2. Does the Welsh Government intend to stop NHS mesh operations, in light of the announcement of an immediate stop to these operations in England? 201

Thank you for the question. I'm happy to have the opportunity to respond. I have written to Baroness Cumberlege to confirm that, in Wales, the use of mesh will be restricted on a similar basis as in England until additional safeguards are in place. The Chief Medical Officer for Wales has written to all medical directors in Wales to advise them of this advice. Officials will continue to work on details with relevant bodies across the UK.

Thank you, Cabinet Secretary, for that response on this very important topical question. On that issue, this issue impacts women from across the UK, and I want to pay particular tribute to Maxine Cooper, a constituent of mine, who has been working with the Sling the Mesh campaign for many years after a procedure she underwent in 2010. I know that Maxine was working closely with my dad on this issue, and I will, too, do all I can to support her. Like so many others, especially those women who have campaigned with courage and commitment, like Maxine, I was very pleased when NHS England made this announcement yesterday that it is putting an immediate curb on mesh operations after safety concerns. I know many colleagues from across the Chamber have been working on this issue, too, and that my colleague Jane Hutt held a meeting just last week with the Welsh mesh survivors group. The report of the Welsh task and finish group on this issue made some very important recommendations and included a list of what women have asked for, and, to no surprise, a ban on the use of surgical mesh was amongst that list.

Now, I have a few points to ask the Cabinet Secretary. Firstly, is he confident that the health boards have in place sufficient levels of clinical governance, consents, audit and research to ensure that all women can be confident that the appropriate safeguards are in place? Just yesterday, the leader of the house made reference to the evidence of a significant reduction in the number of vaginal mesh procedures in Wales. Does the Cabinet Secretary think that this will continue to be the case until the requirements for increased safeguards can be met? Finally, could you update us on the implementation group that will oversee specific areas of women's health requiring urgent attention and improvement? As you rightly say, Cabinet Secretary, we need to ensure that there is early access to specialist support for those treatment complications to prevent the worst outcomes for women and men alike. Diolch.

Thank you for the question. I recognise the conversations that your father had with me about his constituent Maxine Cooper, and the continuing interest he had shown, and that you do too, on this issue. Obviously the statement that I made earlier this year indicated what we would do in response to the expert panel that we'd instituted here in Wales, and the group that you mentioned at the end, the women's health implementation group, will be meeting in August to take forward further measures on the recommendations that have been made. Now, I think it's really important to recognise that it sometimes does take time to make sure everything is in place as we wish it to be. But that is going to meet this summer. There is money to help them in terms of taking forward their recommendations, but my expectation is that we should already be in the position that England have announced. So, that's really important to be able to give that clarification and that assurance to people, because the points you make about consent, audit and safeguards really do matter. Because for some people this is still potentially a treatment of last resort, but it has to be a properly informed choice.

Given the widespread publicity and the stories of where mesh has gone wrong, you could understand that lots of people will not want to give consent to an operative procedure, but some women may choose to do so, and, as long as that consent is real and informed, then there is not a total ban in Wales, just as in England there is not a total ban. I think it's more accurate to say there is a curb on the use of mesh, rather than a total ban. That's very clear from the letter from the chief medical officer in England. What is also worth pointing out to Members is that what I think has changed now is the fact that not only has Baroness Cumberlege made this recommendation, but also the Medicines and Healthcare Products Regulatory Agency, the regulator, have become rather more involved in the conversation on what to do next. Unfortunately, up until this point, that has not been the case. Because politicians do have limits on their powers, and sensibly so, but the regulators' agreement that the curb in place now in England, Wales, and, I believe, in Scotland too, is the right thing to do—. You should be confident that there won't be any less vigilance in Wales than in other countries of the United Kingdom, and I fully expect to be questioned on this issue in this Chamber and beyond as well.

Fourteen months ago I called for a statement here on the issue of mesh implants after a constituent in north Wales had told me of the suffering she had from left hip pain, left thigh pain, pelvic pain and intimate pain, and she told me of thousands of other women in the UK suffering in a similar way. I was then told that health boards should ensure they report any complications, and women who had the procedure were encouraged to self-report problems. Last December, I raised this in the Chamber after you wrote to me stating that you still believed that the benefits outweighed the risks. We know that in May you made your statement, following the report of the Welsh task and finish group to review the use of vaginal synthetic mesh, announcing the implementation group, which Jack Sargeant just referred to, to oversee specific areas of women's health requiring urgent attention and improvement. 

On Monday, I had an e-mail, via my colleague Angela Burns, from a constituent in north Wales that said, 'Mesh is to be suspended in England. I know you understand how important it is that Wales must follow suit.' Attached to it was the press release issued yesterday saying that Baroness Cumberlege's review had called for the immediate suspension of the use of surgical mesh, and it quoted Owen Smith MP, chair of the all-party parliamentary group in Westminster, saying this is wonderful news and long overdue. 

