In 2003 doctors warned if TVT mesh slings caused unexpected complications and needed removing on a wide scale it would have significant impact on women and the NHS.

Two decades later, specialist mesh centres are overwhelmed, waiting lists are growing, access to treatment depends heavily on postcode, and there is still no universally agreed method for safely removing mesh without risking further injury.

Looking back at the history of polypropylene mesh slings for stress urinary incontinence, one question refuses to go away: why were these devices so widely promoted and embedded into NHS practice when the evidence base was repeatedly acknowledged to be limited?

Even more troubling is that surgeons, researchers and injured women raised concerns at multiple points along the way. Yet warnings were dismissed, minimised or ignored.

The story is not one of hindsight. They knew the evidence was limited. They knew long-term safety data did not exist. They knew removal could be difficult and traumatic. They even warned that widespread mesh complications would have serious consequences for women and the health service.

And yet they pushed ahead anyway.

Reading this timeline is absolutely heartbreaking because it shows that the nightmare many women are living with today was not unforeseeable. While manufacturers banked millions from mesh sales, women paid with their health, their careers, their relationships and, in some cases, their lives.

More than two decades later, the profits have long since been counted. The human cost is still being paid.

Do the maths

Between 2008 and 2018, around 81,000 women received a mesh sling in the NHS.

What’s shocking is that we don’t know how many women received mesh slings during the previous decade, from 1998 to 2008, because the NHS did not bother creating a specific hospital procedure code to track them.

Our first Freedom of Information request in 2015 found that a mesh sling kit cost the NHS approximately £325 per device.

That means:

• 81,000 mesh slings × £325
• £26.3 million

That’s the gross profits of the sling kits over a 10-year period.

We don’t know how many mesh slings were implanted in the private sector because no comprehensive data exists. – but we know from the support group that many harmed women had their implanting surgery in the private sector. Private hospitals have frequently been labelled the “Wild West”, reflecting the absence of data and external scrutiny.

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The Mesh Sling Timeline

2000: TVT mesh is upgraded despite concerns

In 2000, the Safety and Efficacy Register of New Interventional Procedures (SERNIP), the predecessor to NICE, upgraded tension-free vaginal tape (TVT) mesh slings from Classification C to Classification A, effectively approving safety and efficacy.

This happened despite surgeons on the committee raising concerns. The classification change occurred after Gynecare, a Johnson & Johnson company, complained that a lower classification could negatively affect its European sales.

This decision helped accelerate the adoption of mesh slings across the NHS despite the lack of robust long-term evidence.

2003: Surgeons warn about lack of long-term data

By 2003, concerns had already been formally raised with the Health Technology Appraisal Committee.

The Health Technology Assessment for TVT stated:

“The most compelling reason for caution is the very limited information currently available about the long-term performance of TVT.”

Researchers noted that trials only followed patients for up to two years and that data beyond four years was extremely limited.

The report went further, warning:

“Also of concern is the current lack of reassurance that TVT will have no unanticipated long-term complication related to the use of tape.”

They specifically identified erosion into the vagina or urinary tract as a potential concern and acknowledged that removal could be difficult and traumatic due to tissue reactions.

Most remarkably, the report included a warning that now reads as tragically prophetic:

“Any complication that required the need to remove the tape on a wide scale would have significant implications for both women and the health service.”

That warning was issued in 2003.

Twenty-three years later, it is exactly the situation the NHS faces.

The 9 UK Mesh centres are struggling to cope with demand. Women wait years for specialist treatment. Access varies significantly depending on where someone lives. Meanwhile, surgeons continue debating the safest methods for complete or partial mesh removal because the evidence remains limited.

The warning was not hidden. It was written plainly in official assessments. Yet the expansion of mesh use continued.

2011: Injured women force the issue onto the agenda

As the number of women reporting life-changing injuries increased, campaigners met with NHS representatives and helped establish the Mesh Working Group.

