, we committed to work with NHS England to review mesh centre outcomes and patient experience. NHS England carried out interviews in September and October with patients who have been treated by the mesh centres, to receive feedback about their experience with the service and the treatment received. The findings of the patient interviews were presented to the mesh centres at the Mesh Centre Clinical Summit.

Mesh Centre Audit – NHS England and the Specialised Women’s Clinical Reference Group (CRG) put in place follow-up meetings with all the centres in April and May. The meetings were put in place to work through the arrangements for conducting the mesh centre audit, and agree regular data returns about activity, waiting lists and patient reported outcomes. They also focused on the arrangements the mesh centres have in place for receiving patient feedback, and how the centres are supporting integrated care boards and engaging with their local GP practices.

Patient and Public Voice members – In March, I met some mesh campaigners and NHS England to discuss plans for the audit of specialist mesh centres. The Specialised Women’s Services CRG will provide governance for the mesh centre audit. Kath Sansom of Sling the Mesh and Paula Goss of Rectopexy Mesh Victims agreed to join the CRG as patient and public voice members to ensure patient voice is considered throughout the audit. The audit is due to take place later this year.

• Regarding financial support for travelling to mesh centres, patients can be referred to another centre if they have concerns about receiving care from the surgeon who originally carried out treatment. Under the Healthcare Travel Costs Scheme, the NHS can reimburse travel expenses for eligible patients. The NHS can also help with a number of costs for those eligible under the Low Income Scheme, and further information can be found at www.nhs.uk by searching for ‘Healthcare Travel Costs Scheme’ and ‘Low Income Scheme’ respectively
• Women in Northern Ireland and Wales – with regard to mesh centres in Northern Ireland and Wales, as healthcare is a devolved matter, this would be for the Department of Health in Northern Ireland and the Department of Health and Social Services in Wales to respond to. During NHS England’s meetings with mesh centres in April and May, it asked them for information on whether patients from the devolved nations are being referred to English centres. NHS England is aware that some patients have been referred, but does not have details of any information about refusals.
• Rectopexy Mesh – NHS England is amending the specialised service specification for women with complication of mesh inserted for urinary incontinence and vaginal prolapse to include treatment for patients – both female and male – with a range of rectopexy complications. Rectopexy mesh removal has not yet been formally commissioned by NHS England, although we recognise that there have been some local services in existence. The services will be commissioned from the specialist mesh centres. Where patients considering rectopexy mesh management are to be treated, specialist mesh multidisciplinary team membership will be expanded to include relevant experts.
• Recording mesh centre patient outcomes – NHS England (NHS Digital at the time) has developed a patient questionnaire, which is serving as the interim patient reported outcome measure (PROM) ahead of an academically validated PROM being in place. Development, testing, evaluation and validation of a new PROM can take two to three years as it requires patient, clinical and specialist academic input to ensure that the data collected is suitable for outcome-based analysis and evaluation. The National Institute for Health and Care Research (NIHR) is commissioning the development of a PROM for prolapse, incontinence and mesh complication surgery. I am pleased to be able to state that the contract for this study has recently been awarded; the study started on 1 May and is expected to run until May 2026. More information can be found on the NIHR website
• Surgeon society membership – All surgeons providing complex surgery for urinary incontinence, and vaginal and uterine prolapse, must be members of the appropriate subspecialist society, and all urogynaecologists must have British Society of Urogynaecology membership. Every urologist forming part of the specialist multidisciplinary team must have membership of the female, neurological and urodynamic urology section of the British Association of Urological Surgeons.
• The Mesh Complications Training pathway – to equip doctors with the necessary clinical skills to treat patients with complications from implanted mesh, the Royal College of Obstetricians and Gynaecologists, in collaboration with partners including the Royal College of Surgeons, has developed a Mesh Complications Management Training Pathway. Patients with personal experience of mesh complications provided input to the development of this pathway. The mesh complications management training pathway launched at the end of 2022, initially starting with established practitioners working at the specialist regional mesh centres. As of 13 April, 11 individuals have either enrolled or are in the process of enrolling on the pathway. They are required to collect a portfolio of evidence, which will be assessed by specialist from each of the surgical specialities. NHS England has asked all the mesh centres to support their surgeons to engage with the Mesh Complications Management Training Pathway.
• More information on the IMMDSR recommendations which goes into detail about mandatory reporting and regulation, and declarations of interest.
• Since summer 2022, NHS England has been developing an Outcome and Registries Programme and a new Medical Device Outcome Registry, and it has been working rapidly to establish these. The programme will involve a single unified outcome registry platform, which will cover the priority medical specialties and therapeutical areas, prioritised according to patient and clinic risk. More information on the progress of the Medical Device Information System