Today, you've told us that you're now going to follow the decision by NHS England to immediately stop mesh operations, but with a view to potentially continuing them in certain circumstances or after certain conditions are met. Human biology is the same both sides of the border. How, therefore, will you be going forward when Baroness Cumberlege recommended a suspension that can only be lifted if certain conditions, including keeping a register of every procedure and of all complications, are met? Are you going to require the same as Baroness Cumberlege is calling for? If not, what, if any, conditions would you be applying before lifting any suspension here?

I think it's important to reiterate the recognition of the significant harm that has been caused where mesh procedures have gone wrong. I've met people in that position directly themselves and all of us have been affected by the very real testimony they provided. The situation here in Wales is that we have had a more vigilant approach since the report that was published and the statement that I made in May to this place, and we need to make sure that similar vigilance is continued. It is important—I don't want to get lost in redescribing what's happening in England or trying to say there is more or less vigilance, but I think there is similar vigilance across the nations of the United Kingdom on this issue. If you refer back to what Baroness Cumberlege herself has said, she said,

'At this stage in our review we are not recommending a ban'.

In the response from the Chief Medical Officer for England, in her correspondence to Baroness Cumberlege, she also referred to a conversation with Baroness Cumberlege where she said, 'It would be wrong to impose a blanket ban. I would emphasise we should remain mindful that, for some patients, this can be a last treatment option for a debilitating condition.'

So, that's the challenge. It's not for the politicians to decide, 'Here is a list of operations where you may use mesh and others where you may not'; this is about the advice and the guidance that is being given to medical professionals about the care they have with and for their patients, and for genuinely informed consent about the risks that exist as well. So, this really should be an area where politicians hesitate to say, 'I have decided for you what is appropriate treatment', including if it's a genuinely last-resort treatment, which is the position that we'd already reached in Wales with the expert review that we had.

We will continue to work on a non-partisan basis between the Governments of the United Kingdom, but crucially with the regulator and with NICE, and also with the clinical community and, crucially, with the individual citizens themselves who have either been harmed through mesh use in the past, but equally for those people where this could be a last-resort treatment. That is the point—that it's genuinely a last-resort treatment and there's action we will be taking in Wales about other treatment options, more conservative treatment options, in advance of any potential decision for a surgical procedure to be undertaken. 

So, I hope that gives genuine reassurance to Members, who I know, in different parties, are concerned about this issue. The approach we're taking in Wales is no less vigilant than any of the other United Kingdom countries. It's in all of our interests to see further action taken on improving care in this area, which is why we have an expert group that is due to carry on and take forward this issue, meeting for the first time, as I said in answer to Jack Sargeant, at the start of August.

Having met a large group of mesh survivors here with Jane Hutt on Monday, both women and men, it's clear to me that the issue of informed consent is quite a major one, because people were not informed about potential complications and it's disappointing that it's taken the medical profession so many years to really listen to their patients and understand the level of suffering that people have undergone. I heard directly from people who said that they'd undergone a major investigative procedure under general anaesthetic, and then awoke to be told that mesh had been inserted without, obviously, any prior discussion about the pros and cons of such a procedure. So, would you agree with me that the lesson from this very sorry saga is that the medical profession has got to be much better at clearly seeking and obtaining informed consent when new procedures are being trialed, so that patients can make decisions themselves about what is best for them?  

I think that's a really important point to make. It was part of the terms of reference for the expert group and review we had here in Wales, and it's really important not to undersell the importance of informed consent, because different people faced with the same information will make different choices about the risks they're prepared to take in treatment and, indeed, on the condition they currently have and the impact that that has upon their lives. It, of course, has been incredibly not just disappointing but really upsetting to hear people describe mesh procedures that have been undertaken and they say they have not consented to them, or they've consented but they do not believe it was informed consent. And all of that matters; we shouldn't try and brush that away. But the point about all forms of medical intervention is that it is about it being a genuine conversation and decision that the patient makes, as opposed to the clinician making it for them, and understanding, 'What matters to me as the person who is potentially undergoing that treatment.'

When you look at the expert report that we have had undertaken in Wales, it is genuinely reflective on past practice, and part of their recommendations are about making sure there is genuine and informed consent for any procedures that take place, as well as making sure that in the pathway to a potential operation, all other treatment options are provided first so that it is a genuine last resort, if it is used at all. And, in fact, what should give people comfort about that is that in Wales, there's been a significant reduction in mesh procedures, as our clinical community have recognised some of the challenges that have existed. That will continue to be the case, as we work through with colleagues across the United Kingdom on what could and should happen in the future. It is, of course, possible still that the regulator will decide to take a different step and to withdraw this as a treatment option, but that is a matter for the regulator, not for an elected politician.     

I thank the Cabinet Secretary. 

The next question is also to you, and it's to be asked by Joyce Watson.