Rather than being recognised as a potential signal of a larger patient safety problem, many women felt they were treated as an unfortunate minority whose experiences did not reflect the wider picture.

2012: Conflicting complication data emerges

The Royal College of Obstetricians and Gynaecologists published its Safety in Gynaecology report in 2012.

The report included NHS Hospital Episode Statistics (HES) showing approximately 1,000 women who had undergone bladder mesh surgery were readmitted to hospital within 30 days with complications.

However, data recorded through the British Society of Urogynaecology (BSUG) showed only 101 readmissions.

By comparison the MHRA received just 4 reports to its Yellow Card reporting scheme in 2012.

This enormous discrepancy raised serious questions about the reliability and completeness of complication reporting.

The same year, the MHRA commissioned the York Report, which has since faced criticism from campaigners who argue that it relied on selective evidence and did not accurately reflect patient experiences. Shockingly, it deliberately left out the risk of dyspareunia / losing your sex life as it was not considered a general risk.

2014: MHRA review downplays risks

In 2014 the MHRA reviewed mesh complications using evidence that included studies showing substantial complication rates.

Some studies cited rates including:

• 22% pain
• 76% urinary tract infections
• 7% erosion

Yet the MHRA’s public messaging suggested complication rates of around 1-3%.

Critics argued that the review lacked transparency because full device-specific safety information was not made public and manufacturer names were redacted from key documentation.

For many affected women, this became another missed opportunity to acknowledge the scale of the problem.

2015: Sling The Mesh is founded

In 2015, Sling The Mesh was launched.

We provided a platform for injured women to share experiences, support one another and campaign for greater recognition of mesh complications.

As official systems continued to underestimate the problem, women increasingly documented what was happening themselves and the media went all-out to raise awareness of the tragedy unfolding.

2018: Deaths confirmed and mesh suspended

In 2018, the MHRA confirmed three deaths associated with incontinence mesh procedures.

The same year, Baroness Julia Cumberlege intervened and suspended mesh slings for stress urinary incontinence due to concerns about unacceptable complications.

Vaginal prolapse mesh was effectively stopped, while abdominal prolapse mesh procedures, including rectopexy, were placed under enhanced scrutiny.

The suspension represented a dramatic reversal after years of assurances that mesh was safe and effective.

Where are we now?

The saddest aspect of this timeline is that many of today’s problems were anticipated decades ago. In 2003 experts warned:

• Long-term data was lacking.
• Unexpected complications could emerge.
• Removal could be difficult and traumatic.
• Large-scale removal would have major consequences for women and the NHS.

All of those concerns materialised.

Today, the tragedy is not simply that injuries occurred. It is devastating and a national scandal that repeated warnings were raised long before the scale of the crisis became impossible to ignore.

Key Dates

• 2000 – SERNIP upgrades TVT mesh slings from Classification C to A despite concerns from some surgeons. The change follows objections from Gynecare (J&J) that Classification C could affect European sales.
• 2003 – Health Technology Assessment warns of limited long-term evidence, potential unforeseen complications, difficult removals and significant consequences if widespread removal becomes necessary.
• 2011 – Injured women meet with NHS representatives and help establish the Mesh Working Group.
• 2012 – RCOG report reveals major discrepancies between NHS hospital readmission data and surgeon-reported complication figures. MHRA commissions the York Report.
• 2014 – MHRA review publishes conclusions that campaigners argue underestimate complication rates and lack transparency.
• 2015 – Sling The Mesh is launched.
• 2018 – MHRA confirms three deaths associated with incontinence mesh procedures.
• 2018 – Baroness Cumberlege oversees the suspension of mesh slings for stress urinary incontinence in England and increased scrutiny of prolapse mesh procedures.
• 2026 – Mesh centres remain under pressure, waiting lists persist, postcode inequalities continue, and many women still struggle to access expert removal surgery.

To find all the relevant links and more read our Flimsy Science is a Patient Safety Disaster Blog